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CONTENTS Health IT NEWS.Direct! www.healthitnewsdirect.com

FEATURED ARTICLE

Figure 1: State Efforts Towards eHealth

• eHealthWA program helps link data across pharmacies, patient administration, clinical information systems, etc.5 • Investments of US$300 million to create health IT infrastructure6

2010-2011 State Budget: • $74.9 million for ICT • $25.9 million for e-Health clinical and administrative support systems • Stage1: roll-out of integrated EMR, RIS, enterprise discharge summary, etc. • Stage 2: continued EMR roll-out through Clinical • careconnect.sa aims at implementing 65 Informatics Program and eMR Viewer Program8 interrelated IT projects by 201715 • Up to $215 million provided by state government for major information • $19.4 million Healthelink EHR pilot technology system upgrades16 project launched in 20049 • Key programs under ICT plan for 2006-2011 include EHR pilots, roll-out of EMR, community health systems, PACS, RIS, patient administration systems, state-specific patient identification system, etc.10

eHealthNT program implements the following projects:7 • Shared Electronic Health Record • Secure Electronic Messaging Service • Electronic Transfer of Prescriptions

HealthSMART HealthSMARTprogram program implements implementsthe the$360 $360million million Victorian VictorianWhole WholeofofHealth HealthICT ICT 1212 Strategy Strategy2009 2009-2013 -2013

• Electronic Health Information Exchange Project (eHIEP) was proposed in 200913 • 2009/10 Federal Budget: $1.2 million grants allotted for 5 years to create a virtual network, to connect providers14

The eHealth initiative, Information Management Maturity Framework (IMMF), caters to access, data analysis, and connectivity across the state11

Western Australia

Australian Capital Territory

Northern Territory

South Australia

Queensland

Victoria

New South Wales

Tasmania

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»» National Health (Pharmaceutical Benefits) Amendment Regulations 2006 (No. 2): The transition from paper to electronic was initiated as an alternative through the 2006 regulations, coming into effect in March 2007. With the barriers to electronic dispensing and prescribing of Pharmaceutical Benefits Scheme (PBS) medicines eliminated from the Commonwealth legislative amendments, hurdles in state and territory legislations are also being removed to align with these amendments, thereby enabling the provision of rules for the automation of the two processes in each jurisdiction.19, 20 »» National E-Health Strategy (2008): A national approach to medication management and transfer of prescriptions electronically has been outlined in the National E-Health Strategy.19 »» National Health and Hospital Reform Commission (NHHRC): The need to prioritize and coordinate ePrescribing and medication management capabilities nationally has also been advocated in NHHRC’s 2009 report. The development of existing applications was recommended in order to lower medication incidents and enable consumer amenity.19

Commonwealth Government, HealthConnect is a change management strategy initiated to enhance health data availability in the healthcare sector, through quick, secure and accurate transfer between care professionals. Aiming towards compliance with national standards set by bodies such as the NEHTA, the initiative intends on leveraging the current eHealth infrastructure and projects.24 • Healthcare Identifiers Service: An initiative of the Council of Australian Governments (COAG), the project has been developed through NEHTA as the foundation service for Australia’s eHealth initiatives.25 Supported by $132 million in grants, NEHTA was tasked to establish three infrastructure projects, namely, Individual Healthcare Identifier (IHI), Healthcare Provider Identifier – Individual (HPI-I), and Healthcare Provider Identifier – Organisation (HPI-O), apart from a national clinical terminology.26, 27 The legislation supporting this service is the Healthcare Identifiers Act 2010, which was enacted ‘to provide a way of ensuring that an entity that provides, or an individual who receives, healthcare is correctly matched to health information that is created when healthcare is provided’. In order to achieve this, a unique identification number was assigned to both, the healthcare provider as well as the healthcare recipient (patient).28

The finalization of jurisdictional legislative amendments, key standards, and a national health information regulatory framework are currently in process.19 In July 2010, NEHTA released a draft containing minimum specifications for interoperable Electronic Transfer of Prescriptions (ETP), which outlines the foundation for a nationwide ePrescribing system that will connect GPs and community pharmacies.21

• Individual Electronic Health Record (IEHR): The IEHR initially started off as the Shared Electronic Health Record (SEHR).26 The establishment of the three infrastructure projects under the Healthcare Identifiers Services was an important stepping stone for the potential establishment of a patient-centered IEHR.29 The system, a record of selected sections of a patient’s health, will contain a26 »» Summary Health Profile: core document in all IEHRs »» Event Summaries: radiology reports, pathology results, referrals, and discharge summaries »» Supported Self Managed Care Questionnaires: health history and self management tools

• Practice Incentives Program (PIP) eHealth Initiative: The incentivizing approach that has been patronized across the globe has been adopted in Australia as well through the PIP initiative, which includes incentives of $6.50 per Standardised Whole Patient Equivalent (SWPE). With an intent to encourage GPs to stay abreast of the recent developments in eHealth technology, the Medicare Australia-administered program was included as a part of the Federal Budget of 2008-2009.22 Developed in consultation with NEHTA, the initiative aligns with the directions of the National E-Health Strategy, and is anticipated to promote new eHealth technology on its availability.23

The individual health record was conceptualized not to replace the local records, but as a new communication channel providing additional high quality data to complement currently used clinical methods.26 • Personally Controlled Electronic Health Record (PCEHR): Australia has allotted $466.7 million over the

• HealthConnect: Financially supported by the

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October - December 2010

coming two years to develop a secure personal eHealth record system. The PCEHRs, which will include patient summaries; allow anytime/anywhere access to health records, provide strict management and governance towards privacy, support providers with planning, core national infrastructure, national standards for the use of the electronic records, will be available for registration from 2012-2013.30 The Individual Health Care Identifiers form a vital building block for the PCEHR, but will be separate from it.31 Funding will be provided over the first two-year individual electronic health record business case, created on consulting with NEHTA, states and territories.30

data. SNOMED CT®AU is Australia’s version of the SNOMED Clinical Terms® (SNOMED CT). In addition, NEHTA has developed the Australian Medicines Terminology (AMT), which provides standard identification of generic and branded medicines, and naming conventions and terminology that support medication management systems in primary and secondary healthcare. »» Secure Messaging: While the Clinical Terminology and Information initiative deals with the terminology and structure of the message, the Secure Messaging initiative concentrates on the security and transport of the messages.35 NEHTA has included basic technologies like authorization, unique identification, and message security to ensure secure exchange of health information among providers. In association with the PIP initiative, NEHTA is collaborating with medical software vendors to create standards and specifications for secure messaging.36 »» Security and Access Framework: This initiative focuses on security issues pertaining to physical security, risk management, security management processes, and policies.35 »» Privacy Management Framework: The National Privacy Principles (NPPs) of the 1988 Privacy Act serves as a basis for a set of privacy principles which NEHTA is working on. The Privacy Management Framework has also been created to enable a structured and proactive methodology for privacy, and recognizes the factors that will impact the ultimate implementation of the IEHR.26

Efforts in establishing the other elements that would support the implementation of a nation-wide eHealth system include: • National Broadband Network: The nation’s investments of up to $35.7 billion to build a National Broadband Network (NBN), has already shown benefits for the healthcare industry as well.32 Speaking at the public hearing of the Senate Select Committee on the implications of the NBN, Dr Mukesh Haikerwal, National Clinical Lead, NEHTA, stated that the highspeed broadband network supports the entire eHealth agenda, and is capable of powering the current healthcare to even better levels.33 • Interoperability Framework: In order to address the interoperability of systems for more effective exchange of data, NEHTA has created an eHealth Interoperability Framework. The framework develops common eHealth standards and principles promoting health data, technology, organizational, and stakeholder interoperability; and specifies testing compliance with interoperability requirements. Some of the interoperability initiatives underway are dependent on the framework, and NEHTA is working towards establishing standards for capture of priority health data by eHealth systems, standard clinical terms for system use, secure electronic data transfer, and designing unique identifiers for patients, caregivers, and medical products.34

• Supply Chain: Realizing the potential benefits in efficiency and cost savings associated with public health supply chain, NEHTA has established the following: »» National Product Catalogue (NPC): a common data source for the precise identification of products in supply chain and clinical applications within healthcare departments »» NEHTA e-procurement solution: indicates the best practice in electronically generated business-tobusiness transactions »» Business intelligence tools: enable collection, summarization and presentation of supply chain data in order to streamline procurement process 37

• Privacy and Security: Various reforms have been introduced to address the many aspects of ensuring privacy and security during the sharing and exchange of clinical information. »» Clinical Terminology and Information: A common, coded clinical terminology or language is one of the prerequisites for safe sharing of medical

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FEATURED ARTICLE

National E-Health Strategy1, 38 In order to enable national collaboration and coordination in the various eHealth efforts, the Australian Health Ministers, through the Australian Health Ministers’ Advisory Council (AHMAC), assigned Deloitte in the year 2008, to create a

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October - December 2010

strategic plan and framework for implementing a national eHealth system in Australia. This serves as a basis to guide future developments in eHealth.

and medication list, etc., with access control, capable of being accessed by consumers and providers »» Healthcare Service Delivery Tools: Support the activities of direct care delivery, including tools for updating/managing IEHR, access of referrals, prescriptions and event summaries, care plan management, online ordering of tests (with decision support), etc. »» Health Information Sources: Allow access to health data sources, like consumer and care provide health knowledge portals, which support decision-making and enhance their own knowledge »» Healthcare Management: Support care delivery management activities, like monitoring compliance, risk analysis, surveillance, healthcare operations management, health policy development, and adverse events, to name a few, across the enterprise, region as well as nation

The current State, Commonwealth, and Territory government collaborations on the primary foundations of a nationwide eHealth system would be reinforced by the strategy. It also identifies priority areas where it can be extended progressively in order to encourage the nation’s health reform. The plan allows adequate flexibility for public and private health sectors, and individual states and territories to determine the approach taken for the implementation of eHealth within a general framework, and certain priorities to maximize on efficiencies and benefits. The primary objectives that highlight and inform the proposed approach and the strategic activity streams identified to address the principles include: • One-time provision of core elements for national eHealth infrastructure, avoiding the duplication of development efforts, rework, and costs • Active involvement of vital healthcare stakeholders in design and delivery of eHealth solutions • Employ incremental and pragmatic approach of creating long term eHealth capability • Balance active support with less developed abilities for providers • Use and scale eHealth activity more effectively • Balance alignment of national eHealth activities, while not limiting implementation of local relevant solutions • Ensure availability of adequate skilled practitioners for delivering the National E-Health Strategy

• E-Health Infrastructure: describes the IT infrastructure required to support the eHealth solutions. These include networking and core computing infrastructure, IT components for healthcare participant identification, healthcare services and providers, secure data transmission, and key information dataset storage. The components enabling this include computer systems, broadband connectivity, patient, practice and clinical management systems, provider and services directories, NPC, National Authentication Service (NASH), and the Universal Health Identifier Service (UHI). • E-Health Enablers: describes those factors that need to be established or addressed to help realize the overall E-Health Strategy. These have been categorized as follows: »» Regulations and policies required to set up a privacy framework for the storage, management, exchange, and utilization of information »» Standards to support eHealth solution implementation »» Activities to promote eHealth adoption across each stakeholder community »» Initiatives for development of workforce having the required skills in health IT

In order to achieve these goals, certain work streams have been developed (Figure 2). E-Health Architecture: A logical model that represents and categorizes all the elements required to form the national eHealth solution is represented in the E-Health Architecture (Figure 3). The segments of the architecture include the following: • E-Health Solutions: describes the various tools and systems required to allow stakeholders to collect, store, exchange and use electronic medical data. These solutions will be categorized based on the following functions: »» IEHR: Enable an IEHR, which would include patient demographics, test results, current health profile

When mapped onto the E-Health Architecture, the National E-Health Strategy work-streams align with and support the development of the components needed to realize Australia’s eHealth vision (Figure 4).

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FEATURED ARTICLE

October - December 2010

Figure 2: National E-Health Strategy Work Streams

Governance: Establish apt governance mechanisms and structures, effective coordination, leadership, and oversight of the work program

eHealth Solutions: Deliver eHealth solutions to the primary users. The recommendations include: • Develope national eHealth solutions investment fund • Create national compliance function • Adopt national priority eHealth solutions, i.e., national prescriptions service and health knowledge portals • IEHR

Foundation: Establish foundation for electronic information exchange throughout care continuum, focusing on • Identification and authentication • Information protection • National eHealth information standards for data, message structures, terminologies and coding, and data display • Encourage investments in computing infrastructure • National broadband services

Change and Adoption: Encourage stakeholder adoption of eHealth solutions through • National awareness campaigns • Financial incentive projects • Accreditation of care providers • Education and training • Stakeholder engagement forums

Figure 3: Pictorial Depiction of E-Health Architecture

IEHR IEHR Licensing Licensing Regime Regime

Privacy Privacy Privacy Privacy Regulations Regulations

Data Data Structure Structure Standards

Standards

E-HEALTH INFRASTRUCTURE E-HEALTH SOLUTIONS

Consent Consent Management Management Policy Policy

Standards Standards

Health Broadband Health Information Broadband Information Connectivity Datasets Connectivity Datasets

Health Healthcare Health Care Health Information Information Management Management Source Source

Medical Medical Terminology Terminology Standards Standards

Computer Computer Svystems Systems

Compliance Compliance Services Services

IEHR IEHR Licensing Licensing Regime Regime

Privacy Privacy Consent Privacy Privacy Consent Management Regulations Management Policy Regulations Policy Standards Standards

Health Broadband Health Information Broadband Information Connectivity Datasets Connectivity Datasets

Adoption

Data Data Structure Structure Standards Standards

Medical Medical Terminology Terminology Standards Standards

Adoption

Awareness Awareness Campaigns Campaigns

Universal Universal Health Health Identifier (UHI) Identifier

Compliance Compliance

Adoption

Professional Professional Practice Practice Standards Standards

Awareness Awareness Campaigns Campaigns

Professional Professional Practice Practice Standards Standards

Workforce Workforce

CareCareProvider Health Provider Health IT IT Workforce Workforce Workforce Workforce Development Development Development Development

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Strategy

Universal Universal Health Health (UHI) Identifier Identifier

Compliance Compliance Services Services

EHEALTH GOVERNANCE E-HEALTH GOVERNANCE

Strategy

Computer Computer Svystems Systems

Compliance Compliance

E-HEALTH ENABLERS E-HEALTH ENABLERS

Investment Investment

EE-HEALTH -HE HEAL ALTH TH IINF INFRASTRUCTURE NFRA RAST STRU RUCT CTUR UREE E-HEALTH SOLUTIONS

Healthcare Healthcare Service Individual Electronic Individual Service Delivery Tools HealthEHR Record (IEHR) Delivery Tools

Governance Governance

Source

Healthcare Health Care Management Management

E-HEALTHSOLUTIONS SOLUTIONS E-HEALTH

Strategy Strategy

Health

Health Information Information Source

Healthcare Healthcare Service Service Delivery Tools Delivery Tools

EHEALTH GOVERNANCE E-HEALTH GOVERNANCE

Investment Investment

Individual Electronic Individual HealthEHR Record (IEHR)

E-HEALTH ENABLERS E-HEALTH ENABLERS

Governance Governance

E-HEALTH E-HEALTHSOLUTIONS SOLUTIONS

Figure 4: E-Health Work Streams Mapped on E-Health Architecture

Health IT NEWS.Direct!

