Guest Columnist
Information Systems Healthcare Trends in 2010
By
Jan 19, 2010 - 7:05:32 PM

(HealthNewsDigest.com) - As we approach revolutionary changes for healthcare policy in the U.S., the industry itself is undergoing complex and confusing changes, many of which involve information systems. The use of IT in medicine has grown in the same way it is growing within the larger cultural landscape: technology is everywhere and though we are not sure what tools may come next, we do know that it is a mainstay.

Information systems in health care practices have not just penetrated the exotic sciences of biotechnology and nanotechnology. The use of database management systems, network-based infrastructures, and the significant growth of Web-based systems- all paired with recent government legislation- is part of an industry-wide boom that will forever change the landscape of health care practices and administration.

Although the ultimate look and feel of the new system is unclear, there are three major emerging trends that will impact the relationships among the federal government, healthcare providers and the consuming public at large:

Electronic Medical and Health Records (EMR/EHR)

One such trend is the slowly emerging groundswell toward the use of Electronic Medical/Health Records, or EMR/EHR. These systems move patient information from paper to electronic file formats so they can be more easily and efficiently managed.

The government is clearly supporting technology-based improvements in healthcare. Both the American Recovery and Rehabilitation Act (ARRA), and The Health Information Technology for Economic and Clinical Health Act (HITECH) provide significant financial incentives for healthcare practitioners to implement technology-driven systems.

Currently, approximately 9% of US hospitals and doctors have deployed basic EMR systems, with a doubling of that number predicted in coming years. There are no laws in place requiring the use of EMR, but it is clear that the impetus for improved patient care and cost efficiencies are significant drivers. Although EMR can provide measurable benefits, the lack of comprehensive system standards and clarity about the legal and regulatory parameters of their use has resulted in a slow adoption process.

Regulatory and Legislative Trends

Two related and complex regulatory and legal requirements are ICD-10 and HIPPA 5010. These both require a sea change in how healthcare organizations use technology to manage data.

International Coding for Disease (ICD-10)

This is the international disease code set developed by the World Health Organization and the United Nations. The Secretary of the Department of Health and Human Services (HHS), which is charged with implementation of HIPPA 5010, is strongly encouraging healthcare organizations to simultaneously plan to meet upcoming deadlines for both HIPPA 5010 and updating from ICD-9 to ICD-10. The migration from ICD 9 to ICD 10 ICD-10 is a requirement that must be fully implemented across the healthcare continuum for practitioners and providers to receive Medicare and Medicaid reimbursement.

Although the mandated change does not have to be in place until Oct. 1, 2013, the ICD-10 deadline is already being considered a “Y2K” event for the healthcare communities. Much advanced planning and action will be required for payers and providers to successfully meet this deadline, and the current consensus by both payers and providers is that the medical community is largely unprepared to meet the demands of either HIPPA 5010 or ICD-10.

The Health Insurance Portability and Accountability Act 5010

HIPAA 5010 requires that providers submit electronic claims in order to be reimbursed by Medicaid and Medicare. Although there are similar regulatory requirements in place now, 5010 requires an increasingly rigid set of reporting requirements that will make standardized technology systems even more important. Deadlines further complicate the issue. The deadline for HIPPA 5010 is January 1, 2012, eighteen months before the federally mandated change to ICD-10.

What do these trends mean for the medical profession?

These matters represent both significant problems and significant opportunities. For example, a Gartner report estimates that there will be a shortage of up to 50,000 healthcare professionals by the end of 2010. This person gap may combine with the lack of clarity around implementation of the legal and regulatory requirements to provide a potential “recipe for disaster”.

But the situation represents opportunities for the healthcare community as well. The unique demands of the American healthcare system mean that, at present, there are few healthcare professionals with a comprehensive understanding of the public and private sides of the American healthcare system. Trained professionals with these skills will be required to implement the many changes required, and since there is some lead time, the healthcare community is well positioned to partner with educational providers to quickly address upcoming demands.

A specific skill that will clearly be in high demand is to interpret and communicate complex issues to diverse audiences. A concomitant skill will be the ability to write well in order to address compliance matters and to write successful grant proposals.

The “new” Information Technology-savvy healthcare professional will have to have specific knowledge of:

General Healthcare infrastructure Operations Management, that is, how the healthcare system works; Managing and implementing successful projects in healthcare environments; The application of healthcare-specific IT management theory and practice; Specific ICD-10/HIPPA architecture (Gap analysis, Project Management, Implementation, etc.); Managing vendor relationships, including negotiations, the RFI/RFP process and vendor management; Contracts and Service Level Agreement (SLA) management in healthcare environments; Network infrastructure and Database Management Systems (DBMS) design and implementation.

In addition, these people should have significant information systems skills, be effective communicators, and be able to interpret complex materials and systems for diverse groups within medical communities. They should be conversant with practical issues in healthcare environments, from the local doctor’s office to the large hospital. They should be able to understand and direct the implementation of changes mandated by various legal and regulatory requirements. Finally, they will have the skills to communicate these matters in multiple public forums.

The current environment can be likened to the Titanic and the iceberg: much of what is inevitable is not in plain view, but is known to exist. Failure to plan a comprehensive execution strategy to address the above noted trends would come at a very high cost both in resources and revenue. Therefore, 2010 is the year where Healthcare management must be positioned to exploit the ensuing chaos and resultant opportunities for smooth sailing through rough waters.

Dr. Steve Nitenson (RN, BSN, MBA, MS(IS), Ph.D)

Steve teaches at the Ageno School Of Business at Golden Gate University, San Francisco, where he has developed numerous graduate level courses in the areas of Information Technology Management, Healthcare IT, and Program/Project Management. Golden Gate University offers a comprehensive curriculum for MBAs in Health Services and in HMO Administration as well as graduate degrees and certificates in Management of Healthcare IT systems.

As an industry recognized expert in the areas of HIPAA 5010 and ICD‐10, Steve has 25 years of experience leading successful programs and teams within traditional manufacturing, financial and healthcare technology organizations. Throughout his career, Steve has held leadership positions ranging from CIO and Director of GIS to Healthcare Project Management Office and IT Governance roles including EMR Program Management and Deployment for Cerner Corporation. Most recently, Steve served as PMO Manager for the migration from Meditech to McKesson at John Muir Health. Currently Steve leads the healthcare Informatics Consulting Practices for Vivo, Inc.

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