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Health IT NEWS.Direct! is a global Healthcare Information
Technology (Health IT) journal providing research,
news, and business intelligence services. We publish
several market research and strategic industry reports
with key information for top management and decision
makers in the healthcare technology industry. Health IT
NEWS.Direct! is used by leading healthcare technology
companies, hospitals, insurance companies, and
media houses from around the globe.
Dr Grant FraserChief Medical Officer
Medical Wizards Corporation
John Lightfoot
Chief Technology Officer
MedVentive Inc.
Designed and Published
on behalf of Health IT NEWS.Direct! byiLogy Healthcare Solutions
Health ITNEWS.Direct!Global Healthcare IT News, Research and Intelligence
CONTENTS
EditorialCloud computing: Weathering the
healthcare data storm
Amoolya Moses
Review ArticleRedefining healthcare communication
on the cloud
Damir Ljuboja
Industry PerspectivesCloud-based systems: Why they
represent the future of patient careJeff Surges
InterviewIndustry strives for interoperable cloud
solution
Chris Gough
PwC foresees Indian cloud computing
market to be $4 billion by 2015Dr Rana Mehta, Rajesh Ranjan
1
2
7
12
10
Editorial Advisory Board
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Editorial Team
Managing EditorDr B M John
Assistant EditorAmoolya Moses
Research AnalystsDr Raghavendra RaoDr Chinmaya Chigateri
DesignVeeresh MathapatiAbhilash A
All rights reserved 2012
INFORMATION
For contributions, author guidelines, and comments:[email protected]
For advertisements and reprints:[email protected]
Terms of use:www.healthitnewsdirect.com/?page_id=9
Editorial process:www.healthitnewsdirect.com/?page_id=7
Disclaimer
Views and opinions expressed in this publication are not
necessarily those of iLogy. While every effort has been
made to ensure accuracy of the information published in thisedition, neither iLogy and its employees nor its informationvendors accept responsibility for any errors or omissions.
Further, iLogy and its information vendors do not take anyresponsibility for loss or damage incurred or suffered by anyreader of this journal as a result of accepting any invitation/
offer published in this edition.
iLogy reserves the right to use the information published
herein in any manner whatsoever. No part of this publicationmay be reproduced in any form without the written permission
of the publisher.
Mini Reviews
eHealth
eClinicalworks deploys EHR solutions at
Ohio Orthopedic Center of Excellence
Partners and AlliancesAgfa and Dell partner to provide medical
image management solution on the
cloud
Microsoft and GE Healthcare form novel
IT company through JV
Products and Solutions
3M releases new ICD-10 financial
analysis software and service
Insights
IDC reports indicate an evolving HIE
market
Healthcare industry experts suggest
strategies to address mobile device
security and privacy threats
H&HN survey illustrates IT utilization
among 2012 Most Wired Hospitals
NEWSIndian pharma giant, Piramal Healthcare
buys USAs Decision Resources Group
Global perspectives on health IT from
Harvard Medical School thought leader,
Dr Blackford Middleton
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EDITORIAL
Cloud computing: Weathering the healthcare data storm
Amoolya Moses
Assistant Editor, Health IT NEWS.Direct!
In the recent decade, the healthcare industry has witnessed major
transformations in its dependence on information technology for
achieving efficient workflow, quality care, and efficient use of
investments. Observing successes in other industries, healthcare
has adopted these IT innovations and applied them to suit its
needs.
The frenzy to transform paper-based medical data into the more
efficient electronic form, and the increased need to document
and store data for future analysis has landed the industry with
yet another dilemma of having to store and archive the exploding
data volume. Innovations around managing large data sets and
providing access without limiting it geographically or by devices
have been addressed by cloud computing. The on-demand,
SaaS offers both tangible and intangible benefits in the form of
self-service ordering, large data storage, reduced maintenance,
continuity of services in the event of a disaster, archiving, lower
capital investment and enabling CIOs to enhance quality care with
reduced costs. Taking the benefits of cloud to the next level, many
feel that it can be leveraged to tackle Big Data, and in turn convert
raw information into actionable data.
Keeping alive the concept first visualized by Professor John
McCarthy in the form of computer time-sharing during the early
1960s, cloud computing is now considered the next big thing in
health information technology.
In 2011 KLAS reported mixed responses for the acceptance
of cloud technology in healthcare enterprises. Although 71%of providers had implemented or planned to implement the
1
technology, patient data privacy and control were the two major
factors for the surveyed hospitals staged and cautious approach
to adoption. Analysts GBI Research finds that although cloud
technology has reached the healthcare sector, it may just drift
over developed economies, with North America, and in specific,
the US having the lions share. The industry growth has been
staked at 20.5% CAGR from 2010 to 2017. Despite global
bigwigs like Merge Healthcare, Inc., Carestream Health, Inc. and
CareCloud in the US, Agfa Healthcare of Belgium, and UKs GE
Healthcare contributing to this market section, no single vendor
holds a share of more than 5%, making it fragmented. However,
this sunny forecast can be slowed down by compliance with
government policies, security concerns with hosting patient data,
and interoperability.
This issue of Health IT NEWS.Direct! outlines the various aspects
of cloud computing in healthcare. With Damir Ljuboja from The
University of Texas, Austin, discussing the hypothesis of the
HealthCloud; Jeff Surges, CEO, Merge Healthcare gives us an
overview of cloud computing from the perspective of storing
and accessing imaging data. The issue also features industry
perspectives on the various issues that plague the cloud
computing industry in particular to the delivery of care and how
these can be addressed.
With this comprehensive outlook on the cloud, the team at Health
IT NEWS.Direct! hopes that IT directors at healthcare facilities will
be able to better manage the internal computing environments,
while finding means to monitor and address the drawbacks inorder to leverage the benefits of the technology to its optimum.
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REVIEW ARTICLE
Redefining healthcare communication on the cloud
To be a patient in the modern era of healthcare means to be submerged in a vast and
expanding body of medical knowledge. Patients seek the expertise of multiple physicians,
across specialties and between institutions, to ensure that they receive top-of-the-line care for
their ailments. The plethora of medical knowledge easily overwhelms specialists and patients
alike. Medical graduates are taught to know more and more about less and less. As a result,
communication and understanding can become muffled in a sea of increasingly complex
test results and an ever-expanding library of treatment options. With so much focus placed
on details, it becomes difficult to visualize the big picture of patient care.
Along with this fragmentation in healthcare delivery, barriers in communication, recordkeeping,
and patient understanding forestall a unified and effective medical system. Changes driven
by technological advancement and growing public sophistication, demand that this problem
be addressed. The answer lies in the cloud.