October - December 2010

The National E-Health Strategy has laid the foundation for the progression towards a more connected healthcare system across Australia. Healthier Future For All Australians3 Building on the National Strategy, the National Health and Hospitals Reform Commission released the final report of ‘A Healthier Future For All Australians’, in June 2009. Driven by a vision of ‘a sustainable, high quality, responsive health system for all Australians, now and into the future’, the reform recommends that every Australian should posses a personal electronic health system by 2012, which provides authorized access to care providers. Endorsing the National Strategy, the reform elaborated on the following: • Need to fortify the governance, level of resources, and leadership committed by governments • No need to involve the government with developing, purchasing, or operating IT systems • Encourage adoption and successful installation of compliant eHealth solutions by including in the National E-Health Action Plan, provision for supporting public health organizations, and incentivizing private providers • National prioritization and coordination of medication management and ePrescribing, probably by developing existing applications • Provide a national health knowledge online portal for citizens and providers. Suggested the National Health Call Centre Network (healthdirect) to enable this requirement The recommendations encourage the Commonwealth Government to be responsible for sufficiently resourcing and promoting the adoption of a National E-Health Action Plan by • ensuring patient health data privacy, while allowing secure authorized access by caregivers • ensuring secure transfer of data through the introduction of a national telecommunication and broadband network • introducing the following by July 1, 2010: »» unique individual healthcare identifiers »» unique health provider identifiers for practitioners »» national authentication service and directory for health, a system to verify patient and provider authenticity »» unique health provider identification for organizations (facility and health service) • reating and implementing appropriate national

social marketing strategy, elaborating on significant advantages and safeguards included in the planned eHealth approach • ccelerating the creation of a framework for open technical standards and national policy framework, and obtain national agreement to the framework by 2011-2012 The investments required, over five years, to achieve the proposed agenda pertaining to national eHealth adoption was estimated by NHHRC to be $1,185 million to $1,865 million.3 NEHTA Strategic Plan40, 41 In November 2009, NEHTA released the NEHTA Strategic Plan, elaborating on the approach taken to support the national eHealth vision for three years (2009-2012). The organization has framed the prospective work program based on the National E-Health Strategy, and has also considered the recommendations made by the NHHRC. The plan includes the following four strategic priorities for eHealth adoption and implementation: 1. Immediately develop the fundamental foundations to allow eHealth. In order to form the backbone of the nation’s eHealth systems, the following basic eHealth services would need to be delivered: a. Secure messaging and authentication b. National Healthcare Identifiers Service c. NASH d. Create and operate NPC for supply chain management, national clinical terminology, and information service e. Establish eHealth standards, and compliance and certification function 2. Coordinate the progress of priority eHealth processes and solutions, pertaining to discharge and referrals, management of diagnostic imaging, pathology, and medications 3. Drive accelerated eHealth awareness and adoption 4. Lead the country’s current and future progression in eHealth In response to the NHHRC recommendations, the 2010-2011 budget has allotted $466.7 million across the next two years to develop the PCEHR system in the country.39 Working in tandem, the NEHTA Strategic Plan has addressed certain work activities recommended by the E-Health Strategy. The requirement for a unique identification and authentication of consumers and caregivers can be delivered through the national Health Identification

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October - December 2010

solutions. The establishment of eHealth standards, compliance and certification functions, clinical terminology and information services, NASH, and the participation and collaboration in national and international forums, will help

achieve the National E-Health Strategy’s recommendation of developing and deploying national standards for coding, terminologies, data and message structures, and information display.

What will be the fate of the eHealth projects underway? Following the initiation of the National E-Health Strategy, questions of the fate of the current ongoing eHealth programs in jurisdiction have been raised. The Strategy, fortifying the present collaboration of State, Territory and Commonwealth governments on the basic foundations of a nationwide eHealth system, allows flexibility of individual States and Territories to determine the process of implementation. Jurisdictional programs would have to be based at State and Territory levels in order to offer a platform for integration and sharing with the nation-wide infrastructure. In addition, successful initiatives will be replicated in a coordinated and planned manner.42

Figure 5: State Efforts Converge to Achieve National Goal

Healthier Future For All Australians (Jun-09)

NATIONAL EFFORTS

NEHTA Strategic Plan (Nov-09)

EMR

On the Horizon43-45 According to a 2009 research published in the Journal of the American Medical Informatics Association, it is important to understand that the establishment of a national healthcare information technology infrastructure involves a lot more than the replication of a clinical information system at healthcare facilities across the country. The development of an initiative on a national scale involves the defining of a framework of policies and standards that will help structure the convergence of local, central, public, and private systems into a functional national-level system. The government role includes supporting the public sector in participating in the national health information system, incentivizing private sector, and frame legislations to support privacy interests of citizens. Apart from the anticipated benefits of more efficient, safer,

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EMR

Tasmania

South Australia

Western Australia

Northern Territory

Queensland

Victoria

ACT

STATE EFFORTS

New South Wales

National eHealth Strategy (2008)

EMR

and equitable care through the seamless exchange of health information, analysts have identified and proposed other advantages in ROI. Global management consultancy firm, Booz & Company has revealed in a recent report that the outcome of successful nation-wide implementation of an eHealth system could generate over $7.6 billion in healthcare savings by the year 2020, which accounts to about 3% of Australia’s total healthcare costs. In accordance with these monetary benefits of the country’s healthcare vision, a recent Frost & Sullivan research has estimated Australia’s health IT market to witness a double digit CAGR of 10.15% and a 38% increase in revenue from 2009 to 2014, driven by the various state and federal initiatives in support of a nationwide eHealth system. The report has proposed potential growth for clinical IT systems market, including laboratory information

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October - December 2010

systems (LIS), critical care information system, radiology information systems (RIS), business intelligence, and remote monitoring systems, following implementation of the national eHealth system.

13. North West Tasmania Electronic Health Information Exchange Project (eHIEP). TAS eHealth. Accessed November 24, 2010. 14. Health and Ageing - 2009-10 Budget at a Glance. Australian Government - Department of Health and Ageing. Accessed November 24, 2010.

According to Pawel Suwinski, Director, Frost & Sullivan, based on the great strides made in realizing its eHealth goal, the country has been able to leapfrog the hurdles of national IT initiatives, and is maintaining its momentum in the right direction in view of the passing of the Healthcare Identifiers Service bill in June 2010.

15. careconnect.sa components. Government of South Australia.

Having experienced and confirmed the potential benefits of eHealth throughout this journey of adopting it in various states and territories of Australia, as well as learning from similar efforts made by other nations across the globe, analysts have expressed the current pressing need to focus on leadership and tools to invest strategically, while addressing the growing pressures faced by the healthcare industry as a whole.

18. Frequently asked questions - eHealth strategy. Government of

Accessed November 24, 2010. 16. New $1.7 billion hospital spearheads health reform [news release]. South Australia: Government of South Australia; June 06, 2007. Accessed November 24, 2010. 17. Bartlett C, Boehncke K. E-Health: Enabler for Australia’s Health Reform. Accessed November 24, 2010. Western Australia - Department of Health. Accessed November 24, 2010. 19. Electronic Prescribing and Dispensing of Medicines. Australian Government - Department of Health and Ageing. Accessed December 7, 2010. 20. Select Legislative Instrument 2006 No. 200. Australian Government - Department of Health and Ageing. Accessed December 7, 2010. 21. National Electronic Transfer of Prescriptions (ETP) specifications

References

released [news release]. NEHTA; July 20, 2010. Accessed December

01. National E-Health Strategy: Summary. Australian Health Ministers’

7, 2010.

Advisory Council. Accessed November 24, 2010.

22. Practice Incentives Program (PIP) eHealth Incentive. Australian

02. Health care in Australia. Australian Government - Department of Foreign Affairs and Trade. Accessed November 24, 2010.

Government - Medicare Australia. Accessed December 7, 2010. 23. Practice Incentives Program. Australian Government - Department

03. A Healthier Future For All Australians - Final Report of the National Health and Hospitals Reform Commission - June 2009. Australian

of Health and Ageing. Accessed December 7, 2010. 24. Health Connect. Australian Government - Department of Health and

Government - National Health and Hospitals Reform Commission. Accessed December 8, 2010.

Ageing. Accessed December 7, 2010. 25. Healthcare Identifiers Service. Australian Government - Department

04. Bartlett C, Boehncke K, Wallace V, Johnstone-Burt A. Booz &

of Health and Ageing. Accessed December 7, 2010.

Company. Optimising E-Health Value Using an Investment Model

26. Shaping the future of healthcare - Privacy Blueprint for the Individual

to Build a Foundation for Program Success. Accessed November

Electronic Health Record. NEHTA. Accessed December 7, 2010.

24, 2010.

27. Healthcare Identifiers Service. Australian Government - Medicare

05. About eHealthWA. Government of Western Australia - Department of Health. Accessed November 24, 2010.

Australia. Accessed December 7, 2010. 28. Healthcare Identifiers Bill 2010. Accessed December 7, 2010.

06. Frost & Sullivan Records Strong Growth Potential Within Australian

29. Council of Australian Governments’ Meeting. Council of Australian

Health IT Industry [news release]. Singapore: Frost & Sullivan; July 22, 2010. Accessed November 24, 2010.

Governments. Accessed December 8, 2010. 30. Personally Controlled Electronic Health Records for all Australians

07. eHealthNT. Northern Territory Government. Accessed November

[news release]. Australia: Minister for Health and Ageing; May 11,

24, 2010.

2010. Accessed November 24, 2010.

08. State Budget 2010-11. Capital Statement: Budget Paper No.3. Queensland Government. Accessed November 24, 2010.

31. eHealth [FAQ]. Accessed December 8, 2010. 32. NBN Co. Business Case Summary. NBN Co. Ltd. Accessed December

09. Minister launches Health elink to put health records online [news release]. New South Wales: NSW Government; May 16, 2004.

8, 2010. 33. Implications of the proposed National Broadband Network. Public

Accessed November 24, 2010.

hearing of the Senate Select Committee on the National Broadband

10. Information & Communication Technology (ICT) Strategic Plan: 2006 - 2011. NSW Health. Accessed November 24, 2010.

Network;August 5, 2009;Sydney, Australia. 34. A National Interoperability Framework For E-Health [fact sheet].

11. eHealth initiatives. ACT Division of General Practice. Accessed November 24, 2010.

35. Secure Messaging [fact sheet]. NEHTA. Accessed December 8, 2010.

12. HealthSMART. Victorian Government Health Information. Accessed November 24, 2010.

NEHTA. Accessed December 8, 2010. 36. Secure Messaging. NEHTA. Accessed December 8, 2010. 37. Supply Chain. NEHTA. Accessed December 8, 2010.

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38. National E-Health Strategy. Australian Government - Medicare Australia. Accessed December 8, 2010.

Accessed December 14, 2010. 43. Coiera E. Building a National Health IT System from the Middle Out.

39. Budget measures: Budget Paper no. 2: 2010â&#x20AC;&#x201C;11. Commonwealth of Australia. Canberra; 2010:225.

J Am Med Inform Assoc. 2009 May-Jun;16(3):271-3. 44. Bartlett C, Boehncke K, Wallace V, et al. Optimising E-Health Value

40. NEHTA Strategic Plan. NEHTA. Accessed December 14, 2010.

Using an Investment Model to Build a Foundation for Program

41. The National E-Health Transition Authority Strategic Plan (20092012). NEHTA. Accessed December 14, 2010.

Success. Accessed December 14, 2010. 45. Frost & Sullivan Records Strong Growth Potential Within Australian

42. National E-Health Strategy [FAQ]. Australian Capital Territory Department of Health ACT Government Health Information.

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FEATURED ARTICLE

Health IT Industry [news release]. Singapore: Frost & Sullivan; July 22, 2010. Accessed December 15, 2004.

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October - December 2010

REVIEW ARTICLE Customer Relationship Management for Payors Creating Enriched Consumer Experience and Differentiation The Patient Protection & Affordable Care Act of 2010 (PPACA), commonly referred to as Healthcare Reform, is pushing more transparency, product standardization, and accountability on health plans, along with tremendous ‘healthcare churn’, driving customer retention and better consumer-centric solutions. The payor industry will see a paradigm shift from the predominant business-to-business (B2B) model seen today, to a business-to-consumer (B2C) model, where healthcare organizations look at avenues to deliver superior and targeted online experience to its consumers.

Sree Sahasranaman Practice Head Payers & Distributors Wipro Technologies

Business Context and Consumer Demands: Consumer demands include • Product and services that match consumer preferences and needs • Faster turnaround of consumer service queries • Ability to quickly and securely access personal information • Simple and seamless on-line and off-line interactions • Greater control over decisions affecting insurance coverage • Greater say in the choice of providers • Better tools and services CRM comes as an elixir for payors, addressing the growing demands of their consumers. Trends, Implications, Opportunities and Consumer Focus: With consumers hogging the center stage, the implications and opportunities that CRM drives are endless. Highlighted below are few implications and opportunities that thrust CRM as the epitome of success in a consumer-centric industry.

Table 1: Trends/Challenges, Implications, and Opportunities of CRM Trends/Challenges •

Healthcare Reforms bill to bring massive churn in payor’s subscriber base

•

Payors are missing a conversion opportunity of over $40 billion; that of members transitioning between major product classes: »» Commercial members becoming eligible for Medicare at 65 »» Commercial members moving to individual market or going uninsured due to life events »» Over 65 year-olds considering a switch to Medicare Advantage

•

Payors increasingly have multiple touch points and interactions with customers

•

Poor visibility and controls on the organization limit value of the data collected

Implications •

Payors will need to identify profitable versus non-profitable customers (sales and marketing predicting forecasts)

•

Payors will need to find opportunities to cross-sell products

•

Payors will need to improve customer satisfaction (customer service to provide better service to members, providers, and brokers)

•

Payors need to have a ‘single view’ of the customer (underwriting to make risk assessments and generate quotes)

•

Payors will need to equip themselves with

Opportunity •

Operational CRM »» Sales, marketing and service automation »» Front end apps for channels »» Contact centre web enablement

•

Analytical CRM »» Integration of analytics with operational customer database »» Data mining tools (e.g. profitability analysis, customer segmentation, and churn analysis)

•

Infrastructure CRM »» Channel integration: implementation of single operational customer database, and integrated delivery platform and distribution channels

automated sales and customer acquisition solutions

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REVIEW ARTICLE

October - December 2010

Key Focus Areas for CRM: CRM has some key areas of focus applicable for all healthcare payors to increase cross sell/ up sell, increase customer retention, identification of cost

effective treatments versus inefficient methodologies, and reduce administrative costs.

Table 2: Areas of Focus for CRM

Functional Area

Understanding Future Focus Area Potential Operational and Analytical CRM

1 Customer Care

2 New Business/Products and Marketing/Sales

3 Claims Management

4 Business Intelligence

• Customer segmentation • Direct-to-consumer capabilities • Increase member personalization • Greater focus on ‘Moments of Truth’ • Develop integrated retail channels • ‘Advise-based ‘ consumer distribution channel • Develop ‘unboundled’ products • Focus on product innovation • Develop fraud, abuse, detection, prevention channels • Mechanism for better risk management/claims recovery procedures • Channels to better claims settlement/payment issues • Customer profitability analysis • Better risk profiling capabilities • Drive consumer centric analytics-member stickiness/predicting behavior • Enhance claims-based analytics Infrastructure CRM

5 Data Integration

• One single view of customer • Collaborate and resolve ‘integration issues’ with multiple data sources for payers • Create common integration channels for data from wellness management, billing, and claims benefit systems

Future for CRM: As one looks at the future for CRM, the opportunities and value drivers seem endless, giving fresh momentum for the ‘consumer-centric care model’. The primary benefits that CRM investments would achieve include: • Accurate projections and precise target marketing campaigns • Better service to providers, members, and brokers

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• Gain unified and enterprise outlook of customers • Retain customers with better service.

References 01. Agarwal A, Harding DP, Schumacher JR. Organizing for CRM. McKinsey Quarterly. 2004 August. 02. Galimi J. CRM for Healthcare Payers Reaches New Levels. Gartner.

2004 September.

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October - December 2010

INTERVIEW Perspectives on Australia’s HIT Industry Dr Grant Fraser, Senior Medical Officer, Nambour General Hospital, QLD, Australia, and Chief Medical Officer at Medical Wizards Corporation, in conversation with Amoolya Moses, Assistant Editor, Health IT NEWS.Direct! Q: Nationwide connectivity is the current focus of many countries. What are Australia’s efforts in this direction? What, according to you, are the key aspects that will help the country realize this goal? A: From my perspective, Australia already has reasonable connectivity in the urban and suburban areas where over 95% of the population resides. Providing connectivity at high speed to the vast regions where very few people live will naturally be costly. During the recent election, Prime Minister Gillard made a major commitment to supply consistent connectivity throughout the country, including rural regions. The government has proposed over $40 billion to fund the implementation of the nationwide internet superhighway. Dr Grant Fraser Chief Medical Officer Medical Wizards Corporation Senior Medical Officer Nambour General Hospital QLD, Australia

Q: What does Australia’s National Broadband Network mean to the healthcare industry? A: There is a significant shortage of GPs in rural areas, and essentially no local access to specialists. The claims made in the recent election were that specialists would connect to patients and advise them on their care at the GPs office, and that some GP consultations would even occur over the web. It is unclear if health professionals are particularly on board with all of this; but especially for access to specialists, this may well be feasible. Q: How do you feel the implementation of a national connected health system would impact the various healthcare stakeholders, in particular the providers and payors? A: I think the concern would be that consultations that are made remotely could be of lower quality and higher risk. The concept of specialist consultation by internet video and audio with the patient is certainly feasible; but that also takes the GP’s time, which is already stretched in rural areas. Nonetheless, this would likely provide benefits to the GP in gaining specialist input and being active in implementation of the specialist’s treatment plan. The payor situation is fairly straightforward. Australia has an excellent national health scheme in which services are greatly covered by the public system (Medicare), which all Australian citizens and permanent residents have. I would expect that consultations over the internet would be paid by a similar billing code as a standard office consultation.

