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Glen Tullman’s 10 for ‘10: Top 10 Healthcare IT Trends for 2010
By Glen Tullman

1. 2010 Will Be the “Year of the EHR”

We are at the beginning of the fastest transformation of a major sector of our economy in the history of the United States. The American Recovery and Reinvestment Act has provided billions in incentives to encourage adoption and “meaningful use” of Electronic Health Records. Given the time-stamped nature of the program, we can expect to see a dramatic increase in EHR adoption. Physician groups recognize the need to deploy an EHR now to be ready to demonstrate “meaningful use” by 2011, when the ARRA incentive payments kick in.

With CMS issuing the requirements for an EHR to qualify for meaningful use, many physician groups that were sitting on the sidelines will feel more comfortable getting their EHR initiative underway. It is clear that 2010 will be the “Year of the EHR”, not only because of the rapid rise in adoption rates, but more so because of the positive impact that this technology will have on how patient care is delivered.

You will continue to see two different approaches to acquiring EHRs. The first are investments by physician groups focused on creating efficiency in their practice and collecting the stimulus incentive. The second are community-based decisions where hospitals and health systems invest on behalf of their owned and affiliated physicians, with an eye toward referrals and being “easy to do business with.”

The most recent example is North Shore Long Island Jewish Health System with their program to connect approximately 7,000 affiliated physicians. In 2010, many more health systems will realize the benefit of leveraging the ARRA incentives and the Stark Safe Harbor to help build stronger connections with affiliated physicians in their communities.

2. Not “One System” . . . “One Patient Record”

The old thinking that you need the same system across your hospitals and ambulatory providers will give way to a new way of thinking. As more physicians automate and connect, the large IDNs, academic medical groups, and other integrated systems will put less emphasis on a single IT solution and more emphasis on connecting existing systems to build One Patient Record. This will enable caregivers to access a comprehensive view of all data available about a patient from any location within or outside of the system. Clearly, many physicians already have systems installed in their practices, so establishing a connection to these existing practices will be as important as the rollout and connection to new practices. Organizations that think strategically about this endpoint will find themselves better positioned to take advantage of new opportunities that will emerge in the market.

3. Communities Will Connect

Healthcare is still a local phenomenon. Depending on the estimates you use, 90 percent of all patient care is provided within 30 miles of a patient’s home. Given its local nature, the first priority must be to electronically connect caregivers across a community, leading at some point in the future to a national health IT infrastructure. In 2010 we’ll see more health systems banding together with others in their communities to create local health information exchanges as well as other approaches that enable One Patient Record across a region. A local network is easier to manage and already proving successful with HIEs like the Transforming Healthcare in Connecticut Communities (THICC), which connects that state’s top 20 hospital systems with each other and with major physician groups.

4. Service and Support Will Become Competitive Differentiators

One of the key reasons ARRA was passed was to create jobs. According the White House, over 50,000 will come from the healthcare information technology sector. Allscripts will hire hundreds of new employees, not only to help our clients deploy the technology, but also to assist them in using it in a meaningful way and optimizing the technology to deliver quality care. Clearly there will be a premium on process redesign and consulting services. Those who have the resources and can deliver these services will be rewarded.

5. Innovation Will Begin to Drive Sales and Use of EHRs

Innovation will become a differentiator and drive adoption as it has in other industries. The ability to access your EHR via your phone (iPhone, BlackBerry, Windows Mobile, etc), use a kiosk to register, check labs at home via a portal, and pay your bill via Quicken Health are all examples of physician/patient-focused innovations that deliver simplicity, customer service, and also take out cost. Using advanced technology from outside the four walls of healthcare is symbolic of the transformation of healthcare into more of a consumer-driven business.

6. Revenue Cycle Management Will Become Integrated

Given the need to focus on new EHRs, most physician groups will choose not to replace their existing practice management systems. As a result, in 2010 the larger hospital vendors and EHR/Practice Management vendors will leverage their large installed bases to aggressively move into Revenue Cycle Management. Early leaders in the standalone RCM space will see growth slow and those firms that can integrate RCM with widely-used EHR and PM will dominate.

7. Management Reporting Will Transition to Actionable, Quality Patient & Population Management

As information becomes more available across bigger networks, more emphasis will be placed on developing proactive quality feedback rather than simply reporting. The focus will be on changing caregiver behavior by driving actionable feedback to providers at the point of care, not after the fact. This is the first step toward the development of true “information systems”.