Figure 1: Information flow on the cloud
Cloud computing, at its core, provides a network for shared resources, software, and
information that is accessible on demand via the internet (Figure 1). Applied to healthcare
on a wide scale, such a system could be the solution to many modern-day problems. While
bits and pieces of present issues have been addressed by electronic medical records
(EMR) and computerized physician order entry (CPOE), these solutions are local, at best. In
a world of increasing specialization and patient privacy, simple communication is a breath
of fresh air.
Damir Ljuboja
The University of Texas at Austin
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REVIEW ARTICLE
The HealthCloud hypothesis
The solution I propose integrates key aspects of various
international approaches to todays pressing logistical problems
in medical communication and compliance with novel ideas,
to improve outcomes (Figure 2). The HealthCloud providesa multifaceted response to the issues of communication and
recordkeeping, public access to reliable healthcare information,
consulting, patient compliance, and hospital efficiency.
Figure 2: HealthCloud physician-patient information exchange
HealthCloud could also provide support for patient self-
management of health by allowing them to gain a greater
understanding of their ailments. On-demand consultations with an
active board of physicians could provide real-time replies to medical
enquiries. Chronic disease management programs operated
by providers could bring together groups of people with similarconditions to provide support and advice. For the sickest patients,
this collaboration can help them stay out of the hospital for longer
than ever before. Patients could more readily assume the role of
With the goal of error reduction in mind, HealthCloud seeks to
merge EMRs with electronic prescribing interfaces, such as
CPOE, across providers (which would also decrease their costof use). Improved software infrastructure and computerized alerts
could prevent patients from receiving medications that may be
harmful (due to interactions with other courses of treatment, for
example). This could be effectively coupled with computerized
decision support to guide clinicians toward safe and cost-effective
treatments. An online system to track patients, their medications
and treatments, referrals, and laboratory/imaging results would
improve the organization of patient data across a fragmented
medical landscape. The burden of documenting and submitting
data to the online HealthCloud database could be lessened
through the use of speech-to-text software. Such a system, if
implemented, could improve the fail-safe measures in place on
the physicians side of the patient-doctor relationship and increase
the efficiency of team-based medicine.
a principal caregiver and monitor their blood pressure, glucose
levels, and other factors that increase the risk of complications.
In order to accomplish this, HealthCloud could offer educationaltutorials and medical tools that could be ordered and delivered
to patients for a fee (e.g. a device to monitor blood pressure that
reports directly to the patients record on the cloud). Reminders
for scheduled appointments, medications, and other interventions
could span across personal computers, mobile phones, and
tablets. This integrated system of communication could lead to
improved collaboration between doctors and patients.
Global communication
In the realm of recordkeeping, global approaches of particular
note are the scannable Taiwanese Smart Cards, that contain
individual medical histories, as well as the United Kingdoms
electronic medical records system, GP2GP. This National Health
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Service Connecting for Health (NHS CFH) project enables the
automatic (but still physical) transfer of individual health records
between the approximately 9,000 general practitioner practices in
the UK when a patient chooses to switch providers.1 EMRs that
automatically transfer between systems across the internet are
a rarity. In 2008, just 20% of clinicians in the United States wereusing EMRs and few of these recordkeeping systems were able
to directly communicate with each other, even within the same
hospital system. Just 4% of doctors were using state-of-the-art,
fully functional EMR systems.2
HealthCloud consolidates all these approaches in order to maximize
efficiency. The proposed system calls for encrypted, standardized
patient records to be kept on hospital, insurer, private provider, or
government servers, which can be accessible via the internet when
needed by physicians or the patient. If implemented on national or
global levels, this could greatly improve communication between
providers from different specialties, institutions, or even nations
and lead to a reduction in redundant and repetitious testing.
This system would be disaster-proof because of online access
and information back-up on redundant servers. Natural disasters
that level cities such as the 2005 Katrina hurricane in New Orleans
or the 2004 Indian Ocean Tsunami would not destroy medical
histories and cause a disruption in care. Residents who endure
these catastrophes could travel to neighboring cities or countries
and find their medical histories readily accessible.
Figure 3: HealthCloud public access model
Public information flow
The accessibility of accurate information is of concern. Corporate
marketing geared at highlighting the advantages of products has
measureable impact on the exactitude and quality of medical
information available through internet search engines. In order tocombat this problem, HealthCloud could feature a consultation
interface that links patient computers and mobile phones to a
managing team of physicians via a patient portal. This system
could allow for the back-and-forth exchange of messages and/
or chat between the two parties in isolation from the external data
made available by medical companies (Figure 3). In doing so,
accurate information could quickly and readily flow into the hands
of the public.
HealthClouds consultation interface could provide answers to
questions or concerns that patients forget to mention during
appointments. A 2002 International Health Policy Survey by the
Commonwealth Fund has found that 31% of sick adults in the US
leave a doctors office without getting crucial questions answered
and 39% do not abide by the physicians advice because of this.3
In an earlier study, 51% of patients surveyed thought that their
primary care physicians had excellent or very good knowledge
about their medical history, and 36% felt that they had excellent
or very good knowledge of their biggest worries.4 By linking the
inquirers to their electronic medical records, each case could be
uniquely considered by the physician team and patients would
have a means of filling in the gaps into their understanding.
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Virtual primary care consultation
Additionally, the HealthCloud could act as a facilitating tool in
family medicine. By integrating an online system that considers
symptoms in a similar fashion as the WebMD interface, the cloud
could generate possible diagnoses and, moving one step further,refer the user to a local specialist (with patient consent). This would
also allow for the identification of high-risk groups of chronic or
infectious diseases and facilitate appropriate responses by health
organizations. Outbreaks could be identified more easily and
accurately than ever before. In order to make this system more
financially feasible, computerized algorithms could be employed
on the cloud, which consider symptom input to generate potential
courses of action. Common questions could be grouped together
in order to minimize the workload undertaken by the managing
body of physicians.
Increased patient compliance
As suggested in Figure 2, the dissemination of dosage information
and medication reminders to patients mobile devices and
computers would increase the likelihood of compliance. Many
patients tend to cease a course of treatment as soon as they
begin to feel better. This is known to result in multidrug resistant
organisms and contributes to the prevalence of disorders that
are difficult to manage, including certain sexually transmitted
diseases and multi-drug-resistant tuberculosis. This aspect of the
HealthCloud could also automatically suggest cross-conditional
treatment that providers may overlook, such as eye exams for
diabetes patients, by identifying target groups based on their
medications and previous appointments.
Improved provider efficiency
Provider efficiency is another area of medicine that HealthCloud
is designed to improve. CPOE systems alone have been noted to
reduce serious medication-related errors by 55%.5 Improvements
in decision support software led to an 83% reduction in the overallrate for medication errors.6
HealthClouds integration of these two systems (as depicted in
Figure 1), along with a prescription fail-safe algorithm, allows
for their combined efforts in the prevention of medication errors.