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October - December 2010

Q: Acceptance by healthcare providers has been one of the barriers of the widespread implementation of health IT, globally. What has been the response of Australia’s caregivers in this aspect? A: Australian doctors seem to have a high level of usage of technology, which occurs due to the fact the healthcare systems are large and government funded. Each state has its hospital system, typically with the same set of technology throughout the entire state (there are exceptions to this – but as a general rule). GPs also have a set of choices for electronic charting and methods to securely obtain data from consultations, laboratory testing, radiology testing, and so forth. Q: Have you identified any loop-holes in the current adoption of IT in healthcare? Could you brief us on this and the means to overcome the same? A: There is a lack of high quality public hospital system electronic charting. I am unaware of any effective approach to this. Some attempts have been made; however, they have been by technical people without the appropriate clinical input. Hopefully this will change. Information resources with regard to diagnosis and treatment of medical conditions seem to be generally available in both the public and private sectors of healthcare. The degree to which doctors utilize these resources is highly variable. Q: Do you feel that the integration of various IT technologies into an end-to-end solution would aid in nationwide connected care? A: This certainly would be a good thing. However, there is no nationwide solution right now as Australia’s public system has dual payors; which yields a fragmented system. There are multiple state governments, which hold responsibility for the public hospitals within their respective states. Currently, each state health system has implemented its own solutions rather than having a national coordinated approach. The movement in the future, to possibly have everything under the federal government, would probably be necessary for a nationwide approach to patient records; which is an essential component of having the correct information to treat one’s patient. Q: Being a CMO of Medical Wizards Corporation, what are the key aspects that are taken into consideration while deciding on the features of today’s mobile healthcare solutions?

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INTERVIEW

A: In general, we are looking at continuing the development of clever solutions that are needed for critical or emergency care, and needed at the point-of-care. Having the ability to carry essential information in a portable device is an important ’peace of mind’ aspect for healthcare providers. Knowing that when you need to calculate an ABCD-2 score or the dose for norepinephrine (noradrenaline) you have a tool that accomplishes this and 1,000s of other critical needs, is ‘peace of mind’. Q: Despite the various benefits attributed to IT, latent errors have been noted. Do you feel that a technology developer should concentrate more on these latent factors that could give rise to adverse events than on human errors that cannot be avoided? To what extent should this be considered while developing an IT solution? A: Errors that relate to technology difficulties are certainly a concern and need to be addressed first. It is this information that providers rely upon to assist them in their decision-making. If there is poor quality or erroneous data being provided to the decision-maker, the decision is negatively impacted. There are improvements and double checks with the implementation of IT solutions that also assist in flagging human errors; such tools would seem a part of any comprehensive solution. Q: What are the various areas where mobile technology could be used at a healthcare facility? What is its application at the emergency room? A: This question requires a reasonable perspective and practicality to answer properly. As someone who has been a huge advocate of mobile technology for a decade – I well appreciate its limitations. Mobile technology should be used to access information, not enter it. So, for viewing data on patients or reference materials, it is great, but at a point when someone builds an application that involves data entry, this shows a lack of appreciation of the limitations of the platform. Just because one can build something, it doesn’t mean that it is good or useful. The application in the ER includes bedside tools for drug dosing, clinical calculators, reference materials; and in the right environment, it should allow access to patient records and lab results. The same could be said for other departments in the hospital as well. Clinical handover tools for patients from one team to another should also be part of any such system when implemented system-wide.

Health IT NEWS.Direct!

October - December 2010

Q: Working at the ER, where time is of the essence, what is your personal experience with the intervention of IT as opposed to manual processes?

Q: What is the current market for mobile technology? What are the driving forces? What would be the market five years down the line?

A: I’ve spent the last decade placing the tools I need immediately, on a mobile platform. Clearly others like the idea as we have a large number of subscribers to the EM Suite. This product provides information on most emergency conditions, drug dosing, clinical calculators for decision making, toxicology reference, extensive pediatric tools, transfusion information, and a lot more: all designed for point-of-care. The value is that all your needed tools are on a single platform with a consistent interface.

A: In the medical space, there are a number of big and medium players; these include MedicalWizards.com, ePocrates.com, UnboundMedicine.com, and Skyscape. com. My experience has been that medical content is heavily utilized among healthcare professionals early in their careers – and this wanes. Drug reference is an ongoing need as are tools for drug and clinical tool calculations. I have focused on these tools for the last 10 years.

Q: What are the innovations (in terms of the development of novel technology as well as application of current technologies to other niche areas of healthcare) that we could expect in the future health IT environment? A: I think that the use of images, sounds, and videos on mobile, both streaming and natively, allows a whole range of educational and reference materials that are beyond the scope available in textbooks. It is the next generation of tools that will be available. Many such tools will allow interaction with the user to modify the user environment. Such materials and tools open up the ability to simulate and teach in a format not possible with traditional printed matter.

The mobile technology market was quite steady in the early days, around 2001 and 2002, with a typical growth of ~50% per year. Currently, it is a growing industry as it is routine to have an iPhone or Android phone, but the growth is more realistically 10% per year. The driving forces are the need for confidence in having one’s tools available at any time, regardless of connectivity (as such resources reside locally on the devices and do not require one’s smartphone or other PDA to have a web connection), and increased physician utilization of smartphones. My suspicion is that the 10% increase per year of usage will likely continue over the next 5 years, as we have smartphones and tablet devices readily available, which are luring more medical users into this space.

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October - December 2010

eHEALTH Medicity to Create HIE for Colorado Salt Lake City-based Medicity Inc. has been contracted by the Colorado Regional Health Information Organization (CORHIO) to provide its technology platform for the creation of a health information exchange (HIE) for the state.

CORHIO will implement health information exchange first at San Luis Valley region and later at Colorado Springs, Boulder, Denver, and Northern Colorado, on getting letters of intent from the healthcare organizations.

CORHIO is tasked to enable sharing of clinical information across the state of Colorado for better quality of healthcare delivery. The not-for-profit CORHIO collaborates with various healthcare stakeholders such as physicians, hospitals, long-term care, public health, laboratories, payors, and patients, in order to establish secure processes and systems for HIE.

The current contract with CORHIO adds to the vendor’s alliances with other state regional health information organizations (RHIOs) and HIEs, such as the California Regional Health Information Organization (CalRHIO) and the Mississippi Coastal Health Information Exchange (MSCHIE), for the state-wide implementation of HIE. Medicity’s network of connected providers encompass above 700 hospitals and more than 25,000 physician practices.

Although there are many providers using electronic medical records (EMRs) to store patient medical information, the full benefits of deploying such technology will only be realized when this data can be easily accessed in realtime and shared across the continuum of care. In order to facilitate quicker accessibility of vital patient data; virtual elimination of costly and redundant tests; decreased hospital readmissions; reduced time to start treatment after medical testing; and minimized errors and overall healthcare costs, CORHIO has planned to develop a state-wide electronic health network. With an aim to link more than 85% of the state’s providers to the HIE within five years, CORHIO plans to deploy HIE community-bycommunity, two in 2010 and two to three per year for the time period between 2011 and 2015. As a first step in achieving its strategic goal, the organization chose Medicity following an eight-month long review process by over 100 representatives of physicians, hospitals, health clinics, and payors. According to Phyllis Albritton, Executive Director CORHIO, Medicity was selected for its ability to adapt to federal legislation influencing health IT, flexible technology platform, and commitment to ensure successful HIE. Using Medicity’s technology platform,

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The vendor’s commitment to enable HIE is exemplified in its recent partnership with the financial and administrative HIE solution provider, Emdeon, Inc., for the creation of a ‘converged’ national health information exchange. Disproving the historically misconceived separateness of both financial and clinical data, the collaboration is considered to link over 500,000 providers across the nation. The company is on a deployment strategy of first establishing the foundation by connecting providers electronically, allowing the flow of health information across the network, and then expanding on functionalities of the HIE initiatives by layering in the right combination of services and applications to meet the required goals. Medicity recently released an HIE deployment approach, in which HIE organizers were recommended to select technology which would • support the current requirements of meaningful use • prepare for future delivery models like medical home and accountable care organizations (ACOs) • prepare for the changing CMS reimbursement guidelines.

Health IT NEWS.Direct!

October - December 2010

Accenture Roped in to Implement National EHR System at Singapore The Singapore Ministry of Health has awarded a contract to a consortium led by Accenture, including HewlettPackard, Orion Health, Oracle, and Initiate Systems, Inc., to implement the first phase of a National Electronic Health Record (NEHR) system for Singapore. As a key to fulfilling the Singapore Minister for Health, Khaw Boon Wan’s vision of ‘one Singaporean, one health record’, the NEHR is expected to enhance care quality, and reduce healthcare costs. The NEHR is part of the Intelligent Nation 2015 (iN2015) program, a 10-year plan to utilize infocomm technologies to establish a well connected society. With investments of $176 million planned for the current phase, the NEHR is anticipated to enable exchange of vital medical data such as medication history, clinical diagnoses, patient demographics, allergies, laboratory investigations, radiology reports, and discharge summaries. By eliminating unnecessary and duplicate tests, patients can benefit from right-sited care and disease management, and lower medication errors. At the 2010 Health Informatics Summit, Yong Ying-I, Permanent Secretary (Health), Ministry of Health & Chairman, Infocomm Development Authority of Singapore, mentioned that the NEHR will allow easier clinical outcomes tracking, and support the efforts made by the clinical community in evaluating and benchmarking outcomes for better safety and quality of care. Ying-I Y also mentioned that apart from the NEHR, the policies and approaches supporting the NEHR-enabled world, is the key enabler of achieving integrated care in Singapore. Clinical Practice Guidelines, including clinical protocols for disease treatment, security and data stewardship, were listed as the current policies and governance being reviewed; changes in these would influence the rollout of NEHR in 2011. In addition, another aspect of change needed in preparation of the new system, would be to analyze clinical quality data with revenue, utilization and unit cost data, so as to allocate resources appropriately. Road to One Singaporean, One Health Record The various programs initiated to reach the goal of providing

each citizen a single health record are listed below. • EMR eXchange (EMRX): was rolled out in April 2004, allowing public hospitals to exchange inpatient discharge summaries electronically. Other patient information, such as medication data, radiology reports, and laboratory tests, were later included in the EMRX. • Integrated Clinic Management Systems (CMS): a S$15 million (US$ 11 million), four-year program, initiated in August 2006 to allow seamless flow of information for GPs. With the completion of Phase 1 in December 2008, two CMS platforms were established, in addition to two e-services with clusters, six e-services linkages to the Ministry of Health, and around 300 clinic subscribers. • Intermediate and Long Term Care: introduced in 2008 to implement a single EMR for connecting community hospitals, the initiative will now be linked to the NEHR to enable coordination and management of care across facilities. • GP IT-Enablement program: established in 2009, to promote electronic medical record (EMR) adoption by GPs. • Personal Health Record (PHR) program: with the implementation of Singapore eHealth Portal in April 2009, the Phase 1 of the PHR program was completed. Phase 2 will involve the inclusion of new functionalities to the portal and extension of personal health management scope by synergizing with the NEHR. According to a 2009 report by the Stanford Center on Longevity, with nearly 27.4% of the Singaporean population being 65 years or older by 2030, greater adoption of eHealth is expected across the country. A recent report by Business Monitor International opined that with the iN2015 plan directing the government’s strategy to focus on IT, complex government tenders are expected to drive significant spending in healthcare, apart from e-government, education, and transport, in the coming years. This has already been demonstrated in the country’s 2009 budget, earmarking US$200 million for the development of the electronic health record system.

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October - December 2010

eHEALTH

Allscripts to Offer EHR and PM Solutions to Berkshire Health Systems Berkshire Health Systems (BHS) has taken a step forward in enhancing the quality of patient care, managing the cost of care, and advancing patient communication by adopting Allscripts’ electronic health record (EHR) and practice management (PM) solution, along with integrated revenue cycle and claims management, for its 108 employed physicians, hospitalists, ED physicians, and mid-level providers. The contract also includes hosting and support services for the solutions for more than 300 affiliated physicians. Located in Pittsfield, MA, Berkshire Health Systems, a private, not-for-profit, integrated delivery system includes a network of associates; namely, 302-bed Berkshire Medical Center, Fairview Hospital, BMC Hillcrest Campus, Berkshire Visiting Nurse Association to name a few. With a vision to provide a robust electronic health record for its complete community of care, BHS selected Allscripts based on its ease of use, ability to connect and share data, and its strong EHR functionality. The vendor was recommended by a committee of employed and affiliated physicians of BHS. Through the current contract, the legacy EHR and PM solutions at BHS’s owned physician practices will be replaced by Allscripts’ offerings, while affiliated physicians can access the solutions via a turn-key solution including Web-based hosted delivery, interfaces to auxiliary services like radiology and laboratory, a help desk, and link to BHS’s Meditech hospital information systems. Emergency physicians and hospitalists will have prior knowledge of patient’s medical history before treatment by accessing patient data from within the EHR. BHS’s decision to deploy Allscripts’ EHR solution was also intended to help its physicians qualify for federal incentives for EHR adoption and its meaningful use. Addressing the certification criteria set by the recovery plan, Allscripts recently received Complete EHR Ambulatory certification for its MyWay EHR (version 9.0) and Allscripts Enterprise EHR (version 11.2) by Drummond Group, and Sunrise Emergency Care (version 5.5) and Sunrise Acute Care (version 5.5) by Certification Commission for Health Information Technology (CCHIT) under the EHR Office of the National Coordinator Authorized Testing and Certification Body (ONC-ATCB) program.

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The ARRA incentive was the driving force for BHS to implement Allscripts’ Clinical Quality Solution (CQS) as well. CQS helps in automating the task of demonstrating the meaningful use of technology by collecting patient results from electronic health records, and compiling clinical quality measurement reports needed for qualifying for ARRA and other pay-for-performance programs maintained by payors and the government. The solution also promotes quality patient care by delivering point-ofcare clinical decision support data to the physicians at any time. Also included in the current contract are Allscripts’ revenue cycle management solutions which are integrated with the PM solution. BHS selected the solutions to help automate claim management, billing, scheduling, and other integral financial functions. Over 300 million annual claims and 600 million overall revenue cycle transactions have been processed through Allscripts’ revenue cycle solutions. According to William Young, CIO of BHS, their partnership with Allscripts and the adoption of its solutions will help provide a robust electronic health record for BHS and assist providers in connecting with each other, which would further lead to better coordination of care, integration, and provide enhanced care outcomes. Allscripts’ CEO, Glen Tullman states that the enhanced outcomes and positive and safe patient experience can be achieved by streamlining care transitions, and connecting clinicians for better access and sharing of vital patient information. Headquartered in Chicago, Illinois, Allscripts provides software, information and connectivity solutions, and services, to around 700 hospitals, 150,000 physicians, and thousands of healthcare providers in post-acute care facilities, homecare agencies and clinics. With 28 office facilities across 18 states, it provides solutions such as EHR, revenue cycle management, PM, electronic prescribing, care management, medication dispensing, document management, homecare automation, and emergency department information systems. Third quarter GAAP revenue of Allscripts for the three months, which ended on September 30, 2010, was $242.4 million, a 12% increase from the previous year’s 3Q.

Health IT NEWS.Direct!

October - December 2010

PRODUCTS AND SOLUTIONS Lawson Makes Available Update to Cloverleaf Interoperability Software Lawson Software has announced the release of the Cloverleaf Integration Services version 5.8 at the annual Lawson Conference and User Exchange (CUE) in San Antonio, Texas. The upgrade is designed to aid in the exchange of vital health data within healthcare organizations, such as integrated delivery networks (IDN), as well as across a community of medical offices and affiliations. In order to survive the current challenges in today’s healthcare industry, it is vital for providers to not only automate the various healthcare operations through the use of information technology, but most importantly, ensure that all the systems harmonize and are interoperable with each other. This way a provider organization can fully optimize the benefits of information technologies and realize its true potential. The updated Cloverleaf 5.8 offers the following enhancements: • Data routing: the tools offered through the system are designed to manage myriad data forms, and route greater amount of data to more endpoints, without requiring complex system configurations • Data processing: improved translation processing to better optimize processing transactions in hardware resources, thereby enabling more precise data flow across disparate languages, formats, and systems • Web services application interface (API): provides access to certain internal functions of Cloverleaf, enabling the creation of utilities above those offered on Cloverleaf web services and availing Cloverleaf Integration platform functionalities The upgraded version also includes an add-on module, Cloverleaf Message Warehouse, designed to help organizations create a copy of all messages routed across the various systems and transfer or archive it to a central data repository. This provides a cohesive source from which clinicians financial professionals and administrators will be able to avail data whenever they require. Touted to serve as the cornerstone of an organization’s strategy of information exchange and interoperability, the new version of Cloverleaf is said to also support the meaningful exchange of data across the clinical and non-clinical systems in the health system. The Cloverleaf Integration Service is a product of Healthvision Solutions, Inc., an integration and application solutions and

services provider, which was acquired by Lawson for $160 million in the beginning of 2010. At the time of the acquisition, the company’s Cloverleaf product is claimed to be deployed in 33% of US hospitals and 40% of large IDNs. Jim Catalino, Lawson Healthcare’s general manager, announced that with this strategic move, the company intends on improving the efficiency in operational and clinical processes, and business advantages of interoperability. Demonstrating its commitment towards offering its clients with the above benefits, the company recently participated in the HIMSS Interoperability Showcase by exhibiting its expertise in the Integrating the Healthcare Enterprise (IHE) event, an initiative introduced to enhance data sharing among healthcare IT systems within the industry. The current announcement closely follows Lawson’s release of part two of its Cloud Services offering, which is designed to bring virtualization and cloud computing benefits to clients deploying on-premise solutions of Lawson. The Internal Cloud Services includes the following: • Lawson Cloud Console: Cloud management tool that helps automate IT operations • Lawson Virtual Appliances: offers the software bundles, Lawson Smart Office and Lawson Enterprise Search • Lawson Grid Technology: helps enhance flexibility and provide opportunity for high-availability infrastructure, and distribute IT operations for some of Lawson’s products across a group of systems St. Paul, MN-based Lawson Software, with more than 3,800 staff employed in the company, offers software and service solutions to a client base of 4,500 customers spanning more than 40 countries. It caters to the requirements of industries such as manufacturing and distribution, healthcare, service industries, fashion, food and beverage, equipment service management and rental, strategic human capital management, and public sector. For its healthcare industry clients, the company offers technology and solutions for business management, such as financial, human capital, supply chain, and workforce management; integration, which also include health information exchange and clinical software; patient administration and operations; performance management; and user productivity. The company reported 3Q FY10, ending February 28, 2010, revenues of $186.2 million, which showed an increase of $173.8 million from the same quarter of the previous year.