8. Payers, PBMs, and Pharmacies Will Use EHRs to Deliver Information

As the market for Electronic Health Records heats up, we’ll begin to see payers, pharmacy benefit managers, and pharmacy chains partnering with e-prescribing and EHR solutions to efficiently deliver new kinds of information on best practices, care plans, and additional clinical guidance to physicians as they begin to directly tie compensation to results. We have already seen this with current pay-for-performance programs and it is likely a preview of things to come.

Changing physician behavior at the point of care has been the Holy Grail of healthcare. Now the “cable system and set-top boxes” will finally be in place to do just that. Think of this as a formulary, but with a focus on something beyond just the cost of a medication or which one to choose .. but rather an entire plan of care for the patient.

9. Intuitive is Best

Whether it’s ease of use or ease of deployment, “easy” is a must in 2010. We’ll see the customer experience transformed in both areas with an emphasis on intuitive, easy-to-install, easy-to-learn systems (think the difference between your average cell phone and the iPhone).

10. Software as a Service

Software as a service has been advertised as “the” solution for healthcare. The reality is that SaaS is a great option and will be one of a number of solutions. The fact is that physicians don’t really care whether the Electronic Health Record and Practice Management Systems, along with other solutions, are hosted, client-server, or SAAS — they just want them to be easy to access and use. And, many physicians think software as a service is synonymous with monthly payments, like leasing a car. That is a critical and appealing element. The answer is that SaaS will need to be a part of a vendor’s solution set.

As noted, we are watching and participating in a major economic transformation, one that is being driven from all sides. What we know is that while Electronic Health Records are not sufficient by themselves to solve the healthcare crisis in America, they are a necessary component of any solution that drives safer, higher quality healthcare provided cost effectively.

2010 will be the “Year of the EHR” and our current healthcare system of disconnected silos will begin the transition into a connected system of health.

Glen Tullman is CEO of Allscripts.

Major Flaw In Claims Operations Model Found Responsible For Payer Overpayments
By Stephen Ambrose

As part of the insurance industry, subrogation has at times been a bit of a dirty word to policyholders and personal injury attorneys, but a necessity to payers. Known as “the great balancer”, the "right of subrogation" means that a (health) insurer may choose to take action to recover a calculated amount from a claim paid to a policyholder if the loss was caused by a third party.

A major flaw identified within today’s subrogation model is the inability for a payer or their outsourced vendor to accurately identify only those times when their policyholder has pursued and successfully settled a third-party claim. There exists no public database of third-party liability claim filings and the use of court records only applies to less than ten percent of all claims anyway.

Over many years, the most widely utilized method for identifying policyholders who are involved in injury claims is through an indirect identification method of data mining patient claims via diagnostic codes, billed procedures, doctor type, and accident / injury check boxes. Such flagged information generally leads to form letters sent to the patient, who is supposed to complete and return them, both timely and accurately, to the payer or their outsourced claims vendor.

This ubiquitous system of TPL claim involvement has suffered from a number of shortfalls including patient accuracy, inability of complete follow-up, use of indirect identifying factors, timeliness of detection, as well as missing claims filed for chronic illness and malpractice. These factors greatly limit a payer’s knowledge of wasteful injury claim overpayments and make identification of TPL claims more of a “good-guessing” game.  Additionally, the current system allows outsourced claims vendors to demand large collection fees from recoveries made on behalf of their payer clients.

A new model of injury claim identification offers health payers greatly increased TPL claim knowledge while addressing waste reduction and delivering more cost-effective operations to the payer community. Known as Collaborative Subrogation, or Subrogation 2.0, this Web-based technology connects patient release-of-information (ROI) requests, made of the provider with a health payers claim department.

The innovation of better identifying TPL claims stems from limitations, inherent within the use of claim forms and electronic claims data, submitted by providers in their billing. Chiefly noted and now improved upon is the understanding that injury claims are not just “accidents”, but rather any claim involving, in part, the use of medical billings to substantiate value. This opens up areas of medical malpractice, chronic illness, product liability, and other non-auto liabilities.

Collaborative Subrogation is employed as a lower-cost, Web-based operation, where health payers use an online search engine to match provider-submitted TPL data. The approach is one of layering on a new model, in conjunction with existing subrogation software and outsourced vendors. 

Stephen Ambrose is executive director of SubroShare.