This online system could reference patient EMRs on the cloud
when doctors attempt to prescribe new medicines and verify the
compatibility of the drug in question with the patients current
ailments, particularly those outside of the providers specialty,
and medications.
In addition to order entry support, the HealthCloud is designed to
increase the availability of patient discharge summaries by linking
them to the individuals EMR. A 2007 study found that summaries
were available to primary care physicians just 51%-77% of the time
four weeks after a discharge, because of which the quality of care
was compromised in about 25% of follow-up visits.7
On the part of the consumer, the subjectivity of symptoms input
remains the biggest concern. Many patients tend to downplay thesignificance of the pain they are experiencing, while others in the
same circumstances amplify it. This could skew the diagnoses
made by the virtual physician team and impact prescribed courses
of action. A possible way of combating this would be to use the
online system as a way of merely categorizing the types of health
complaints users submit before referring them to a primary care
physician. In this way, the online team would act as an initial
evaluation checkpoint whose conclusions are forwarded to a local
physician.
Security
HealthCloud, like any online system, is not without its share of
security concerns. Issues of identity management, physical
accessibility of data servers, availability of access to the network,
and patient privacy are of significant importance.
Commercial companies developing medical record services
assure the public that their data will be stored in encrypted
databases with privacy measures entirely in the control of the
individual. The same concept applies to HealthCloud. Patients
in the system will be indentified by an assigned numerical code,
and to ensure the strictest confidentiality, the code will only be
made obtainable to the individual. Access to the cloud will be
freely available to anyone with an email address and approved
numerical code. Thus, any type of internet access confers
theoretical access to HealthCloud. Those who live without internet
could reach the cloud at their doctors offices, internet cafes, or
in public libraries.
Access control will entail the input of several personal identifiers,
including name, date of birth, and a government-assigned code,such as social security number, in combination with a self-
assignment pin and password to enter the cloud. The patient will
not be referred to by name in any of the online records and no
identity-compromising information shall be placed on the servers.
As a back-up, records identifying which numerical code belongs
to a particular user shall exist on private servers in the HealthCloud
infrastructure. These servers will not be connected to the internet
and are a precautionary measure in case users lose their numerical
identifiers. Documented access to these private files shall only
be granted to a limited number of employees with high-level
clearance. Thus, the system shall avoid using federated identity
management and will instead rely on single sign on through
patient portals.
REVIEW ARTICLE
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Fraud is another user concern, but could be avoided by requiring an
email and verifiable form of government identification (depending
on country of residence) upon user sign-up.
Scalability
The goals of HealthCloud are rooted in granting equal access
to a wide user pool. In order to accomplish this, the systems
functionality must be made plausible on a grand level. Vertical
expansion through the addition of hard drives, servers, and
central processing units will enable the cloud to accommodate
an increasing number of virtual machines by adding resources
within the same logical unit to increase capacity. Horizontally, the
addition of clustering solutions and access points, in combination
with multiple load balancers (server farms), will design the system
in such a way as to handle and distribute heavy traffic, optimally.
To prevent possible complications, software clutter will be kept
at a minimum and an appropriate amount of caching will be
maintained. This will allow for the maximum scalability factor and
therefore lead to improved performance. Although the process for
scaling up is dynamic, the aforementioned approach will allow for
maximum theoretical growth under ideal conditions.
Sustainability
In order to be permanent, a system must promise longevity.
HealthCloud maintains its functional integrity through the
incorporation of weekly data save points. This ensures that patient
records are constantly backed-up in case of emergency failure or
an infrastructural breach. Redundant servers aid in this effort by
assuming control of the cloud during primary server(s) failures.
Often, primary and secondary servers are both functional and
share duties to increase overall throughput. In the event that one
fails, the redundant assumes full command until the primary is
repaired and brought back online. In this way, HealthCloud would
be prepared for unexpected spikes in demand or other sudden
increases in bandwidth requirements.
Conclusion
Health information technology stands at the precipice of change.The demands of an international public on an increasingly isolated
body of physicians, stress the fabric of medical care. The solution
lies in organization and communication. The HealthCloud, albeit
not infallible, proposes a novel paradigm of healthcare delivery
on the cloud.
References
01. GP2GP: why its needed. NHS Connecting for Health. http://www.
connectingforhealth.nhs.uk/systemsandservices/gpsupport/gp2gp/
needed/index_html?url=http://www.connectingforhealth.nhs.uk/
programmes/gp2gp/. Last accessed August 31, 2012.
02. DesRoches CM, Campbell EM, Rao SR, et al. (2008). Electronic Health
Records in Ambulatory Care - A National Survey of Physicians. N Engl
J Med. 359(1):50-60.
03. Blendon RJ, Schoen C, DesRoches C, Osborn R, Zapert K. Common
concerns amid diverse systems: health care experiences in five
countries. Health Aff (Millwood). 2003;22(3):106-121.
04. Lee TH, Mongan JJ. Chaos. In: Chaos and Organization in Health Care.
Cambridge, MA: MIT Press; 2009:18.
05. Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician
order entry and a team intervention on prevention of serious medication
errors.JAMA. 1998;280(15):1311-6.
06. Bates DW, Miller EB, Cullen DJ, et al. Patient Risk Factors for Adverse Drug
Events in Hospitalized Patients. Arch Intern Med.1999;159(21):2553-
2560.
07. Kripalani S, LeFevre F, Phillips CO, Will iams MV, Basaviah P, Baker DW.
Deficits in communication and information transfer between hospital-
based and primary care physicians: implications for patient safety and
continuity of care.JAMA. 2007 Feb 28;297(8):831-41.
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INDUSTRY PERSPECTIVES
Cloud-based systems: Why they represent thefuture of patient care
Ive been in the healthcare IT industry for more than 20 years. During that time, Ive seen my
share of trends, fads, buzzwords and hot topics, but if I had to pick the one trend I think will
change the way healthcare providers do business and share information, I would absolutely
pick the cloud. Cloud-based systems can do more than just give providers the ability to store
and share data more easily. It can give the entire healthcare community (including patients)
the power to communicate more freely and actually talk to each other as never before. This
article will explain why I feel that way.
Imaging has always appealed to me. In my opinion, its the most important part of an
electronic health record. When a patient goes to the doctor, the first thing he or she asks is,
Wheres your X-ray? However, the average file size of your basic medical image is about
5 gigabytes (GB). In healthcare, that is an extremely large file. You cant e-mail that as an
attachment, and storage of such files requires staggering amounts of server space that
need to be updated constantly. However, you or I can easily download approximately the
same size of the file every day on YouTube or Netflix. Thats what we do. In fact, I like to say
that Merge Healthcare is the YouTube or Netflix of healthcare.