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October - December 2010

PRODUCTS AND SOLUTIONS

Verizon Broadens Medical Data Exchange Platform to Enhance EMR Adoption Verizon has announced its plans to expand its Medical Data Exchange platform to assist the healthcare industry in sharing additional digital patient health data, such as X-rays and lab results, in an attempt to accelerate the adoption of electronic medical records (EMR). Launched in March 2010 at the Atlanta Healthcare Information and Management Systems Society annual conference, the initial version of the Medical Data Exchange has aided in the exchange of dictated notes among physicians as well as with transcriptionists; and was in itself aimed towards encouraging the use of EMRs. Now, the currently expanded platform is expected to help providers, ranging from large healthcare systems, small physician practices to rural hospitals, to be able to share additional digital records securely and privately. The open standards-based, interoperable platform is further anticipated to aid in the transition from paper to electronic-based medical records, and in turn help accelerate patient diagnosis and improve productivity. Enabling the exchange of information through the adoption of EMRs, the Medical Data Exchange solution is expected to maintain the existing workflow. It also provides secure and easy access to relevant data like protected health information (PHI). The solution functions from a cloud-based platform, allowing medical transcription organizations, hospitals, imaging and EMR vendors, and others to seamlessly share digitized patient data with providers. Verizon’s Data Exchange offering is said to help physicians meet meaningful use criteria established under the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, with mandatory security audits, and address traditional restraints in eHealth adoption, compliance, as well as investments for updates, or purchase of new equipments or software. Some of the new members to Verizon’s expanded exchange include Alert Notification, a personalized emergency notification provider; Amaji, which provides digital clinical documentation services; and NLP International

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Corporation, a natural language processing software provider. In its attempt to enhance electronic health data sharing, Verizon recently announced that around 2.3 million US nurse practitioners, physicians, and physician assistants will be issued medical identity credentials from January 2011, which is intended to help them meet the federal requisite for the HITECH Act. According to the Act, starting from mid-2011, practitioners need to use strong identity credentials to digitally share and access patient information. With these credentials, professionals will be able to access health data through Verizon’s Medical Data Exchange, healthcare IT applications, and platforms such as e-Prescribing services, EMRs, and health information exchanges (HIE). These credentials are devised to meet the Level 3 authentication standards set by the National Institute of Standards and Technology (NIST). This move of Verizon’s is believed to help providers in the secure sharing of health data and also address the various IT challenges. Verizon Business, a part of Verizon Communications, provides IT, communications, networking, security, and mobility services. With over 200 data centers across more than 20 countries, the company serves 98% of the Fortune 500 companies. Through its IT consulting services, Verizon Business helps clients improve business strategy, globalize and modernize infrastructure, facilitate remote workforce, and also enhance global customer service. It offers a wide array of solutions to increase access to care, improve availability of information, maintain security and compliance, mobilization, and plan for continuity of operations. With providers working towards equipping their facilities to exploit the incentives allotted for meaningful use of technology, the current move of Verizon, which is aimed at increasing the adoption of EHRs through the updation of its Medical Data Exchange platform, would further aid in meeting the growing demands of the providers.

Health IT NEWS.Direct!

October - December 2010

MERGERS AND ACQUISITIONS Allscripts-Eclipsys Merger: Making of a New Health IT Leader Healthcare IT leaders, Allscripts, a post-acute care and physician-office solutions provider, and Eclipsys Corporation, a performance management and inpatient enterprise solutions vendor, have entered into an estimated $1.3 billion definitive all-stock merger agreement. The synergy is anticipated to form a leading healthcare information technology entity, providing the most comprehensive solutions for providers of all sizes and settings. Highlights of the Agreement • Closing: Approved by Board of Directors of both companies, the merger is expected to be completed in about four to six months, following customary closing conditions, as well as the completion of a secondary offering of Misys-owned Allscripts shares. The merger will be subject to regulatory approvals including termination or expiration of any pertinent waiting period under the Hart-Scott-Rodino Antitrust Improvements Act of 1976. The acquisition was recently approved by the stockholders of both the companies. • Leadership: The designation of roles according to the agreement is given in the table below.

Current Designation

New Role in the Combined Company

Glen Tullman

Allscripts’ CEO

CEO

Phil Pead

Eclipsys’ CEO and President

Chairman - focus on strategic and important client relationships, integration of products and processes, company strategy and international business

Bill Davis

Allscripts’ CFO

CFO

Chris Perkins

Eclipsys’ CFO

Head the integration of Allscripts and Eclipsys

Sharing a common vision of a connected health system, Phil Pead believes that the current merger will help realize the goal of enabling the flow of vital information seamlessly to all caregivers attending to a patient, and delivering care across the care continuum. Expecting it to be the most fastest transformation in any industry in the history of US, the current move will combine Allscripts electronic health record (EHR) product portfolio for physician practices and post-acute care market, with Eclipsys’ hospital enterprise solutions.

The remaining current officers in both the companies will form the executive team, while the present directors will initially form the Board of Directors of the merged company.

Impact on Misys In relation to the merger with Eclipsys, Allscripts will lower the equity stake of Misys plc, Allscripts’ current majority stockholder, from approximately 55% to about 10% through a share buyback and an underwritten secondary equity offering, which is also expected to be completed in four to six months. Through the secondary offering, Misys will sell a minimum of about 36 million of its shares in the company to the public. In addition, Allscripts will buy back approximately 24.4 million shares owned by Misys at $18.82 per share or at a total value of $460 million, plus $117.4 million premium with regard to Misys’ sale of controlling interest for $577.4 million. If Misys elects to exercise its right to expect Allscripts to repurchase an additional 5.3 million Allscripts shares, its equity stake in the merged company is anticipated to be about 8%, while stakeholders of Eclipsys will own about 37% of the combined company. The merger is anticipated to contribute to Allscripts’ nonGAAP earnings from 2011 (calendar year), and enable cost savings of more than $100 million across its first three fiscal years following the close of the deal. The company estimates bookings of about $117 million for 4QFY10, which will exceed the previously expected range of $105$112 million, and revenues of $700-$705 million.

Table 1: Executive Leadership Following Merger

Executive

• Shares: As per the agreement, for each share of Eclipsys, the company’s stockholders will get 1.2 shares of Allscripts, which equals to 19% premium when based on the closing price as of June 8th, 2010.

The combined entity aims at developing a single patient record system to connect devices and applications within a facility as well as across organizations in a community. As Allscripts’ products, and Eclipsys’ Sunrise Performance Management and Enterprise solutions leverage common platforms, such as Microsoft.NET and other technologies,

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October - December 2010

the synergy is anticipated to accelerate the delivery of an integrated solution for the specific provider sectors catered to by the individual companies. Additionally, with both following an ‘open architecture’ approach, they hope to simplify the linkage to third-party applications, which would result in a single patient record. With combined resources and a workforce of above 5,500 employees, the merger is expected to provide a single platform, from which the collective clientele of nearly 1,500 hospitals, more than 180,000 US physicians, and about 10,000 nursing homes, home care, hospices, and other post-acute organizations, can avail clinical, connectivity, information, and financial solutions. Glen Tullman of Allscripts states that by sharing a similar vision with the American Recovery and Reinvestment Act (ARRA) of leveraging IT for connecting providers across care settings, enhancing quality and reducing care costs, the consolidation of Allscripts and Eclipsys forms a single company with the breadth of technologies, scale, and client footprint capable of helping realize this goal. It is also expected to drive meaningful use of technology and aid clients to efficiently avail the federal incentives for the adoption of EHR under the ARRA. In addition, the merger is also thought to accelerate technology acceptance by creating a ‘hub’ of hospitals, connecting 50,000 practices which utilize Allscripts offerings: considered the largest physician user base in the industry.

MERGERS AND ACQUISITIONS

The Players and their Stories So Far Both Allscripts and Eclipsys have proved themselves in the healthcare sector through the delivery of award-winning solutions which aid in improved efficiency and quality of the healthcare delivery system. Founded in 1986 as Allscripts Healthcare Solutions, the now Chicago-based Allscripts-Misys Healthcare Solutions, Inc. equips providers with information and connectivity solutions, software, and services, in order to supplement care delivery with patient safety, and enhanced clinical and financial outcomes. With their EHR solutions certified by CCHIT, Allscripts has been accredited by organizations like KLAS, TEPR, and Frost & Sullivan. The company caters to above 160,000 physicians, 800 hospitals, and 8,000 postacute care facilities and homecare agencies. For the 2010 fiscal year third quarter ending February 28, 2010, Allscripts reported total revenues of $179.9 million, a 12% increase from the same quarter of the previous year. The full year’s revenue, ending May 31, 2009, was $548.4 million, when compared to $383.8 million reported in 2008. Apart from the current, the other strategic moves made by Allscripts are mentioned in the table below. Through its acquisitions, Allscripts has not only been able to expand its product portfolio, but has also been able to connect the various key components of the care delivery system.

Table 2: Allscripts’ Strategic Moves January 2001 Acquisition of ChannelHealth from IDX is said to have allowed Allscripts to avail significant traction with its TouchWorks EHR

March 2006 Acquiring A4 Health Systems®, a PM and EHR solutions provider, was intended on extending services to small, independent physician groups, and mid-sized medical practices

January 2008 Extended Care Information Network (ECIN) was acquired to help Allscripts extend patient data exchange between case managers within hospitals, physicians outside the hospital, and post-acute care centers

October 2008 Divestiture of Physicians Interactive® business unit to investment firm, Perseus, L.L.C. Merger of Misys Healthcare Systems LLC, of Misys Plc, lead to the creation of the current Allscripts-Misys Healthcare Solutions, Inc.

April 2009 In order to focus on core business of connectivity and information solutions, and clinical software, a definitive agreement was signed to sell Allscripts Medication Services business to A-S Medication Solutions

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Incorporated in 1995, Atlanta, GA-based Eclipsys operates across offices in the US, Canada, and India, and offers integrated revenue cycle, clinical, and performance management software solutions, professional services, and clinical content to over 6,000 healthcare systems, clinics, hospitals, and physician practices. The company has been recognized by KLAS CPOE Digest 2009 as a leader in CPOE adoption for the seventh year in a row, and named ‘Best in KLAS’ for its Business Decision Support solution for 2008. Receiving the 2008 Frost & Sullivan Award for Healthcare Innovation under the North American Clinical Information Systems market, for its physician practice management

systems, the company’s Sunrise Clinical Manager™ was named one of three healthcare IT solutions to receive the highest level of computer-based patient record (CPR) capabilities set by Gartner. The Outcomes Company posted full-year 2009 revenues of $519.2 million in contrast to $515.8 million of 2008, and $128.4 million for the first quarter 2010, ended March 31, 2010, when compared to $130.2 million reported for the same period of the previous year. An important aspect of the company’s business strategy for expansion has been through acquisitions.

Table 3: Eclipsys’ Strategic Moves February 2004 Merger agreement with Clinical Practice Model Resource Center (CPMRC) was intended towards extending clinical content in Eclipsys’ SunriseXA™ information solution

December 2004 eSys Medical Systems Inc., an RIS company, was acquired to broaden and deepen its diagnostic imaging solutions

July 2006 Certain assets of Sysware Healthcare Systems, Inc. were acquired to include LIS as a core model into its Sunrise Clinical Manager

December 2006 Sysware’s sister company, Mosum Technology Pvt. Ltd. was acquired for its laboratory software Through the acquisition of Van Slyck & Associates, Inc. (VSA), Eclipsys was able to provide clients with patient acuity management tools

December 2007 CPMRC was sold to Elsevier as part of the strategy to enhance and extend integration of content in Sunrise Knowledge-Based Charting™ and other Sunrise Clinical Manager™ integrated solutions

February 2008 Enterprise Performance Systems, Inc. (EPSi), a business performance improvement solutions provider, was acquired. Exceeding sales targets for Sunrise EPSi™ solution within the first three quarters, it accounted for $10.9 million of increase in total 2008 revenue

October 2008 Acquisition of the physician practice solutions provider, MediNotes Corporation accounted for $2.2 million of increase in total 2008 revenue

January 2009 Acquisition of Premise Corporation included patient flow solutions to Eclipsys’ Enterprise Performance Management product suite

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MERGERS AND ACQUISITIONS

Intuit Pays $91 Million for Medfusion Mountain View, CA-based Intuit Inc., a financial and business management solutions provider, has acquired North Carolina’s Medfusion, a privately held firm specializing in patient-to-provider communications, for approximately $91 million. The acquisition was made with an intent to expand Intuit’s web-based healthcare delivery and support its Connected Services strategy by combining its expertise in easy-to-use small business and consumer offerings with Medfusion’s communication solutions. According to the terms of the agreement, Medfusion will function under Intuit’s Other Business unit, with the founder and CEO of Medfusion, Stephen Malik, continuing to oversee the operations of Medfusion as a general manager and senior vice president of the healthcare business from Medfusion’s headquarters. Stephen Malik will be required to report to Intuit’s president and CEO, Brad Smith.

sees the current merger with Intuit as one which will enable it to build upon the stability, innovation, and trust that the company holds in the industry. Founded in 1983, Intuit offers the healthcare industry the Quicken Health Expense Tracker, an online service, which enables patients to understand and pay their medical bills. This mode of payment has been accepted for implementation by several key health plan providers, including CIGNA, Medical Mutual of Ohio, and UnitedHealthcare, covering nearly 26 million members. With the closing of the transaction, Intuit plans on enhancing its Quicken Health solutions to enable better understanding of medical bills for patients and faster payment to providers. The merger will enable the two vendors to combine Intuit’s user interface and know-how in design with a wider offering of portals, payment and bill presentment solutions provided by the acquiree.

Established in 1996, Medfusion allows healthcare providers to deliver services to their patients with improved efficiency through web-based communication solutions. The company partners with the Medical Group Management Association, American Academy of Family Physicians and North Carolina Medical Society, and has a client base of more than 31,000 providers. Products included in its portfolio are solutions for front and back office, clinical, website development, and implementation and support. Through its offerings, patients can interact with providers for sharing secure messages on care and administrative topics, complete medical forms, prescription refills requests, pay bills, review clinical summaries and lab results, schedule appointments, and receive reminders.

Intuit’s CEO states that the current move will extend the company’s Software-as-a-Service offerings with a solution employed by over 30,000 providers, most of whom are small businesses. In addition, the combined resources are expected to help in the development of new products that would • improve administrative, financial and clinical sections of healthcare • enhance efficiency and effectiveness of online patientprovider interactions • enable accessing and management of personal health data • devise more efficient means for patients to track and pay healthcare costs

Some of Medfusion’s services include solutions provided by Intuit, such as the online bill payment solution using the software development kit of Intuit Payment Solutions division. Medfusion also offers its products to thousands of medical practices currently using Intuit Websites and about 75,000 Intuit QuickBooks care practices. Medfusion’s CEO

Reporting fiscal year 2009 revenues of $3.1 billion, Intuit anticipates a dip of approximately 1 cent per share in its 2010 FY GAAP and non-GAAP diluted earnings as a result of the current strategic venture. However, the company does not expect this to have a material effect on the next fiscal year’s earnings.