In 1999 I co-founded a company called Extended Care Information Network (ECIN). At that
time we did not use the term cloud, but we knew that we needed to help our customers
discharge planning in a more cost effective way that made it easier to share information.
At that time we touted the benefits of SaaS, but many of the basic principles and benefits
of todays cloud-based solutions remain the same and more than ever, they represent
the future.
The issues: Where to house all the data and who
manages it all?
Every year, countless dollars and hours are spent archiving diagnostic images. A single
image can need as much as two gigabytes or more for storage, with regulations requiring
these image data to be stored for years. Traditional methods of image and data archiving are
now giving way to an exciting new advance in healthcare technology: cloud-based imagestorage and sharing, which has been proven to help healthcare stakeholders collaborate,
improve the delivery of care, and reduce its cost.
Without the accessibility and scalability of the cloud, C-suite executives face the unenviable
task of managing terabytes or even petabytes of imaging data, which can mean real
inefficiencies that have proven to escalate IT costs. A cloud-based solution can help providers
create a complete patient record that can eliminate inefficiencies, such as patient-borne CDs
and duplicate scans that expose patients to radiation, and enable faster collaboration. This
new efficiency is catching on quickly with a variety of users across the nation. By 2015, it
is expected that cloud storage will account for more than 35% of the six petabytes of new
studies annually captured in vendor neutral archives (VNAs).
Along with images, providers continue to bring in more corresponding studies, which
then grow in size once they are stored, as they are updated and modified. In addition,
7
Jeff Surges
CEO
Merge Healthcare
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these studies and images need be managed and organized. As
data warehouses grow and grow, additional staffing and training
within hospitals and health networks are required, just to keep
track of everything and problem-solve. This type of training is not
a one-time expense, but rather an ongoing cost to stay on top of
system updates. Hardware must be purchased and maintained.Continued investment is needed for basics such as memory,
speed and updated operating systems, to name but a few. Finally,
healthcare data may be managed on private networks that are
often times inaccessible from other platforms.
Then, there are basic housekeeping issues, such as reports
and worksheets, which have to be filled out manually for each
patient. In many settings, a provider has to make the effort to
match up a specific report with a specific image on CD, or even
video cassette. The paperwork can pile up fast. A provider may
have his or her own style for dictating reports, so uniformity can
also become a real issue. Finally, the increasing amount of paper
archives in addition to data warehousing can create storage and
management problems. The likelihood of misfiled or misplaced
reports can grow, which may require further staff to manage and
organize the growing reams of paper.
Through our daily dealings with providers and other customers,
it has become clear to us that the current system is becoming
more and more unwieldy and does not serve the best interest of
patients. Just the cost of servers to house all these data can easily
balloon to an unsustainable level.
Image sharing
The simple task of image sharing in a timely manner has
become a real issue of cost and efficiencies within healthcare
delivery. The most glaring example is the CD. Even in todays
technologically advanced world, patients continue to bring any
vital images corresponding with their care to the hospital on a
CD, which may cause frustration among in-house specialists and
referring physicians if they are ever lost or damaged while beingtransported from one place to another. There are times when a
CD is unreadable, which may cause a delay in care. In many
cases, providers and specialists still rely on the video cassette
and corresponding players to view critical images.
A provider may be unable to share an image quickly with a
colleague or specialist due to incompatible viewing systems,
resulting in a loss of efficiencies. If several providers need to
view the same image and exchange critical information relating
to care for that patient, such a process can take days or even
weeks, because they are unable to view images simultaneously
from different locations. They cannot share images over a mobile
device. If a provider needs to view an image, and that image is only
stored on a CD in a single place, then he or she needs to physically
leave his or her office, walk or drive over to the lab or office where
the image is located, and view it there. In all these cases, time to
treatment is delayed significantly.
Duplicate scans
Finally, duplicative scans and tests are an increasing cost issue.
Annual healthcare costs of as much as $100 billion have been
attributed to diagnostic imaging tests. Of these, an estimated
35% are of duplicates. This is the equivalent of $35 billion in
unnecessary costs. Time and money can be spent just on locating
a crucial image, as opposed to simply going to a cloud-based
solution where images are stored securely and in one place.
For example, a patient may go in for a procedure and need
imaging work done. A radiologist, instead of being able to access
a single HIE for this patients complete set of images, may be
forced instead to play detective and hunt down these images,
which may be stored in a variety of different formats in several
different places. Its easier just to order a new scan, but this is
exactly how costs absolutely add up over time.
In fact, it is estimated that a single-clinician practice spends, on
average, about $17,000 a year associated with traditional methods
of exchanging patients health information.
The cloud: A game-changerIn a cloud-based storage system, images are securely stored in
multiple locations. They are accessible anytime and anywhere, via
a standard web-based browser. As health systems storage needs
grow, providers and managers can simply add capacity to the cloud
as opposed to adding onsite storage hardware, management, and
bandwidth. That way, managers are only paying for the capacity
they actually need. In a cloud-based infrastructure, images and
data remain secure and meet all regulatory requirements.
Furthermore, physicians and specialists can also share imagesworldwide through the cloud, and in many cases, such a service
is free. Image sharing offers an easy-to-use and efficient means
of quick image sharing, which result in faster diagnoses and
treatment for patients. Efficiencies are greatly increased.
Examples of efficiency
A cloud-based system can also marry reports to images and keep
them all in one place, which can solve many filing and storage
issues. Once these images are on the cloud, it can be viewed
by everyone and does not necessitate the need to burn them on
a CD. This would be important if a patient changes his or her
physician. When a patient goes to a provider for follow-up, he or
she can pull out these images quickly, instead of having to rely on
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INDUSTRY PERSPECTIVES
9
memory or ordering a duplicate scan. All these time efficiencies
definitely lead to better patient care, as they decrease the time
patients need to spend in the hospital.
Emergency rooms and trauma centers can also potentially benefit.
Doctors can receive and review images from trauma centers inoutlying areas long before patients who have suffered an accident
arrive, providing extra time to process, prepare a diagnosis, and
get ready to treat. Also, the burdensome process of transferring
and importing a CD with an incoming trauma patient can now
become a thing of the past. Unnecessary steps are eliminated in
the process, such as duplicative scans. More educated decisions
on whether a patient transfer is necessary can be made, because
physicians are able to view the patients images ahead of time
to determine if he or she is not in a critical enough state for the
transfer to be necessary.
Emergency room doctors like such a system because it helps
them better manage patient flow, and the staff greatly appreciates
the clouds ability to help them make decisions more quickly.
Switching to cloud-based systems also creates greater staffing
efficiencies, through improved flexibility in how hospitals staff their
services. IT specialists would no longer be needed to help with
the uploading, reading (and in some cases, locating) of CDs.