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Ingenix Demonstrates Expansion Plans with Acquisition Spree In a span of two months, health IT and services company, Ingenix has acquired Picis, Inc., a high-acuity health IT solutions vendor, and announced its intent to acquire Executive Health Resources, a physician medical management and medical necessity compliance solutions provider, and health information exchange (HIE) services company, Axolotl Corporation. Convergence of Health Intelligence and High-acuity Clinical Workflow Directing its focus towards extending its delivery into the high-acuity market, Ingenix has entered into a definitive merger agreement with Picis. Picis’ operations will continue at its headquarters, Wakefield, Massachusetts, and its offices across the US and Europe. Catering to high-acuity areas such as surgical suites, intensive care units and emergency departments, Picis’ solutions are deployed at over 1,800 hospitals, medical centers, and integrated delivery networks (IDNs), across 19 countries that span Europe, North America, and Asia. By integrating administrative, clinical, and financial data, Picis’ solutions help connect clinicians and hospital management and enable them to drive better efficiency, enhance care quality, and use best practices. These benefits for the healthcare industry are delivered through the company’s CareSuite family of solutions. The company has seen more than 50% annual compound growth rate since 2001, and is said to have experienced increased revenues during the 2009 economic downturn while other HIT companies reported revenue declines. While the current merger-acquisition is expected to allow Picis to leverage Ingenix’s information, resources, and analytics know-how, to build on its current position in the market, Ingenix looks forward to fortify its stand in its present client footprint of about 6,000 US hospitals. Over the previous years, the high-acuity market is said to have been growing at approximately two times the rate of the entire HIT market. With the $46 billion Health Information Technology for Economic and Clinical Health Act (HITECH) incentives governing most of the trends witnessed in the healthcare IT market, the same is expected for the high-acuity segment as well. The recent release of the final ‘meaningful use of technology’ rules has designated the ED as a covered area of inpatient care. Andy Slavitt, CEO, Ingenix, believes that the industry has great opportunities to leverage information technology for modernizing the acute care setting by enabling greater

efficiency and care delivery at these high-volume sectors of the hospital, which require large resources. Ingenix Targets Healthcare Regulatory Environment Closely following the merger agreement signed with Picis, Ingenix announced its intent to acquire Newtown Square, PA-based Executive Health Resources. Following customary closing conditions and regulatory approval, the transaction is set to close by the year end. Introduced in 1997, Executive Health Resources, through its workforce of Physician Advisors and technology-supported services, aids healthcare facilities in managing Medicare and Medicaid rules and policies and state-initiated medical necessity rules. The company enables the maintenance of financial performance and regulatory compliance through outsourced technological, clinical, and operational resource. With a client base of over 1,100 health systems and hospitals, Executive Health Resources is said to have performed hundreds of audits at hospitals, concurrently and retrospectively detected and reversed thousands of inapt medical necessity denials at every level of appeal, and conducted over 1.5 million medical necessity reviews. With health systems and hospitals having to cater to a growing number of patients with health benefit plans sponsored by the government, the merged entity will be better equipped to aid hospitals manage the requirements for medical necessity compliance. Andy Slavitt states that the combined resources of the acquiree’s evidence-based clinical insights and know-how, and the health information and analytics abilities of the acquirer, will help sustain clients in the ever-changing regulatory healthcare milieu. In turn, Executive Health Resources hopes to leverage Ingenix’s technologies and data assets in order to accelerate its delivery of vital, technology-based intelligence for its clients. Combining Decision-support Capabilities with HIE The acquisition spree continued with Ingenix’s acquisition of Axolotl, which was aimed at enabling the effective and secure exchange of health data. San Jose, CA-headquartered Axolotl has been equipping more than 200 hospitals, 100,000 healthcare professionals, about 30,000 physicians, four state HIE and 20 regional health information organizations (RHIOs) with Clinical Networking™ solutions since 1995. The company’s Elysium® suite of solutions are based on cloud infrastructure, open standards, and delivered as a Software-as-a-Service (SaaS).

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With national importance given to HIE in the form of $783 million and $36.5 billion investments made through the American Recovery and Reinvestment Act of 2009 (ARRA) for setting up state and community HIEs, and adoption of interoperable electronic medical record (EMR) systems, HIE is no longer considered as an option. Axolotl’s solutions are said to offer clinical networking capabilities that could support ARRA interoperability standards and help the healthcare stakeholders meaningfully use health information and electronic health record (EHR) systems. Ingenix’s decision-support capabilities is expected to enhance Axolotl’s HIE solution for improved efficiencies and better health outcomes. Both companies deliver solutions that are compatible

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with various health information systems. Through the current acquisition, Ray Scott, Axolotl’s CEO states that Ingenix will help drive the company’s growth and enable continued deployment of its secure health information technology. About Ingenix Eden Prairie, MN-based Ingenix, a wholly owned subsidiary of UnitedHealth Group, delivers healthcare technology, information and consulting services to providers, payors, employers, consumers, pharmaceutical companies, government agencies, and property and casualty insurers across the globe. Over the past 10 years, Ingenix has acquired over 50 companies specializing in the various disciplines of the healthcare industry.

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TELEHEALTH Telemedicine Collaboration to Connect Indian Rural and Urban Care Delivery San Jose, CA-based Cisco has entered into a joint initiative with Apollo Hospitals to use information and communication technology (ICT) for revolutionizing the delivery of care in rural and urban India. With a population of more than 1 billion, of which nearly 72.2% reside in rural areas, Indian healthcare providers are faced with many challenges in extending their care services, particularly to these and other suburban areas of the country. The factors encouraging the use of telemedicine in India have been compiled in a 2009 article by the Apollo Telemedicine Networking Foundation (ATNF), and published in the Telemedicine and e-Health journal. • The healthcare system of the country is considered a paradox: while growing into a destination for global health tourism, 700 million residents still lack direct access to secondary and tertiary care. • In order to meet the minimum standards of the World Health Organization (WHO), it has been estimated that a minimum of 750 hospitals having 250 beds need to be built, which could involve recurring annual costs of $5 billion. • The bias in healthcare delivery is evident from the fact that nearly 80% of physicians reside in urban areas, leaving 70% of the rural population with limited access to care services. In an attempt to bridge the health divide, the current alliance will encourage the accelerated access to healthcare through the integration of Cisco’s HealthPresence™ Extended Reach solution and Apollo’s Medintegra, a webbased telemedicine application. Incepted in 1983, the Apollo group of hospitals includes 50 hospitals, with a total of 8,500 beds in India and overseas, a chain of Apollo pharmacies, clinical research divisions, BPO and health insurance services, and diagnostic clinics. Medintegra, the technology integrating with Cisco’s offering, is the flagship product of Apollo Telemedicine Networking Foundation, a multi-specialty telemedicine network created by Apollo Hospitals. The lifecycle of the solution in enabling remote care delivery includes the capture and secure conversion of patient data into the electronic medical record (EMR), which is then sent to a specialist for analysis. The conclusions and opinions drawn by the specialist is communicated back to the peripheral

unit, where the physician can use this information to treat the patient in real-time. Cisco Services’ Chief Globalisation Officer, Executive Vice President, Wim Elfrink, states that the company is excited on partnering with Apollo in an attempt to develop and showcase collaborative healthcare solutions with ubiquitous broadband access, which will help provide high-quality and cost-effective care services in rural and urban areas. HealthPresence is a care-at-a-distance, communication and collaboration technology platform, which enables patientphysician interactions for remote healthcare consultation. Following trials since 2008 and implementations through pilot programs across UK, South Africa, France and China by the Cisco Internet Business Solutions Group (IBSG), HealthPresence was recently launched in March 2010. The product was rolled out in India as a part of an initiative to support remote education and healthcare. Cisco entered into a memorandum of understanding (MoU) with CSC e-Governance Services India Ltd, formed to enable and speed up various eGovernance services through the Common Services Centers (CSC) framework. The solution integrates two technologies: Cisco® Unified Communications and Cisco TelePresence™, to provide connected medical devices, clear audio, and highdefinition video. The application advances over traditional telemedicine models, which focus primarily on solving the physical access problem to medical care, by addressing the following additional challenges: • Shortage and productivity of medical expertise • Collaboration of a patient with various clinicians, as well as between providers and among patients themselves • Ability to view and exchange critical health data • Personalization to empower patients to take active participation in consults It encourages active participation between patients and physicians by allowing patients to view and listen to sounds from devices such as digital stethoscopes. Using the integrated technology, doctors can connect with patients, even on their laptops via the internet, and will not be required to visit a telemedicine room. Physicians will be able to seamlessly gain detailed clinical examination

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information of the patient and analyze all investigations, and also have the choice of recording the complete interaction for further reference. According to the agreement, the partnership will be carried out in three phases, with the current announcement being the first. Apollo Hospitals Group and Apollo Telemedicine Foundation have already begun the deployment of hundreds of Ciscoâ&#x20AC;&#x2122;s telemedicine solution in its super-specialty hospitals and remote

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TELEHEALTH

clinics. Through this connectivity, patients will be able to avail 24/7 care across the Apollo system. To demonstrate the transformation of care in a rural setting through telemedicine, the two institutes have collaborated in Raichur (Karnataka, South India) as part of the current alliance. In phase II of the agreement, the two will embark on combined thought leadership activities and create industry standards for open health IT, and implement ICT solutions across India, Asia-Pacific, and other emerging nations in the last phase.

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INSIGHTS HIMSS Survey Demonstrates Medical Device-EMR Integration at One-third US Hospitals HIMSS Analytics recently released the results of a survey conducted to evaluate the use and progress of interfacing medical devices with electronic medical records (EMR). The survey showed that despite the widespread use of major medical devices, such as electrocardiographs, vital signs monitors, physiologic monitors, and defibrillators, just one-third of US hospitals have exhibited an active interface between medical devices and EMRs. The primary reason for this integration was indicated as the ability to automatically chart information from the device into the EMR. Manual paper-based or electronic charting of vital signs by clinicians can lead to errors and also delay in feeding data into the EMR. This risk is especially critical at intensive care units, where vital signs are constantly being monitored. The final rule of meaningful use of technology has included recording and charting of modifications in vital signs, like weight, height, blood pressure, plotting and displaying growth charts, and calculating and displaying BMI, as criteria for availing the federal incentives. Detailing the progress on these efforts, the survey investigated the various types of devices deployed, but not the overall number of devices. Sponsored by Lantronix®, a secure communications solutions provider, the study was conducted from June 2009 to June 2010, during which 825 US hospitals responded to questionnaires related to medical devices and their integration with EMRs. The medical devices included in the research were fetal monitors, infant incubators, cardiac output monitors, electrocardiographs, ventilators, intelligent medical device hubs, infusion pumps, interactive infusion pumps, physiologic monitors, vital signs monitors, and defibrillators. The study showed that none of the hospitals utilized all 11 devices: 13% used 10, another 1/3rd employed 9, 23% have 8, and <10% have deployed 5 or fewer of the devices. Table 1: Widely Deployed Devices Devices

Percentage Deployed

Defibrillators

Physiologic monitors

Electrocardiographs

Vital sign monitors

Intelligent medical device hubs

Based on the above observation, HIMSS concluded that with the saturation of these devices, there exists opportunities in market growth for fetal monitors, infant incubators, and interactive infusion pumps. On investing their integration with the EMR, the research found that, while intelligent medical device hubs were the least deployed, the numbers interfacing with EMRs were the highest (71.70%) among all the 11 devices. However, although defibrillators were the most widely used device, only 1.60% interfaced with EMRs. The integration can be enabled through Bluetooth or wireless technology, or hard-wiring (such as a USB connection). While about half of the respondents of the current survey stated that wired local area network (LAN) forms the sole means of connectivity between EMRs and medical devices, 8% relied entirely on wireless connections, and a quarter (28%) used a combination of both, wired LAN and wireless connections. While studies show that manual entry of vital signs data into a system reduces error rate when compared to paperbased documentation, the transfer of this data directly from a medical device into the EMR is considered to help enhance care delivery as there is no manual intervention, improve workflow by reducing the time consumed by the clinical staff, improve clinical outcomes and patient safety, and further lower the error rate to almost zero. Many studies have advocated improvements in the quality of healthcare services through the implementation of effective EMR systems. Recognizing system interoperability between devices and EMRs as an impediment to EMR deployment in outpatient settings, Jong Soo Choi et al (International Journal of Medical Informatics, 2010) designed and tested a framework that will allow comprehensive and seamless integration of the systems. Based on 76% of the users who responded with ‘strongly satisfied’ or ‘satisfied’, the researchers concluded that the framework helps streamline clinical workflow satisfactorily. Earlier in 2009, HIMSS released a whitepaper on intelligent medical devices, defining them as networked diagnostic equipments capable of providing data streams

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of the diagnostic readings and allowing them to be interfaced. Having bidirectional interfaces with an EMR, these devices have been found to be emerging as a vital component of the electronic records. The study found that even with the 2009 recession impacting the capital markets for hospitals, 58.86% of the respondents planned to buy intelligent medical devices, or replace/upgrade their existing ones, which depicted the importance of these devices in providing efficient care.

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The current HIMSS survey has observed that with the criteria for Stages 2 and 3 of meaningful use to be released by the Centers for Medicare & Medicaid Services (CMS) over the coming 3-5 years, more hospitals are anticipated to interface their medical devices with EMRs so as to comply by the Stage 3 goal of medical device interoperability. In addition to this, facilities that already have the interface will enhance the number and extent of devices that are integrated with EHRs.

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PARTNERS AND ALLIANCES WHO and IHTSDO Collaborate for Global Interoperability of Standards Sharing similar goals of improving care delivery through enhanced health information, Denmark-based International Health Terminology Standards Development Organisation (IHTSDO) and World Health Organization (WHO) have signed a collaborative arrangement, in an attempt to enable interoperability of SNOMED CT with WHO Classifications. Tasked with the development, maintenance, and implementation of global health information standards that would serve as a consensual, meaningful, and beneficial common language for the various healthcare stakeholders, WHO has produced internationally-accepted classifications. The classifications provide over a period of time, insights on trends, which in turn inform the plans and decision processes made by health authorities. These facilitate the capture, storage, analysis, comparison, and interpretation of vital data on disabilities, diseases, interventions, and other population health indicators. The primary classifications include • International Classification of Diseases (ICD) is the international standard diagnostic classification of diseases and conditions documented in various health records, and is used for health management, clinical use, and all general epidemiological purposes. ICD-10 is the latest version which needs to be implemented by October 1, 2013 by all covered entities. • International Classification of Functioning, Disability and Health (ICF) is a framework that evaluates disability and health at the individual and population level. • International Classification of Health Interventions (ICHI) offers a common tool for health service providers, researchers, organizers, and Member States to report and evaluate the evolution and distribution of health interventions. It supports the statistical process by facilitating the comparison of information between services and countries. The WHO Classifications are complementary to the IHTSDO-maintained clinical terminology, the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT). Considered the most comprehensive multilingual clinical terminology, SNOMED CT is the result of the merger, reconstruction and expansion of UK’s National Health Service (NHS) Clinical Terms and SNOMED RT® (Reference Terminology) in 1999. Originally created by the College of American Pathologists (CAP), SNOMED CT was taken over by IHTSDO in 2007. Used across more than 50 countries worldwide, the standardized terminology helps represent

clinically relevant data in a reliable, consistent, and comprehensive way in electronic health records (EHRs), enabling patients and caregivers to collect vital data on disability, interventions, and disease from the health records in more detail. Now, the collaboration of the two international standards is expected to facilitate greater reliability, accuracy, and care quality through better information; remove gaps in data; and control costs. Utilized in an appropriate way, the synergy is anticipated to simplify the aggregation and summarization of patient data from individual health records for health services management, health policy, and research. Tim Evans, Assistant Director General for Information, Evidence, and Research, WHO, states that the way to health passes through information. He continues to say that with increased collaboration, the two organizations will be able to develop an integrated, commonly functional terminology and classification systems that would allow more effective and efficient utilization of public resources, and eliminate effort duplication, which is essential for the creation of health information standards as an internationally common language. Apart from the current collaboration, IHTSDO has partnered with The International Council of Nurses (ICN), developers of the International Classification for Nursing Practice (ICNP®) used by nurses all over the world. This joint venture was aimed at supporting collaboration among the nurses and other caregivers by enabling access to standardized patient data. IHTSDO has also recently joined hands with Brussels, Belgium-based GS1 through a memorandum of understanding to facilitate compatibility between SNOMED CT and the latter’s standard system where suitable. GS1 provides standards for data synchronization, traceability, and automatic identification (through radio frequency identification and bar codes). Aligning with its commitment towards advancing the harmonization of terminologies and promoting health information system interoperability, IHTSDO is supporting the interoperability and compatibility of standards by coordinating with other standards organizations such as GS1, European Committee for Standardization or Comité Européen de Normalisation Technical Committee (CEN TC)

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251, Health Level Seven (HL7), International Organization for Standardizationâ&#x20AC;&#x2122;s Technical Committee (ISO TC) 215, and Clinical Data Interchange Standards Consortium (CDISC) under the umbrella of the Joint Initiative Council (JIC). Standardization is the establishment of approved specifications, including norms, units, definitions, and rules, which create a universally understandable language for sharing information. Consistent utilization of the standardization process improves efficiency, reliability, accuracy, and comparability of data locally, regionally, nationally and internationally. With the increasing volumes of health data, standardization is required to aid in the consolidation, storage, retrieval, archiving, processing, and analyzing of these vast amounts of information, which could thereby facilitate informed decision-making, and evaluating performance and outcomes, cost analysis and statistical reporting. Now, with the extensive use of technology, primarily in the form of EHRs, the exchange of information through these systems would also require

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a standardized clinical terminology for both IT as well as the content. In view of the various programs initiated to build national healthcare information networks (NHINs), a 2007 study by Russell A Hamm and colleagues has expressed the need for adopting established codes for accurate data exchange facilitated through NHINs. Each organization abides by multiple clinical terminologies that do not necessarily align with those of other organizations. With the NHINs aimed at sharing data across various organizations across the nation, this disparity in standards pose a great challenge for the various NHIN programs. Multiple standards and terminologies have been established; however, the need of the day is interoperability of these standards. This calls for combined action towards the development of internationally accepted criteria to review materials and make available standardized terminologies to act as references for an integrated standard.

Health IT NEWS.Direct!

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Infosystems and Wellogic Collaborate to Target Indian ICT Industry Sharing a mutual commitment for enabling safer and costeffective delivery of care, India-based HCL Infosystems has joined hands with Cambridge, Massachusetts’ Wellogic, in an effort to develop healthcare solutions that would help create India’s National Health Information Exchange Environment (INHIEE), a nationally integrated healthcare delivery platform. The adoption will be supported by interoperability standards of the National Health Information Network (NHIN), and facilitated through Wellogic’s electronic health record (EHR), personal health record (PHR), and portal. This initiative is expected to leverage Wellogic’s know-how in healthcare data management and HCL’s understanding of India’s information and communications technology (ICT) market in connecting private and public healthcare stakeholders including providers, payors, trading partners, and patients across the country. Enabling anytime-anywhere medical information access to authorized patients and caregivers, the INHIEE is set to create a ’one patient one record’ system. On a national level, the INHIEE is anticipated to promote HIT adoption and integration, while influencing the quality, timeliness, efficiency, and cost of healthcare provided by India’s healthcare providers. With knowledge gained from global initiatives, INHIEE is anticipated to drive the healthcare industry in India to exploit worldwide HIT innovations, bring about advancements in their infrastructure, and enable interoperability to exceed national borders. Nationwide healthcare connectivity is a vision of many nations worldwide. Listed below are the various global initiatives and the investments made towards linking healthcare stakeholders. • American Recovery and Reinvestment Act (ARRA) 2009: $19 billion across five years • Australia’s National eHealth Strategy • Canada Health Infoway: $10-$12 billion over 10 years • UK’s National Programme for IT (NPfIT): Up to £12.7 billion (US$19.5 billion), across 10 years. Considered UK’s largest single investment in IT. • Hong Kong: Hospital Authority of Hong Kong will invest HK$1 billion (US$128 million) to create eHealth record system over 10 years • Germany’s Elektronische Gesundheitskarte (electronic health card) • European Patients Smart Open Services (epSOS): minimum budget of €22 million (US$28.3 million)

Despite heavy investments and efforts made by the various countries in establishing an eHealth system, a white paper by Health Industry Insights, market researchers and analyst, identifies the following challenges faced by nations on the EHR journey: • Need to enable equal access for private as well as public providers, and GPs • Establishing a framework for privacy and security • Inclusion of non-text data such as digital x-rays and radiology images • Inclusion of clinical workflows, such as basic disease management, case management, clinical quality monitoring, adverse drug reaction surveillance, and eReferrals • Have governance, leadership, and change management A 2010 study by Eva Deutsch and coworker from the Core Unit for Medical Statistics and Informatics, Medical University of Vienna, have analyzed challenges faced by global EHR programs, and derived upon common vital aspects of these programs across countries. Considering the long timelines and costs involved in these projects, the objective of the research was to draw on the conclusions inferred thus far to facilitate efficient implementation of future national EHR initiatives from an economic standpoint. After reviewing nationwide programs that have been in existence for at least five years in Canada, Australia, England, Germany, and Denmark, the researchers found the following commonly involved critical areas: • Change management and acceptance • Demonstration of funding and benefits • Project management • Goals and implementation strategies of health policies • Basic legal requirements, predominantly for data protection Concluding that the measures used till now to address the critical aspects were approaches towards solving individual problems, the researchers suggest setting up a comprehensive method that covers all the critical factors mentioned and supports the entire implementation process of national EHR programs. Following the country-wide connectivity, the next step would be to enable access of patient medical records across countries. This would aid in medical tourism, which is becoming a fast growing market in countries like India. Providing extensive benefits in coordinating care through automation, a global eHealth system would involve synchronization of diverse standards and governance followed across the globe.

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October - December 2010

PARTNERS AND ALLIANCES

iMDsoft and Med Web Technologies Partner to Offer Integrated Preoperative Solution iMDsoft® and Med Web Technologies, LLC (MWT) have entered into a collaboration to jointly offer their technologies in the area of preoperative workflow. Through this partnership, MWT’s One Medical Passport, an online preoperative workflow solution, will be offered as a part of iMDsoft’s end-to-end perioperative product package. The Scituate, MA-based MWT, a medical information solutions provider, offers web-based patient centric solutions based on the application service provider (ASP) model, to aid in healthcare processes like patient registration, medical history, pre-admission test centers, progress notes, online scheduling requests and post procedure question and answers via email. One Medical Passport helps doctors, hospital staff, and nurses to securely access complete medical history, upon submission of the information by patients. Through the current contract, One Medical Passport will interface with the MetaVision® Anesthesia Information Management System (AIMS), iMDsoft’s perioperative workflow solution, has embedded decision support and analytical tools designed to create an accurate, billable and complete anesthetic record. MetaVision’s role in the perioperative areas is as below: • Preoperative: Electronically integrates patient’s data from various hospital systems in order to aid in preoperative assessment, order medicines and preoperative tests, and prepare an anesthesia plan. This data is made available during the surgery. • Intra-operative: Automatically captures data from monitors and various other devices after anesthesia administration, creating a comprehensive anesthesia record. Bar code-assisted syringe labeling technology automates the preparation and administration of drugs. MetaVision notifies expired syringe swaps or syringes. • Postoperative: At the post anesthesia care unit, MetaVision helps view data from bedside devices and allows the anesthesia record to be accessed. It simplifies the review and on-time delivery of medications as planned by the anesthesiologist. By consolidating relevant patient data, it also aids in the discharge process. The inclusion of One Medical Passport into iMDsoft’s offering is expected to benefit customers by getting the preoperative process online, and reducing the time spent on manual administrative work, and minimizing the errors associated with it.

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iMDsoft’s CEO, Phyllis Gotlib says that the partnership with MWT would benefit both caregivers and patients in terms of efficiency and convenience of an integrated online patient admission tool and AIMS system. She also elaborates that with the incorporation of One Medical Passport, customers will benefit from an increase in the return on investment already experienced by them. Founded in 1996, Massachusetts-based iMDsoft offers clinical information systems (CIS) for critical and preoperative care. Its flagship product, MetaVision® Suite includes solutions for clinicians, IT professionals, executives and hospitals. It automates the workflow in high acuity departments like intensive care, perioperative care and step-down units as well as at in-patient bedsides. Having its presence in Australia, Germany, Israel, Japan, and Netherlands, the company caters to a client base located across approximately 16 countries. Importance of IT in Perioperative Environment The perioperative setting poses various challenges to caregivers owing to factors such as the involvement of sophisticated technologies that are most often not interoperable, complex clinical care, and a large number of instruments, supplies and implants that are not easy to manage. As any mishandling in the complex process proves to be hazardous to a patient, a lot of emphasis should be laid on developing and designing software to support the perioperative environment. A study by Paul J St Jacques and Michael N Minear suggests the need for creating industry partnerships and forming new work groups to improve care at the perioperative setting. Further, they have listed the following as some of the areas where informatics can aid in the enhancement of perioperative care: • Documentation of perioperative templates • Analysis of perioperative data, errors, and trends • Optimizing and designing workflow • Development of models for evaluating the influence of novel technology designs and standards on process and patient outcomes • Creation of interoperable clinical equipment and software in terms of standards, design, and testing • Maintenance and creation of surgical knowledge base According to a 2006 report by Frost & Sullivan, the following are the forces driving the high acuity IT market

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October - December 2010

in the US: • Wired for Healthcare Quality Act, which aims to develop a nationwide interoperable health information technology system • Centers for Medicare & Medicaid Services’ (CMS) payfor-performance model (P4P) The research identifies medication management, computer

physician order entry (CPOE), and verification modules as the systems that could add substantial revenues to the high acuity care solutions market. The analyst states that niche vendors focusing on providing solutions for a particular department can extend their product portfolio through the development of robust information system (IS) solutions for other departments in the high acuity care environment, especially offering solutions on a single clinical platform.

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October - December 2010

VENDOR WATCH Accenture to Render IT Support Services to U.S. Social Security Administration Accenture has been selected by the U.S. Social Security Administration (SSA) as a prime contractor under the Information Technology Support Services Contract (ITSSC), to provide solutions for enhancing SSA’s capability of offering its services to present beneficiaries and future retirees. SSA, a Baltimore, Maryland-based independent organization of the US federal government, provides services through old-aged, disabled and survivor benefits, administers the supplemental security income, Medicare programs, etc. It has a nationwide presence with 10 regional offices, about 1,300 field offices, and 6 processing centers, and a workforce of 62,000 employees. With an agenda for implementing agency-wide IT support services, SSA has awarded multiple ITSSC contracts for integrating, modernizing and enhancing its existing systems. Each contract, under the $2.8 billion government order, has a base period of one year, with optional six years. ITSSC’s scope emphasizes on the growing demand for information technology at SSA’s healthcare arena, as electronic health record data will help determine disability claims and entitlement programs. Anticipating lower costs, greater user satisfaction with SSA’s core benefits programs and acceleration of benefits delivery with the integration and use of emerging technologies, Accenture National Security Services, a wholly-owned subsidiary of Accenture, has entered into the ITSSC contract to help SSA realize this vision. The task order for the deal is expected to require the services of the contractor for the following: • Determining means to enable seamless integration of data from electronic health records • Extending social media and web for improved user accessibility • Applying analytics capabilities and predictive models to SSA’s business Encompassing a range of services directed towards SSA’s IT modernization initiatives, the indefinite delivery, indefinite quantity (IDIQ) contract has issued task orders to the following companies as well: • Computer Sciences Corporation (CSC) of Virginia to offer IT and consultation services to manage and modernize SSA architecture and systems in software engineering and technology, application validation, along with

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systems administration for UNIX, z/OS, WebSphere, and Windows software • Bethesda, MD-based global security company, Lockheed Martin Corporation, to support SSA in design, creation, testing, maintenance, and aid in imaging, document management and database administration • Northrop Grumman Corporation, a Washington D.C.headquartered global security company, to deliver its services to SSA in analysis, requirements, application and business planning, software engineering management, programmatic repository, data administration, and enterprise architecture. Northrop Grumman will work with Reston, VA-based Maximus; Unisys of Philadelphia; and McLean, Virginia’s SAIC; along with many small business partners. The managing director of Accenture’s US federal health programs, Steve Shane states that SSA’s aim of introducing advanced technologies requires innovative thinking and expertise. In 2008, Accenture bagged a three-year contract worth $79.6 million from the New York City Department of Information Technology and Telecommunications (DoITT) to provide business process support and technology for the Health and Human Services Connect (HHS-Connect) program. Virginia-based Accenture National Security Services provides solutions to the US government classified market, to manage change, modernize information systems, optimize key headquarters governance and processes, and create improvement strategies for enterprise performance. The New York-based parent company provides technology, outsourcing services, and management consultancy. With a global presence of more than 200 cities across 53 countries and a workforce of approximately 204,000, Accenture caters to a client base which includes 94 Fortune Global 100 companies. It delivers solutions and services to 19 industry groups, including media and entertainment, life sciences, and health and public service, through five operating groups, i.e., Financial Services, Communications & High Tech, Products, Resources, and Health & Public Service. For the fiscal year 2010, ending August 31, 2010, the net fourth quarter revenue of the Health & Public Service operating group was reported to be $856 million, and $3,581 million for the entire year.

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October - December 2010

Merge Healthcare Inks Perioperative Solutions Deal with New Jersey Health System Health IT provider, Merge Healthcare Incorporated has been chosen by New Jersey’s Saint Barnabas Medical Center to provide Anesthesia Information Management System (AIMS), with patient portal and Medication Management modules, to enhance the overall perioperative experience. Saint Barnabas Medical Center, considered the state’s largest and oldest non-sectarian, nonprofit organization, is affiliated to Saint Barnabas Health System. Its services include a certified burn treatment facility, heart center, and renal and pancreas transplant center to name a few. The 597-bed hospital has been accredited by the American Medical Association Accreditation Council for Graduate Medical Education (ACGME) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Dr Rick Pitera, who headed the purchase process, considered Merge AIMS as the best choice for caregivers focused on safety, and one that could engage patients early and retrieve accurate information in the correct format before surgery. Merge AIMS, a perioperative solution, helps minimize manual efforts at the surgery department by creating an electronic medical record (EMR), and provides comprehensive documentation of data across the perioperative setting. The solution enables interfacing with medical devices at the operating room, and focuses on safety and compliance with quality reporting initiatives, such as the Surgical Care Improvement Project (SCIP), an effort to minimize postoperative complications. AIMS has integrated into it an anesthesia drug management system for storing, accessing and tracking medications through barcode at the operating room. By using a risk management and presurgical testing solution, Merge’s Presurgical Screening System helps streamline the workflow of surgical preparation. Substantiating the robustness of Merge’s clinical solution and its compatibility with Saint Barnabas’ existing information systems, Mike McTeague, CIO, Saint Barnabas Health System, mentions its ability to meet the requirements of the remaining hospitals under the Health System. Broadening its client community, Merge recently added Exempla Saint Joseph Hospital, a non-profit hospital in Denver, Montana-based The Surgery Center of Northwest Healthcare, and Kalispell Regional Medical Center for its perioperative solutions.

Established in 1987, Hartland, WI-headquartered Merge Healthcare provides solutions to help automate diagnostic workflow and healthcare data in order to improve product development for devices, health IT and pharmaceutical companies, and facilitate better electronic recording of the patient. Its offerings include data management and imaging technology for cardiology, radiology and orthopedic domains, computer-aided-detection (CAD) applications, as well as interoperability solutions that enable connectivity between the systems.

AIMS Market There has been a marked increase in the functionality and rate of deployment of anesthesia information management systems over the past decade, and are said to have emerged into systems with more than what the generic automated record keepers that were proposed and created in the 1980s could accomplish. A recent survey by Surgical Information Systems (SIS) emphasizes on the need for anesthesia information management systems. Among those surveyed, 91% respondents said that it is “extremely important” or “important” to access day-of-surgery data in order to efficiently manage the anesthesia department. It was seen that, apart from delivering quality care, anesthesia practices need to comply by the changing regulations and scheduling predictability and accuracy, and accurate billing. An 84% response indicated a high level of importance of analytic tools at the anesthesia department. Endoscopies, pain clinics and surgical procedures were noted by anesthesiologists as key areas of growth in relation to demand for anesthesia services. Recognizing the increasing need for anesthesia services outside the OR were 76% of the respondents who stated that mobile technology will aid in real-time access to anesthesia data, which would thereby facilitate better communication with respect to cases and scheduling, monitoring of multiple patients and cases, and access to guidelines and drug information. Highlighting on the need and the benefits of moving to a consistent and accessible automated anesthesia record, SIS CEO, Ed Daihl mentions the importance of immediate AIMS implementation recognized by anesthesia providers, and states that automation at the anesthesia department holds enormous opportunity and growth for providers.

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October - December 2010

GOVERNMENT Overview of VA’s Recent Moves in Embracing Healthcare IT The U.S. Department of Veterans Affairs (VA) supports the health care of more than 5 million veterans each year. It has been suggested that the quality of services delivered to the veterans has been reinforced by concerted efforts made to extend the use of health IT, apart from other measures like managing chronic conditions, improving the provision of evidence-based medical practices, coordinating services offered by various providers, etc. Health information technology systems are being used by VA for over 20 years to enhance its efficiency and outcomes. Through these years, VA has adopted IT systems to support the continuum of care, such as bar-coded medications, laboratory and medication ordering, computerized patient records, and radiological imaging. Some of VA’s recent activities in using technology to deliver better care have been mentioned below.

• VistA Although the potential of electronic health record (EHR) systems was identified decades ago, the Centers for Disease Control and Prevention’s (CDC) 2009 National Ambulatory Medical Care Survey (NAMCS) has reported that only 6.9% physicians possess a fully functional medical record system, as apposed to 20% who have basic electronic record systems. Veterans Health Administration (VHA), VA’s medical system, has been one of the few early organizations to adopt an integrated EHR system. VHA operates the Veterans Health Information Systems and Technology Architecture (VistA) system, an enterprise-wide EHR system, which is considered to be used by almost half of all the nation’s hospitals. Using the EHR system, VHA has been able to lower the rate of medication errors to 7 per million written prescriptions, which is much lower than the national average of 1 in 20 errors. VA recently entered into a national agreement with Document Storage Systems (DSS), which specializes in VistA EHR integration, in order to deploy its Mental Health Suite (MHS), a fully integrated EHR module, with VA’s Computerized Patient Record System (CPRS)/VistA, across 153 VA medical centers. The one year contract (plus four-year option) was awarded based on the successful deployment of the product at 50 VA medical centers.