Through cloud-based solutions, costs in that area can be reduced
and resources diverted to more value-added IT projects. Finally,
hospitals can save money on the number of contracts needed for
maintenance and archiving. These are hard costs that managers
can realize right away just from switching to the cloud.
Issues of security
When considering whether to implement cloud-based storage
and image sharing, hospital and health network executives need
to make sure such an infrastructure is absolutely 100% secure.
Its a noteworthy issue. Recent surveys have shown that 91%of physicians feel open-access systems designed for sharing
medical images can be beneficial to patients; however, 70% are
worried about the security aspect. When selecting a cloud storage
system, decision makers should choose a system that features
the following, so that the security of images, and corresponding
studies and reports are paramount:
Extensive experience with applications, healthcare providers,
and patients
Physical and application security
Compliance with HITECH, HIPAA, and other federal
policies
Highly available and technically innovative datacenter
environment
Datacenters distributed geographically to ensure disaster
recovery following a major event
Presence of a technical network operating center and full-time
year-round staff for managing any data loss or crises
The benefits of cloud-based solutions continue to evolve, allowing
hospitals and health networks to remain responsive to change
across the healthcare continuum, which can undoubtedly lead
to greater efficiencies, reduced costs, and ultimately better
patient outcomes. Better patient outcomes are why I got into the
healthcare industry in the first place.
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INTERVIEW
Industry strives for interoperable cloud solution
Q: We have observed that the adoption of cloud computing among healthcare
providers has increased. In your opinion, are there processes or technologies that
healthcare organizations still use off the cloud that you think should migrate into
the cloud?
A: Today, many organizations are struggling with the exponential growth of the data that
they need to store, secure, and maintain. The situation is a bit more dire in healthcare than
in other industries due to data retention requirements. Depending on who you ask, data
storage requirements in healthcare are doubling every 12-24 months, with medical imaging
as the largest contributor to this trend. For some organizations, more than 50% of overall
storage capacity is dedicated to medical imaging.
This application domain is ripe for migration to the cloud. We are starting to see the
beginnings of this with cloud-based vendor neutral archives (VNA), where image archives
can be hosted on the cloud, abstracting away the specifics of a given vendors PACS solution.
This can provide a healthcare organization with greater flexibility to switch PACS vendors as
solution offerings and business needs change over time. Perhaps most importantly, scaling
the infrastructure to support the ever growing set of data is accommodated by the cloud
platform; which was designed and optimized for scale from the beginning.
Q: Can you please provide an example as to how cloud computing has made a
significant impact in a healthcare organization?
A: South Florida Medicine is a multi-specialty practice that was experiencing several
challenges related to the rapid growth of their business. They decided to centralize their
practice management platform across their multiple locations using a software-as-a-service
(SaaS) solution offered by CareCloud. This decision resulted in significant positive impact
for their organization:
It is now easier for them to scale/grow because they no longer need to manage the
hardware and software associated with their practice management solution.
As new practices are added to the organization, they can be integrated very quickly;
simply given access to the centralized, cloud-based solution. South Florida Medicine can leverage expertise of external organizations. For example,
to take advantage of cutting-edge security capabilities and best practices that allow
them to better keep sensitive information secure and satisfy regulatory requirements.
Together, these benefits can enable healthcare organizations like South Florida Medicine to
focus on improving patient care, or growth rather than on keeping the lights on.
Q: In the healthcare industry, which is the most preferred service model that
vendors adopt: software-as-service, platform-as-service, or infrastructure-as-
service models?
A: Software-as-service (SaaS) is by far the most heavily adopted cloud service model in
the healthcare industry, and I expect this will continue to be the case for the foreseeable
future. Infrastructure-as-a-service (IaaS) is getting some traction in large healthcare
10
Chris Gough
Lead Healthcare,
Cloud Computing Architect,
Intel
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enterprise organizations that are building private clouds. This is an
evolutionary step that enables these organizations to realize some
of the benefits of cloud while still getting good return on existing
datacenter investments. Both platform-as-a-service (PaaS) and
IaaS are compelling service models for healthcare organizations
that have software development operations. Large enterpriseorganizations are taking a pragmatic, phased approach to cloud
adoption with Test & Dev as the typical phase-1 environment
that uses IaaS or PaaS in a multi-phase cloud adoption strategy.
I should mention, however, that the life sciences industry is an early
adopter of IaaS, and uses this service model quite extensively
for research and development. This is due to the fact that this
industry is not as heavily regulated as the payer/provider space
and because typical applications/workloads lend themselves very
well to the pay-as-you-go model offered by large public cloud
providers.
Q: What are the newer trends that we could be witnessing
with respect to cloud computing in healthcare?
A: Today, the largest obstacle to cloud adoption in healthcare is
security and privacy. This is due, in part, to the highly regulated
nature of the industry. Intel is working very diligently with McAfee
and a host of other partners to ensure that cloud environments are
just as secure as their in-house enterprise IT counterparts. Over
the next several years, you will see security come to be viewed as a
significant benefit of adopting cloud solutions rather than a barrier
to entry. Even today, for many healthcare organizations (especially
organizations that lack a large, dedicated IT staff), there are many
security benefits that can be realized by moving to a well-managed
cloud environment.
Q: We are again in a situation where we observe a large
number of distributed and competing cloud platforms that
organizations are using. This situation, similar to those
faced in legacy, in-house systems has the same challenge
of limited interoperability among them. How do you think wewill be resolving this challenge in the future?
A:Yes, we are seeing vendor lock-in reemerge as a top IT concern
with the emergence of cloud. In order to solve this problem, what is
needed is a set of open, interoperable standards that can support
the key use cases and requirements of enterprise IT departments,
both inside and outside of healthcare. Intel has a long history of
promoting and creating open, interoperable, standards-based
solutions, and I believe this will be required to maximize the long-
term, sustained success of cloud computing.
In order to help make this vision a reality, Intel works very closelywith an organization called the Open Data Center Alliance (ODCA),
serving as the technical advisor. This organization comprises
more than 300 enterprise organizations around the world that
are dedicated to speeding up the migration to cloud computing.
The ODCA identifies key enterprise use cases and requirements
for cloud, and works with the vendor community to ensure that
emerging solutions address these requirements. In addition, the
ODCA collaborates closely with industry standards bodies to make
sure that these use cases and requirements can be addressed in
an open, interoperable, standards-based manner.
Q: Please add a note on the estimated market scenario
expected in 2020 for cloud computing in the healthcare
domain.
A: We are already seeing a cloud first approach for smaller
companies and start-ups that dont see a value proposition in
building their own datacenter from the ground up. In this timeframe,
healthcare enterprise organizations will be taking the same
approach. Hosting and maintaining applications on-premises will
start to become the exception rather than the rule.
As open, interoperable cloud solutions emerge, there will be many
key benefits for healthcare organizations:
Lower cost
Ability to select best in class solution components from
multiple vendors
Less complex and more feature rich-solutions for high
availability and disaster recovery, spanning multiple
datacenters and geographic regions
However, the highly-distributed nature of future cloud solutionswill also introduce some new challenges. For example, I suspect
that data sovereignty issues associated with cross-border flow
of sensitive information will come to the fore. As a result, there
will be an increasing need for solutions that can restrict data and
application execution to approved geographic regions to ensure
patient privacy and regulatory compliance.
INTERVIEW
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PwC foresees Indian cloud computing market to be $4 billion by 2015
Q: The benefits of cloud computing is being propagated across the industry. What
are the factors that a healthcare organization needs to keep in mind before adoption?
A: Its very important for the healthcare fraternity to know what the function of IT is in
healthcare: cutting cost or providing better value to the business. This will determine what
types of applications need to be moved to cloud, what type of SLAs to be ensured, and
what type of security mechanism to be kept in place.
Patient data privacy would be critical for hospitals planning to get on cloud. Then there is
data integration, where there is a definite need to create a strategy for syncing the data,
i.e., data residing in various clouds need to be integrated with the data in the company.
Q: What are the drivers for the adoption of cloud technology in healthcare?
A: The use of the cloud technology brings with it several benefits and these are same for
cloud adoption across the healthcare sector as well. These are driving the uptake of cloud
in the healthcare sector:
For a large unorganized sector, with small hospitals for whom it is not viable to install
in-house hardware and software, cloud solutions are very cost effective.
It is difficult to find qualified staff for maintenance and up-gradation of IT systems which
can be taken care of automatically by cloud technology.
It is useful in increasing a number of multi-location chain of hospitals because scalability
is easier with cloud.
It facilitates reduced capex on building ones own IT assets, as IT cost is managed as
operational cost on pay per use basis.
It helps remove cost and complexities of managing sophisticated IT infrastructure
in-house, which requires huge capital cost to plan for the peak capacity and skilled
manpower to maintain it.
Q: Could cloud be the answer to Big Data in healthcare? Do you feel the two can be
incorporated for an advantage?
A: Definitely! This is a trend to keep a watch on, as cloud-based analytics is already in the
market. However Big Data is more core to business than IT, and integrating it with cloud
will be a big leap.
Q: Data security, interoperability, and regulatory compliance have been identified as
the road bumps to widespread adoption of cloud in healthcare. How can a healthcare
organization overcome these issues with the use of cloud?
A: The regulatory need of privacy and security of the patient record should be a key
concern before adopting cloud services. However this can be tackled through proper need
assessment and transition planning that will help the healthcare organizations to take the
right decisions.
Dr Rana Mehta
Leader Healthcare
PwC India
Rajesh Ranjan
Leader Emerging Technologies
PwC India
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Cloud interoperability standards are evolving by consortiums
of standards and definitions. Currently there is a lack of cloud
interoperability standards understanding between the cloud
providers and platform. However, since healthcare has established
standards of HL7 and DICOM protocols, this will continue to be a
functional protocol residing on top of the cloud platform.
Q: Will there come a time when cloud technology will be
advocated by the government for implementation?
A: Definitely yes! This is a great opportunity for state governments
to extend the reach and provide better heath-related services.
Cloud can be used to implement HIS, which will uniquely identify
a patient and store its health records across all government
hospitals in any state. Our firm is already advising some of the
state governments on this.
Q: Who are the major cloud players? What are the key
differentiators?
A: There are big MNCs like Google, Amazon, Microsoft as well
as Indian names like Tata, Reliance who provide cloud-based
services. Most of their offerings are similar in nature; however,
they can be differentiated on the basis of offerings for large and
small enterprises and some also specialize in specific industry
domains.
Q: What stake does the Indian market have in cloud
computing?
A: The Indian cloud computing market is currently at 900 million
USD and is projected to grow up to 4 billion USD by 2015. The
growth potential in the areas such as IaaS and SaaS are huge
and the Indian SMBs including healthcare players are poised to
move directly to the cloud to reduce cost on infrastructure and
manpower to manage applications in-house.
Q: What is the future for cloud technology in healthcare?
A: The future of cloud will be about integrating patient information
across the healthcare providers and payers, and adopting CRM
and analytics services on cloud. It will also have great potential
for government adoption so as to meet the goal of healthcare
for all.
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eClinicalworks deploys EHR solutions at Ohio OrthopedicCenter of Excellence
eHEALTH
In an attempt to increase the efficiency and reduce the time lag
in delivering services, Ohio Orthopedic Center of Excellence has
chosen eClinicalWorks, an ambulatory clinical solution provider,
for its electronic health record (EHR) solution to be used by 59
providers, located at various regions.
Established in 1965, Upper Arlington, Ohio-based Ohio
Orthopedic Center of Excellence offers an array of services
such as spine surgery, total joint replacement, hand surgery,
ambulatory surgery, sports medicine, and digital imaging. TheCenter zeroed in on eClinicalWorks for an EHR system in view of
the companys ability to facilitate the provider in complying with
the meaningful use criteria, aid in R&D, and streamline reporting
by using a fully integrated platform.
Customized for over 50 specialties and sub-specialties, the
EMR will be licensed by the orthopedic center for the following
components:
Unified EMR/PM: Embedded with quality measure and
registry reporting, and e-prescribing, it enables physicians toseamlessly communicate with peers, access patient-related
information, and also qualify for meaningful use incentives.
Integrated with a practice management (PM) system, it aids
in achieving optimized workflow from the time of patient
admission until billing.
eClinicalWorks Patient Portal: Allows patients and
physicians to exchange various information such as lab
reports, reminders, educational material, medical history,
appointment schedules, paying bills, refill prescriptions via
a secure network, anytime, and anywhere. eClinicalMessenger: Uses voice-over-internet protocol
(VoIP) technology to promote the sharing of data between
provider and patient via voice messages and SMS texts.
Enterprise Business Optimizer (eBO): A financial and
clinical analytics tool.
The solutions suite also includes eClinicalWorks Electronic Health
eXchange (eEHX), eClinicalWorks P2P, and eClinicalMobile.
Headquartered at Westborough, MA and operating at New York
City, Pleasanton, Chicago, and Alpharetta, eClinicalWorks caters
to more than 370,000 medical professionals, 180,000 providers,
in physician groups, health centers, hospitals and communities,
correctional health centers, regional extension centers, and the
U.S. Department of Health (DoD). The vendors solutions are
certified by the Certification Commission for Health Information
Technology (CCHIT) Office of the National Coordinator
Authorized Testing and Certification Body (ONC-ATCB; 2011-12),
and Child Health (2008 and 2011-12). Reporting revenues of over
$200 million for 2011, the company has been featured in Inc.