• Health Information Exchange Recognizing the lack of a comprehensive system that would allow medical data exchange between Department of Defense (DoD) and VA, the President directed the two departments to create a lifetime unified EHR, the Virtual

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Lifetime Electronic Record (VLER), for Armed Services members by 2012. Enabling safe and private exchange of health data electronically between DoD and VA, the $52 million initiative is expected to improve care quality and continuity by avoiding the delay in providing service due to the shift in status from active duty to a veteran. In order to support the VLER, VA has roped in CACI International Inc, an IT solution and service provider, as a prime contractor, to develop a solution that will combine Armed Forces members’ electronic medical records into a database that can be accessed by VA, DoD facilities/ providers, as well as any other civilian or private medical offices that the members may visit. The Blanket Purchase Agreement, awarded through the General Services Administration’s Schedule 70 contract vehicle, is worth $91 million for five years. This involvement with the VLER initiative is expected to support at least 10 complimentary health IT projects that will be managed under a single structure. These programs include the Nationwide Health Information Network (NHIN), a group of services, standards, and policies that allow Web-based sharing of health information securely; the Health Data Repository (HDR), a clinical data repository residing on one or more independent platforms, etc. In the process of implementing the lifetime electronic record, VA has introduced pilot health information exchange programs at San Diego, CA; Tidewater, VA; Indianapolis, IN; and Puget Sound. The recent pilot was initiated at Spokane, under a contract in which health information exchange network, Inland Northwest Health Services (INHS) has partnered with Spokane’s Fairchild Air Force Base and the Spokane VA Medical Center. The pilot will aid in the adoption of the VLER by enabling the sharing of EHR information through the NHIN. The NHIN has been another initiative aimed at enabling secure standards-based, exchange of data across the nation. Using NHIN protocols, the Utah Health Information Network (UHIN) has collaborated with HIE solutions vendor, Axolotl Corporation to facilitate clinical Health Information Exchange (cHIE) between rural providers in Moab, UT and VA. Records from rural VA-participating physicians in rural areas can be viewed by authorized physicians by querying the cHIE. The pilot ranks fifth in a series of pilot programs initiated across the country aimed at extending care to Veterans by accessing the NHIN. Enabling access and coordination of care delivery for service members

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and veterans from rural areas, the current pilot has been recognized as the first with a definite mission of expanding care services to rural communities, and one of the first to allow electronic sharing of veterans’ health data across VA and non-VA clinicians throughout the state.

• Claims Processing and Data Access According to Eric K Shinseki, Secretary of Veterans Affairs, VA has been rigorously testing any innovation that will help simplify, quicken, or enhance the services rendered to the veterans. Aligning with the claims transformation plan, aimed to ensure that Veterans’ claims are decided within 125 days, VA has released a pilot project to quicken this process via the internet. The project plans to evaluate preliminary estimations of a specialized contract providing records for Veterans’ disability compensation claims processing in 7-10 days as opposed to the average 40 days. The program is also aimed at significantly lowering the average time required to acquire healthcare records from private physicians by having a private contractor to scan the documents into a digital format and send it to VA via a secure network. With plans to test the project using about 60,000 records at regional benefits offices in Indianapolis, IN; St. Louis, MO; New York City; Portland, OR; Phoenix, AZ, Chicago, IL; and Jackson, MS; VA officials will decide to either cancel, change, or extend any changes in procedures on a national level.

• Telemedicine A team of researchers from VA are also studying the impact of telemedicine, internet-based education, and case management, among others, on the ability to enhance health outcomes of veterans and others suffering from diabetes, as well as increase the access to care.

• Anesthesia Record Keeping VA has entered into a contract with Picis, a provider of high-acuity solutions (now a part of Ingenix), to deploy Picis’ anesthesia record keeping (ARK) system at the VA Stars & Stripes Healthcare Network, a Veterans Integrated Service Network (VISN). Picis’ Anesthesia Manager, PACU Manager, and Preop Manager have been selected to aid in streamlining anesthesia documentation, clinician’s workflow, and continuity of perioperative care. The Picis solution for anesthesia and the ICU will also enable the VISN providers to access comprehensive patient care records, including ICU and surgical care information, from a single application on a common centralized database.

• Coding and Compliance Since 2005, QuadraMed® Corporation, a leading provider of healthcare technologies and services, has been catering to the needs of VA through its Quantim suite of solutions. VA recently extended this relationship through a fiveyear, $211-million agreement with the vendor to deploy Quantim® Coding, Compliance, and Abstracting solution. The integrated solutions are expected to enhance accuracy and coding productivity of VA’s health system through customizable billing processes and real-time compliance monitoring. Also included in the deal are QuadraMed’s Central Reporting and Physician Query Tracking tools, along with support services and technical training.

Benefits of IT Implementations Eric Shinseki expresses VA’s commitment in leveraging the finest technology, along with the brightest minds in private sectors and the government to ensure that the veterans can obtain benefits that they have earned. VA’s efforts in adopting healthcare technology to improve care and its outcomes at its centers have not gone unnoticed. In 2010, DoD/VA Healthcare Data Synchronization was recognized by Government Computer News (GCN) for exceptional IT initiative. Since 2003, the program is in the process of developing a Medical Product Data Bank (MEDPDB) for establishing an accurate, authoritative and coordinated product data warehouse for the federal healthcare supply chain. VA has been considered an important source of experience and information for understanding the impact of health IT on achieving potential financial and clinical outcomes, and the means by which organizational structure may be fundamental for attaining these outcomes. A recent study published in Health Affairs, conducted between 1997 and 2007, demonstrated $7 billion savings out of an investment of $4 billion in health IT; most part of the savings resulting from the areas that also enhanced safety, quality, and patient satisfaction. Greater than 86% of the savings resulted from avoiding duplication of tests and decreasing medical errors, while the remaining were achieved from reducing workload and lowering operating costs. In comparison to private healthcare sectors, the research found that VA’s expenditure on IT was higher, which was also indicated in the resulting levels of adoption and quality of care. As a result of equipping its center with the different IT systems through various initiatives, Veterans Affairs is considered as one among the few health IT-enabled national integrated delivery systems in the United States.

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October - December 2010

GOVERNMENT

PwC Opines on Implications of US Health Care Reform on Stakeholders The Health Research Institute of PricewaterhouseCoopers has released a report on how the recently passed health care reform act will impact the reshaping of the American healthcare industry. The analysis says that the modifications, consequent to the implementation of the law, will develop an environment which is profoundly different, as a result of which current markets, business practices, and silos may not be relevant anymore. It is estimated that the current Medicaid does not cover many low-income individuals, childless adults except pregnant women, above 65 years of age, or those inflicted with serious disabilities. With the House passing the health reform legislation in November 2009, President Barack Obama signed the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act on 23rd March, 2010. The health reform was passed, to extend affordable healthcare coverage to more than 32 million Americans, including non-elderly individuals with incomes up to 133% of the poverty line, or incomes of approximately $29,000 for a family of four. Providing coverage also to individuals with pre-existing conditions, the Act will allow 95% Americans to have health insurance coverage. The Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) estimate that 23 million non-elderly residents will be uninsured by 2019, out of which one third include unauthorized immigrants. For the payor sector, the law is expected to bring about greater accountability, and introduce a new competitive market. Further, the Act is expected to stabilize the government’s budget by keeping a tight rein on waste, overspending, fraud and abuse, and also through more than $100 billion reduction in deficit across the next ten years and greater than $1 trillion over the second decade. Considered as the first and most complete analysis of the reform-induced changes and its implications on healthcare organizations, the report provides a prospective outlook on the healthcare scenario after ten-years of the reform, and suggests ways to transform challenges into opportunities. The recommendations include combining three primary mechanisms that would help in achieving the reform: new regulators, flow of funds, and coverage to develop a health system which would require the collaboration of various sectors in bringing about changes in care quality, cost and outcomes. Some of the anticipated changes that could be brought about through this approach include the following: • Public or private payors would now provide most of the coverage given to the uninsured • Focus will be directed more towards incentivizing physicians and hospitals based on quality

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• Payors, although greatly regulated, will gain accessibility to new clients via health exchanges • Businesses and individuals will have to either pay and provide for health insurance or will succumb to penalties In order to survive in the post-reform world, the various executives in the health industry will have to re-evaluate their present strategies, break down silos and find opportunities to work together. The research has predicted the following implications of the provisions in the law on the provider and payor sector. • Hospital-physician partnership: New reimbursement models prefer physician alignment with hospitals over the conventional model of private physician practices. Increase in quality-driven financial incentives towards primary care, promoting accountable care organizations and Medicaid medical homes, injection of bundled payments, and reduced readmissions resulting from the reform are expected to further drive payment partnerships between physicians and hospitals. • Penalties: Starting from 2015, the penalties levied against a 300-bed hospital for generating poor quality metrics will not only include a monetary damage of above $1.3 million, annually, but is also expected to tarnish the reputation of the facility, as the metrics will be published online. Also, the penalties may impose increased pressure on the hospital to improve quality as some of these metrics will be evaluated on a relative basis, as grading is on the curve. • Medicaid: With an anticipated increase in Medicaid recipients by over 40% between 2010 and 2019, hospitals would have to learn to operate on Medicaid rates, and would have to quickly consider fixed costs as traditionally these rates do not cover the entire expenses. • Administrative expenses: In order to meet 80% (for small group and individual market) and 85% (for large group market) medical loss ratio (MLR), many payors will be required to reduce administrative costs. • Type of plan: With predictions indicating a substantial rise in Medicaid coverage over the next 10 years and a three-fold increase of individual plans from 2010 to 2019, payors would have to shift their focus from group plans to individual plans. • Categorization: Payors will be required to set themselves apart based on service, price, quality, and provider

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October - December 2010

network in insurance exchanges. With limits on cost sharing, essential health benefits, four standard benefit packages included in the health reform, insurers will be left with areas other than design of the benefits to compete on. PricewaterhouseCoopers estimates that healthcare organizations are on the run to meet the criteria of over 60 major regulatory deadlines under the health reform in the next ten years. Considered as one of the most vital healthrelated legislative acts since Medicare, the health care reform is said to hold the blueprint for a novel health system. The legislation encourages the use and implementation of technologies like the electronic medical record (EMR) and ePrescribing capabilities. Compliance with the new Act will also introduce the requirement for traditional IT hardware, software and products for new organizations, web portals, and extended areas of programs. A recent report by INPUT, a Reston, Virginia-based privately held company, has explored the impact of the health care reform on healthcare information technology (HIT). According to the research, vendors can optimize on the demand for solutions to support new or extended organizations, comparative effectiveness research, health information exchange (HIE), and the designing and maintenance of web portals. Other vital opportunities for the IT industry include tax and new Centers for Medicare & Medicaid Services (CMS)/Medicaid Management Information Systems (MMIS) ramifications, and tracking/ reporting/business processes. The kind of technologies that would fulfill the requirements for the health reforms include electronic health records (EHRs) and clinical decision support systems; medical technology such as imaging hardware and software; and solutions for billing, and case and document management for the business of healthcare. The report predicts that local, state and federal governments

would spend more than $5 billion on traditional IT solutions and other health information technologies within the first five years of implementing the requirements for the reform. The estimates of the investments, made by various parties, for IT to support specific operations include: • Internal Revenue Service: $2.5 billion for documentation, eligibility determination, and verification tasks for costsharing and premium subsidies • Health and Human Services: about $1.8 billion for implementation of modifications to Medicaid, Medicare, and related systems, and other legislative mandates • States: $2 billion to startup health insurance exchanges With its recent enactment, health care reforms joins the Health Information Technology for Economic and Clinical Health Act (HITECH) under the American Recovery and Reinvestment Act (ARRA) of the previous year in raising speculations on its impact on the various stakeholders of the healthcare industry. As indicated by Kelly Barnes of PricewaterhouseCoopers, it would be futile and would be missing the purpose of the reform agenda if the impact of the reform is confined to only the healthcare organization’s current practices. She continues to say that if the organizations continue to function in silos, the financial implications of the Act could be destructive, even threatening the survivability of the healthcare organizations. The current industry norm is the requirement to comply with various healthcare regulations put forth by either federal or other regulatory bodies. As the government introduces reforms to improve the way care is delivered, it is important for both the vendors as well as health executives to optimize the various opportunities available as a result of these reforms. While health executives work towards modifying their present practices to accommodate the reform, a new surge of competition could be witnessed among vendors in their attempt to help achieve the reform requirements.

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October - December 2010

GOVERNMENT

Harris Corporation to Assist VA in New HIPAA Standard Migration The US Department of Health and Human Services (HHS) has mandated the adoption of an updated HIPAA X12 version 5010 standards for electronic transactions by January 1, 2012. In order to aid in the migration from the currently used HIPAA X12 version 4010A1, the Veterans Health Administration (VHA) has awarded Melbourne, Florida-based Harris Corporation a contract for eight months to function as the primary subcontractor. Being a primary subcontractor on the Engineering Services Network, Inc. team, which was allotted a potential $10.9 million, Harris is tasked with the delivery of a complete range of services for software development, such as the designing, testing and deployment of the software, along with documentation and requirements definition. The healthcare industry stands at the crossroads as it prepares to implement various mandates set by the US government. HHS, in the beginning of 2009, published two final rules advocating the adoption of the National Council for Prescription Drug Programs (NCPDP) Version D.0 and X12 Version 5010 for HIPAA transactions. With the new standards proposing reduced administrative expenses and improved efficiency, a 2009 Healthcare Information and Management Systems Society (HIMSS) report opines that the industry as a whole could either embark in full implementation of the upgraded electronic transaction standards for dissemination of a single set of transactions across the industry or adapt these standards to fit into legacy systems. The initial HIPAA implementation, which took place about a decade ago, resulted in majority of payors opting for the latter approach. With HHS attributing monetary benefits of up to $33.8 billion to the industry on the complete implementation of the new standards, the report continues to state that the current requirement for the migration from HIPAA 4010 to HIPAA 5010 provides a second chance for the industry to experience its full benefits. Table 1: Proposed Timeline for HIPAA 5010 Implementation Final rule

January 16, 2009

Beginning of 5010 Level 1 Testing (Internal)

January 1, 2010

5010 Level 2 Testing (External with Trading Partners)

January 1, 2010

5010 Implementation in US

January 1, 2012

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Despite the implementation dates drawing close, only less than half of the providers and payors have started preparing for the 5010 HIPAA electronic transmission standards, according to the findings of the consulting firm, Ingenix. While most healthcare stakeholders opine that they have time for the implementation, Larry Watkins, Managing Consultant, Ingenix Consulting, emphasizes in the company’s newsletter that although the 2012 deadline is the main focus, they still have to meet the 2010 and 2011 benchmarks. Watkins also mentions that the first level of testing should be completed by the end of 2010, for which the 5010 designing and building, and internal testing should be performed across the year. By the time Level 2 testing is completed at the end of 2011, the 2012 compliance dates will not be so far away. This lag in implementation may be due to many challenges associated with the transition of HIPAA 5010. Some of the common hurdles expressed in individual reports developed by the Healthcare Financial Management Association and Cognizant are as follows: • Having to meet deadlines of other regulatory initiatives like the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) • Burdens faced in administration, apart from cost and management challenges during the transition period, when entities should accommodate both HIPAA 4010 and 5010. During this period, electronic trading partners and covered entities will need to coordinate with each other, as not all will be able to implement a dual-use transition capability. • As modifications in rules could differ based on business case and situation of the involved entity, specific cases should be attended to comprehensively • Tracking compliance • Complexities associated with the monitoring of transition from IT and business perspectives • Need for collaboration, communication, and coordination with electronic trading partners for the testing of capabilities of internal business systems, changes in business processes, and interfaces Jim Traficant, the general manager and vice president of Harris Healthcare Solutions is confident that the company will be able to help in enabling a smooth transition to the upgraded standard, keeping in mind the challenges that a large national provider such as VHA would face to incorporate new data elements to the system along with over 850 modifications to the standards. The current deal is one among the many contracts awarded by the U.S. Department of Veterans Affairs (VA)

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since Harris’ 2009 acquisition of Patriot Technologies, the vendor catering to VA’s imaging, healthcare IT, and enterprise software solution requirements. Harris was recently roped-in by VA, under a $72 million, three-year agreement, to offer its services towards the nationwide extension of the Consolidated Patient Account Center (CPAC) business model. This contract closely followed the 10-month, follow-on agreement with Evolvent Technologies Inc., to support the ongoing improvement of the U.S. Department of Defense (DoD) Military Health System (MHS) program, the Healthcare Artifact and Image Management Solution (HAIMS). As a sub contractor to

Evolvent, Harris is also aiding in patient information exchange capabilities between VA and DoD by enhancing the Bidirectional Health Information Exchange (BHIE) interface. Harris Corporation, a communications and IT vendor, caters to government and commercial industries across more than 150 countries. Under its healthcare delivery, it offers enterprise intelligence software and services, enterprise digital content management, advanced visualization and display, intelligent infrastructure, systems integration, and IT solutions.