5000 list of the fastest-growing companies by revenue, and in
the 2011 vendor assessment report on US ambulatory EMR/EHR
for midsize and large practices by International Data Corporation(IDC), a market research company.
Significantly driven by the meaningful use incentives, researchers
from Harvard and the University of California at San Francisco
(UCSF) have noted that despite the increased rate of EHR
use (90% and 71%), functionalities to achieve meaningful use
have been utilized to a minimum (2% and 30%, respectively).
Also repor ting increased acceptance, athenahealths recently
released annual Physician Sentiment Index (PSI) findings differ
on the benefits provided by EHRs. From 2011 to 2012, the surveyfound that the number of respondents relating the electronic
record to better care delivery not only dropped, but a greater
association was made to the worsening of patient care. Apart
from this, a majority of physicians (44%) felt that EHRs were built
not keeping the physician in mind, and achieving meaningful
use is a burden (75%). For physicians who choose to dif fer, as
of April 2012, CMS has paid more than $5 billion in incentives
to 94,097 providers, and there are currently more than 132,000
primary care providers working towards achieving meaningful
use.
Frost & Sullivan, in a 2011 report, has predicted the US market
to shoot up to $6.5 billion in 2012, a steep increase from $973.2
million of 2009. Furthermore, anticipating a $8.3 billion US market
share by 2016, Millennium Research Group has reported over 750
companies that have entered into the market space in a matter
of two years, offering solutions that have some form of EMR
features. In addition, an estimated average 12% per annum rate
in growth through 2016 has questioned the long-term viability of
these products in the market. Also suggesting increased market
saturation in the near future, Frost analysts opine that vendor
displacements will become a natural effect of changes in provider
management and ownership.
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Agfa and Dell partner to provide medical image managementsolution on the cloud
PARTNERS AND ALLIANCES
Round Rock, TXs Dell will provide its cloud platform to host
its clinical archive portfolio and Greenville, SC-based Agfa
HealthCares Imaging Clinical Information System (ICIS). This
partnership has been inked in an attempt to enable offsite
expansion, facilitating access to archived information, and provide
comprehensive electronic medical records (EMR) that supports
the management of images.
Agfa, a part of Agfa-Gevaert Group, among its many deliverables,
focuses on including medical images into EMRs, in accordancewith an imaging strategy that outlines both the clinical role of better
health outcomes, as well as the business role of streamlining
operations and facilitating insurance reimbursements. Its suite
of solutions under this vertical, which are included in the current
collaboration, include ICIS, a workflow-centric clinical platform
that enables a longitudinal imaging record, IMPAX Data Center,
a scalable enterprise-wide or regional imaging management
solution, and XERO Technology Viewer, a web 2.0-based platform
that enables real-time image access. Although ICIS was already
accessible on private clouds at client data centers, its currentavailability as a completely managed service on the cloud,
extends the choices of clinical information system for providers,
simplifies image viewing, management, and archiving, facilitating
the establishment of an image-enabled EMR.
According to the agreement, Agfa HealthCares US clients can also
access Dell Cloud Clinical Archive, a solution to retrieve archived
information at times of system downtime or natural calamity, and
Dell Cloud Clinical Recovery, which acts as a secondary archive to
an existing onsite archive, allowing disaster recovery and businesscontinuity.
The cloud-based portfolio, by simplifying image archival
and management, allows healthcare providers to focus their
investments on supporting care, strategic services, and technology
development, and its cost predictability helps increase return on
investment.
Apart from Agfa, Dell has inked similar deals with Siemens
Healthcare, and NextGen Healthcare and Puerto Rico Hospital
Supply, enabling the presence of healthcare solutions on the
cloud. Dell, through its cloud-hosted clinical archives, supportsdata in more than 800 clinics, 5 billion diagnostic imaging objects,
and over 72 million clinical studies.
Healthcare data constitutes 30% of the global data, according to
a 2008 survey by Ponemon Institute, an education and research
organization. More recently, BridgeHead Software, a provider
of healthcare data storage management solutions, found that
63% of the surveyed providers attributed this increasing volume
of healthcare data primarily to imaging information. In order to
address this, healthcare organizations are deploying disasterrecovery and data archival tools for effective information
management. Disaster recovery has also been mandated by
Health Insurance Portability and Accountability Act (HIPAA)
Security. A data management survey by BridgeHead has
found disaster recovery as a top area of interest for healthcare
IT investments, with 55% planning to have it as one of their
top 3 investment areas. In support of data management, the
industry has taken to cloud computing technology, which offers
healthcare organizations a centralized means to store, exchange
and retrieve medical images, while enabling archiving anddisaster recovery.
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Microsoft and GE Healthcare form novel IT company through JV
The shift from sporadic individual patient care to continuous
population management has given rise to the need for greaterinsight into care delivery, integrated care processes, and the
engaging of patient experiences. These in turn mandate a transition
towards new payment models that require the providers to connect
disparate silos of care and integrate data. In an attempt to address
this need, IT giants GE Healthcare and Microsoft Corporation have
entered into a 50-50 joint venture to form a new company called
Caradigm, which is aimed at providing the healthcare fraternity
with real-time intelligence that it can use to enhance the quality of
healthcare rendered and patient experience.
The idea which was incepted in December 2011, has now reached
completion following the establishment of a firm set of goals, and
steered by a strong leadership team to enable the company to
achieve its outcomes. The leadership team for the new company
has been established by constituting a team of executives from GE
Healthcare, Microsoft, Care Innovations (an Intel and GE company),
and Philips Healthcare. Michael Simpson is spearheading the new
establishment as CEO, Neal Singh as CTO, Lauren Salata as CFO,
and Michael Willingham as regulatory affairs and quality assurance
executive. Obtaining regulatory approvals from the initial list of
countries, the company is located at City Center Bellevue, Bellevue,
WA, and operates from Andover, MA; Salt Lake City, UT; Chevy
Chase, MD; with centers across the globe as well.
Through this new venture, Caradigm intends on developing
and marketing collaborative clinical applications and an open,
interoperable healthcare intelligence platform, which aims to
improve population health management systems, thereby
reducing costs and enhancing outcomes of care delivery. The new
company will serve as a platform for software vendors to develop
customized and demand-driven solutions for the industry, and
leverage and connect these applications to Microsoft HealthVault,
which will remain with Microsoft as a cloud-based service.