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October - December 2010

GOVERNMENT

CMS Selects HP for Data Integrity Enhancement Solutions In an attempt to enhance the accuracy of Medicare payment data, the Centers for Medicare & Medicaid Services (CMS) has awarded a task order worth up to $26 million to HP Enterprise Services, for maintaining the Integrated Data Repository (IDR) and offering data quality services. Integrated Data Repository, an enterprise database, integrates the Medicare and Medicaid data, and provides data services for the National Level Repository (NLR), developed and managed by CMS. NLR was built as a single point of registration for Medicaid and Medicare electronic health record (EHR) incentives, allowing for the national level tracking, avoidance of duplication between the payments as well as between the states, and enabling eligibility verification in Medicaid EHR incentives. With a complete complement of Part A, B, and Durable Medical Equipment (DME) claims data, the IDR plans to continue to expand its database. The current contract is expected to help CMS manage a federally legislated incentive project. Suggesting the adoption of greater levels of data integrity for more accurate incentive payments awarded by CMS to providers, Dennis Stolkey, senior vice president of HP Enterprise Services, states that HP would support CMS in integrating, maintaining, and managing large volumes of Medicare data, with the progression of the programs. As an NLR Data Quality contractor, HP will be tasked to ensure that the payment grade data is fed into the NLR by setting up audits, data reconciliation, and reporting processes in order to authenticate the IDR data. In an attempt to maintain the accuracy of IDR data, HP will provide the following services: • Integrate individual physical models into separate databases • Manage the existing IDR database production environment to ensure that it functions at the required availability and performance levels • Analyze the quality of the data fed into the IDR • Develop automated workflows for accurate and timely loading of data that populates IDR, and supports NLR • Guide and recommend CMS on the maintenance and improvement of quality data services • Abide by CMS repository standards while creating and performing data warehouse backup and recovery processes Electronic Data Systems (EDS), now HP Enterprise Services after the acquisition by Hewlett-Packard Development Company, was awarded the NLR Data Quality task order in 2007 under the Enterprise System Development

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(ESD) indefinite-delivery-indefinite-quantity contract vehicle. The task order was introduced to support CMS’ administration of the incentive programs formed by the Health Information Technology for Economic and Clinical Health (HITECH) Act, under the 2009 economic stimulus Act. According to the program, eligible professionals, critical access hospitals (CAHs), and hospitals that execute and exhibit the meaningful use of EHRs will be awarded $44,000 and $63,750 for professionals under Medicare and Medicaid EHR Incentive programs, respectively. In their interest to ensure accuracy in the EHR incentive payment transactions, CMS also awarded Los Angeles, CA-based Northrop Grumman Corporation the HITECH National Level Repository task order in May. The global security company was roped in to design, create, deploy, and manage a data warehouse that enables the administration and incentive payment to hospitals, medical professionals, and other organizations. In its efforts of fulfilling the responsibilities, Northrop will be assisted by its teammates, Columbia, SC-headquartered Companion Data Services (CDS), a company offering data center hosting, and Ashburn, VA-based InnovTech, an IT services and solutions vendor. CDS will deliver application development consultant services to Northorp. Closely following this, CDS was contracted through an up to $24 million, one-year, task order with four year renewal options, to offer hosting and data processing services for NLR.

HP’s Medicare and Medicaid Services Founded in 1939, Palo Alto, California-based HewlettPackard Company provides technology solutions like infrastructure, printing, software, services and personal computation, to customers across 170 countries. It currently stands 10th among the Fortune 500 companies, and employs approximately 304,000 people worldwide. Net revenue generated for fourth quarter, ending 31st October 2010, was $33.3 billion, and $126.0 billion, for the full year 2010. In the second half of the year 2008, EDS was acquired for approximately $13.9 billion, and the new business unit was named as HP Enterprise Services in 2009. HP Enterprise Services, an information technology vendor, offers services in business process, applications and infrastructure technology outsourcing. It delivers IT services, solutions, and systems to healthcare organizations, and develops standards-based IT solutions for government agencies like Military Health Systems (MHS), U.S. Department of Health and Human Services (HHS), and the Department of Veterans Affairs (VA). The

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October - December 2010

broad range of comprehensive solutions offered covers both clinical and administrative aspects of healthcare IT, such as EHR/health information exchange (HIE), claims administration, medical management, clinical systems development, IT modernization services, customer relationship management, fraud and abuse detection, and commercial payer and government BPO. With 44 years of experience in handling Medicare and

Medicaid clients, managing 35% of all US Medicare and Medicaid claims, and processing 2.4 billion annual healthcare transactions, HP offers data center services, non-base system support, and Medicare Part B system maintenance for CMS and Medicare contractors. Some of the other contracts awarded to HP Enterprise Services and EDS with regard to Medicare and Medicaid services are cited in the below table.

Table 1: Medicare and Medicaid deals struck by EDS and HP Enterprises Services Year

Deal Details

Agency

Deal Particulars

2005

$48 million; seven-year contract

The contract includes designing, building, implementing, Commonwealth of and managing a new Medicaid Management Information Massachusetts System (MMIS).

2005

About $59.1 million; three-year State of Oklahoma deal extension

Contract extension of a seven-year alliance with Oklahoma Health Care Authority. Tasked with processing healthcare provider claims and offering MMIS’s hardware and software upgrades.

2007

Up to $92 million; one-year base period with five additional options of one year

CMS

Task order was awarded under the CMS Enterprise Data Center indefinite delivery/indefinite quantity contract vehicle, to host applications for Medicare claims processing to service hospitals and doctor’s offices across 12 states.

CMS

NHIC Corp., a subsidiary of EDS, was awarded the Medicare Administrative Contractor (MAC) Jurisdiction 14 contract to govern Part A and B Medicare claims payment for providers in five northeastern states.

State of Tennessee

The contract included updating and managing the state’s MMIS and deploying new business intelligence tools to enable healthcare data analysis, and establishment of new programs.

EDS

HP Enterprise Services

2009

$176 million; five year contract

2009

$170 million; four-year, with 1 year option

2010

Up to $200 million; one base year and seven one-year options CMS for renewal

Under the Medicare Part B Shared System Maintainer deal, HP will offer application services for enhancing the Medicare Part B claims processing, and provide beneficiaries with healthcare services.

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October - December 2010

NEWS Virginia REC to Promote Statewide eHealth Adoption with athenaClinicals

of $188.5 million for the year 2009, and $54.5 million for its first quarter fiscal year 2010, ending March 31, 2010, which was a 33% increase from the same time period of the previous year.

Working towards meaningfully using technology to automate care delivery, the HITECH Act of 2009 authorized the formation of Regional Extension Centers (RECs) specific to a particular geographical region, to technically assist, guide, and impart information on best practices in support of the accelerated deployment of electronic health records (EHRs). For the state of Virginia, the Virginia Health Information Technology Regional Extension Center, in collaboration with the Center for Innovative Technology, has chosen athenahealth for its EHR solution. As a preferred EHR partner, athenahealth will provide the state REC athenaClinicalsSM, which, as a Web-based service, allows regular updates and enhancements, without the user having to invest in subsequent iterations. The solution facilitates online record keeping, patient information at the bed side, clinical fax categorization, lab information connectivity, and routing. The EHR integrates with athenaCollectorSM, a practice management and billing service, and includes an inbuilt clinical rules database, which provides updates to clinical rules, guidelines, and incentives. athenaClinicals was recently recognized by KLAS as the solution attaining 100% client confidence in achieving the 2011 meaningful use standards. By implementing athenahealth’s EHR system, the current contract is estimated to benefit 2,300 primary care physicians in the Commonwealth of Virginia. The selection of athenaClinicals is said to have followed an extensive selection process, which evaluated about 200 potential EHR systems. This evaluation also resulted in the selection of two other partners to offer a Software-as-aService (SaaS) solution; these included Chicago’s Allscripts, an information and connectivity solutions, software, and services vendor, and New York-based healthcare solution provider, MDLand. Headquartered in Watertown, MA, athenahealth provides Web-enabled business services for physician practices. Employing a staff of 1,166, the company’s products and services include athenaCollector; patient communication service, athenaCommunicator®; and its CCHIT® Certified EHR, athenaClinicals. Ranked 31 among the industry’s largest firms, based on revenue, by the 2009 Healthcare Informatics 100, the company reported full year revenue

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McKesson Offers RCM Solution to Radiology Practice McKesson Corporation has been chosen by an independent radiology practice, Association of Alexandria Radiologists (AAR), for its Revenue Management Solutions (RMS) to aid in practice management and radiology billing. Since its establishment in 1970, Virginia-based AAR has been offering diagnostic imaging and treatment by radiologists and interventional radiologists who collaborate with regional surgical and medical professionals. AAR’s CEO, Sid Greenwell stated that the facility required a partner who would help manage complicated documentation and coding challenges, oversee associations with providers and payors, as well as attend to regulation compliance. The decision for the current contract is said to have been based on the McKesson’s industry knowledge and reputation for revenue management, reporting capabilities, resources, and focus on compliance. Challenged by the pressures of regulatory compliance and reimbursement, AAR hopes to optimize the management of its daily operations through the current contract with McKesson. McKesson’s RMS solution includes accounts receivable, reporting, and medical billing services. The reporting tools offered by the vendor are expected to help use real-time information for providing business intelligence to practices. The range of resources is expected to be used by the facility’s 26-physician practice. Having a common focus on regulatory requirements, McKesson’s physician education services and RMS solutions are expected to serve as an extension to AAR’s own initiatives for regulatory compliance. McKesson has recognized greater requirement and scrutiny of compliance, denial management, and declining reimbursements as some of the challenges commonly faced by healthcare organizations with regard to revenue cycle management, specific for radiology services. The vendor has also identified the following as the main causes for loss of investments by radiology groups: inaccurate

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October - December 2010

coding, inadequate documentation for proper coding, insufficient clinical data from referring physicians, lack of efficient denial management, and managed care rates set very low. With the increase in healthcare costs, the optimization of investments made by a healthcare organization has been the focus of many facilities across the globe. McKesson offers its RMS services to over 1,000 customers nationwide, supported by 4,000 employees. Its revenue cycle management client base for radiology includes over 360 groups and 4,100 radiologists. Considered to have the largest database of radiology claims information, the company has 25 processing centers specifically for radiology. A San Francisco, CA-headquartered, FORTUNE 500 company, McKesson offers healthcare services and information technology solutions for providers, payors, homecare, and pharmacies. The company reported revenues of $27.5 billion for the first quarter of 2010, ending June 30th, compared to $26.7 billion for the same period in the previous year.

The selection of DGI and CCHIT to authorize complete EHR and EHR modules follows within two months of releasing the final meaningful use rule, as well as the standards and certification criteria, as of July 28, 2010 by the Centers for Medicare & Medicaid Services (CMS), and ONC, respectively. CCHIT intends on releasing its authorized certification program later in the year, and announcing the first set of HHS-certified EHR and EHR modules within weeks of the launch. EHR vendors can now approach the two organizations for certification of their systems. By investing in these certified systems, providers will be assured of achieving the meaningful objectives and the incentives associated with the action. David Blumenthal, MD, National Coordinator for Health Information Technology, considers this as a vital achievement as it makes available certified EHR products for providers to invest in, and enable them to be interoperable with each another on key standards. CMS also plans on developing a system for online registration and attestation for the EHR incentive programs. ONC is initiating new programs for training and technical assistance; all in an effort to encourage accelerated and effective EHR adoption across the care system.

Drummond Group and CCHIT Named as Authorized EHR Testing and Certification Bodies The Office of the National Coordinator for Health Information Technology (ONC) has named Austin, TX-based Drummond Group Inc (DGI) and Chicago’s Certification Commission for Health Information Technology (CCHIT) as the initial two review bodies that would be tasked with the testing and certification of electronic health record (EHR) systems for compliance with the criteria and standards of meaningful use of technology. Using certified EHRs is a key prerequisite for procuring the incentives authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act. To aid providers in ensuring that the systems used in their facilities comply by the meaningful use criteria, a certification and testing organization was required. In March, the United States Department of Health and Human Services (HHS) issued a notice of proposed rulemaking (NPRM), which proposed the establishment of two certification programs, one temporary and one permanent, to enable the testing and certification of the technology. The final rule for the temporary certification program was issued in June 2010, specifying the requirements of the ONC-Authorized Testing

and Certification Bodies (ONC-ATCBs).

About CCHIT Established in 2004, CCHIT, a 501(c)3 not-for-profit, independent organization, focuses on the acceleration of health IT adoption. Until mid-2009, the Commission has certified 200 EHR products, covering more than 75% of the marketplace. Going by their vast acceptance, CCHIT offers three approaches to certification, namely, CCHIT Certified®, which evaluates an EHR’s interoperability, security, and integrated functionality; the ONC-ATCB certification; as well as certification based on one or both of these programs. Apart from these, the Commission also plans on offering the EHR Alternative Certification, an on-site simplified certification for customized products. About Drummond Group Founded in 1999, Drummond Group offers testing services for products used in industries like government, consumer product goods, petroleum, automotive, financial services, energy, pharmaceutical, and retail, apart from healthcare. The services offered include software certification, QA, auditing, custom software test lab, conformance testing, consulting, web services testing, and interoperability testing.

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October - December 2010

QuadraMed Bags $211 Million VA Contract to Provide Health Information Management Solution QuadraMed® Corporation has been roped-in by the U.S. Department of Veterans Affairs (VA) through a $211 million, five-year contract, to deploy the Quantim® Coding, Compliance, and Abstracting solution in an effort to enhance the coding efficiency and accuracy through customizable billing processes and real-time compliance monitoring. According to VA’s officials, originally deployed as its go-forward solution for ICD-10 compliance and coding, Quantim has now been chosen for its flexibility to be incorporated into the VistA Health Information System of VA. Currently utilizing Quantim for streamlined inpatient and outpatient claims editing, coding, compliance, and revenue-cycle operations, the following capabilities and enhancements will be included through the current contract: • New functionality that will enable the monitoring of the Veteran’s Equitable Resource Allocation (VERA) • Physician-query tracking functionality for clinical documentation compliance, accuracy, and timeliness • Enterprise-wide, unified, central-management monitoring and reporting of Quantim’s important performance markers The information collection tool, QuadraMed Abstracting is used for capturing, structuring and analyzing patient’s financial and clinical data from various sources, ensuring data quality and compliance with regulatory standards.

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NEWS

The solution seamlessly integrates with Coding and Compliance solution to enhance and streamline the coding and abstracting operations. While Quantim Compliance, a billing and coding compliance management solution, aids providers in automating auditing and monitoring operations for inpatient and outpatient visits, Quadramed’s Quantim Coding is an integrated software for automating coding and compliance processes within a healthcare setup. Under the terms of the agreement, VA will also purchase QuadraMed’s Central Reporting and Physician Query Tracking tools. The current contract is an expansion of its relationship with VA. Under its government solutions, the company also offers a suite tailor-made for VA’s specific needs; the VA Chart Complete Suite that utilizes the VistA-integrated Quantim Record Management system. QuadraMed’s Quantim solution is being used at 150 VA medical centers since 2005, to streamline claims editing, compliance, revenue cycle, and outpatient and inpatient coding. The company’s product lines, Patient Access Management, Smart Identity Management, Care Management, Health Information Management, and Patient Revenue Management, are designed to improve the profitability, transparency, safety, and quality of patient care. Founded in 1993, Reston, Virginia-headquartered QuadraMed offers information technology solutions and services for healthcare providers in areas spanning clinical to patient information and revenue cycle management. It caters to a client base of about 2,000 healthcare providers across US, New Zealand, Canada, Australia, Puerto Rico, and United Kingdom, through its 600 professionals.

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October - December 2010

EVENT LISTING Healthcare Law & Compliance Institute Organizer: International Performance Management Institute Date: March 6-8, 2011 Location: Atlanta, GA Link: http://www.ipmionline.com/healthcare_gc.html

2011 Health 2.0 Spring Fling Organizer: Health 2.0 LLC Date: March 21-22, 2011 Location: San Diego, CA Link: http://www.health2con.com/san-diego-2011/

3rd mHealth Networking Conference Organizer: mHealth Initiative Inc. Date: March 30-31, 2011 Location: Chicago, IL Link: http://www.mobih.org/meetings/

CIO Healthcare Summit Organizer: CDM Media Date: April 3-6, 2011 Location: Scottsdale, AZ Link: http://www.ciohealthcaresummit.com/

IHE-Europe Connectathon 2011 Organizer: Integrating the Healthcare Enterprise (IHE) Date: April 11-15, 2011 Location: Pisa, Italy Link: http://www.ihe.net/Connectathon/

Leadership Strategies for Information Technology in Health Care Organizer: Harvard School of Public Health, Center for Continuing Professional Education (CCPE) Date: May 16-20, 2011 Location: Boston, MA Link: https://ccpe.sph.harvard.edu/programs.cfm?CSID=TECH0111&pg=cluster&CLID=1

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connecting leaders across asia pacific to advance quality healthcare through IT

Conference & Leadership Summit Incorporating HIMAA 2011 National Conference

20 - 23 September 2011 | Melbourne, Australia

SAVE THE DATE www.himssasiapac.org