Caradigm will also host collaborative clinical applications directed
towards achieving the long-term goal of developing a healthcare
performance management suite aimed at better population health
management. Backed by a common vision of a connected,
patient-centered health system, the parent companies bring to
the table complementary expertise:
Microsofts know-how in creating ecosystems and platforms,
and solutions including Microsoft Vergence: single sign-on, context management
software
Microsoft Amalga: health intelligence platform for the
enterprise
Microsoft expreSSO: single sign-on solution for the
enterprise
GE Healthcare, its experience in administrative and clinical
workflow solutions including
GE Healthcare eHealth Information Exchange: health
information exchange
Qualibria Quality Management Solution: clinical decision
support application
Through this collaborative effort, GE Healthcare and Microsoft
hope to address pressing concerns of the healthcare sector,
such as healthcare-associated infections and chronic disease
management, and global challenges to quality care, including
access to patient-critical information and healthcare costs. This,
they plan to achieve by focusing on interoperability of health
systems, accountability and performance of healthcare delivery
systems at all levels of care and in every country.
In support of GE chairman and CEO, Jeffrey R Immelts belief
in the potential of the combination of leading companies with
complementary capabilities to meet a common vision, GE
Healthcare embarked on a previous JV with Intel Corporation for
the establishment of Care Innovations LLC. The combining of
Intels Digital Health Group and GE Healthcares Home Health
business, Care Innovations was incepted in January 2011 to cater
to home health monitoring and the telehealth sector.
For Microsoft, many analysts consider this move as an exit from
the clinical market, except for HealthVault, with the previous sell-off
of its Amalga HIS to Orion Health in 2011. This is augmented by
the conditions in this JV, wherein Microsoft contributes through
its intellectual property, and the rest of the business is handled
by GE. Although, Microsoft has held onto to HealthVault in this
JV, analysts, Chilmark Research, wait to see whether it can be
converted into revenue generating sustainable business for the
company, or ends like the recently closed Google Health.
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PRODUCTS AND SOLUTIONS
3M releases new ICD-10 financial analysis software and service
3M Health Information Systems, a provider of health IT solutions
and services, has announced the inclusion of an analysis tool and
consulting services into its International Classification of Diseases
Revision 10 (ICD-10) transition planning solutions suite. This
has been designed to assist providers in estimating the ICD-10
transitions financial impact on each, diagnosis related group
(DRG), hospital department, and on an organization as a whole.
Offered as a component of ICD-10 code translation tool, the
financial impact analysis tool evaluates ICD 9-derived DRG claimsalong with the base payment rate of an organization, and details
the probable reimbursement that could be derived if the same
DRGs were generated from ICD-10 codes. The financial impact
tool also detects the DRGs that will remain as is and those that
will change.
ICD-10 financial impact analysis consulting service, includes
executive-level reports, onsite record review, data analysis,
and education to enable providers make informed decisions
on educational requirements, and operational and personnelenhancements. Services are also provided for improving clinical
documentation, along with a web-based curriculum, the ICD-10
Education Program.
According to 3M, by evaluating the financial impact, healthcare
organizations can review contracts, project receivables, and
incorporate training programs and enhancement of documentation
where they are most required. With this, Ray Terrill, the senior vice
president at 3M believes that they can transform the transition to
ICD-10 as a strategic advantage by purging probable oversightand risks.
The latest addition adds to Salt Lake City, UT-based 3M Health
Information Systems wide array of ICD-10 transition solutions and
services that help clients enhance documentation and coding,
identify potential risks, map and convert systems, translate codes,
and educate employees. For more than 30 years, the company
has been catering to over 5,000 hospitals, globally, through more
than 100 coding experts. With more than 15 years of expertise in
managing ICD-10 products and services, 3Ms code translation
tool was chosen, in 2011 by CMS, to assist in the conversion of
applications, systems, and reports from ICD-9 to ICD-10. It was
also licensed to Medicare Administrative Contractors (MACs) and
carriers, and Fiscal Intermediaries (FIs). 3Ms association with
CMS goes way back to 1995, when the company was contracted
to provide ICD-10 General Equivalence Mappings (GEMs),
Procedure Coding System (PCS), and the initial conversion of
MS-DRGs to ICD-10.
Apart from 3M, many vendors such as Healthcare Informationand Management Systems Society (HIMSS) and Jvion, CSC,
and Edifecs have come up with ICD-10 financial impact analysis
solutions to aid providers in making the transition.
The U.S. Department of Health and Human Services (HHS) has
proposed a ruling mandating the healthcare industry to shift from
ICD-9 to ICD-10 by October 1, 2014. Regarded as a massive
task, the implementation of ICD-10 is said to affect almost every
operational system and process of the providers revenue cycle
and payors administrative procedures.
While gearing up for the switch in the coding systems, several
concerns related to planning, implementation and cost associated
with the process, dearth of skilled coders and trained staff, and
reduction in overall productivity daunt the healthcare fraternity,
according to a recent article published in the journal Perspectives
in Health Information Management. Although the migration to ICD-
10 may initially offer many challenges, it is anticipated to provide
significant benefits over a period of time. The research article finds
ICD-10 to reduce cost as it allows for improved cost analysesand data integrity, enhanced monitoring of health outcomes,
and reduced fraud and abuse. With the requirement of better
documentation, according to Milliman, a consulting and actuarial
organization, the new coding system will result in more precise
coding and payments in return.
In conclusion, it has been suggested that healthcare entities
can successfully make this transition by understanding both, the
challenges, benefits, and related costs of implementation, and
choosing an appropriate adoption strategy.
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IDC reports indicate an evolving HIE market
IDC Health Insights finds the health information exchange (HIE)
market landscape to be evolving, through two market reports
that have analyzed HIE vendors. Sixteen vendors providing HIE
platforms, including tools for development, educational and
professional services, an extensive partner network, and published
APIs; and 10 vendors for packaged solutions were evaluated
through these two studies.
The IDC MarketScape: U.S. Health Information Exchange
Packaged Solutions 2012 Vendor Assessment study finds the HIEmarket to be fragmented, with vendors offering products of varied
origins, including composite applications, integration engine
platforms, clinical messaging, portals, managed network services,
and information management. It was also seen that the enterprise
industry forms the fastest growing market, in account of its ability
to support collaborative care and demonstrate meaningful use.
Released consequently, the IDC MarketScape: U.S. Health
Information Exchange Platform Solutions 2012 Vendor
Assessment found that the HIE market continues to evolveas the attention is shifting towards the conversion of data into
actionable information for collaborative care or accountable
care initiatives, from enabling connectivity for data exchange and
using technology meaningfully. As a consequence of this shift,
additional vendor consolidations have been reported. This has
been demonstrated by seven MnAs and the emergence of new
vendors, like telecommunication and payor organizations, since a
2010 analysis by IDC. In view of such activities, the HIE packaged
solutions study proposes a dynamic market with continuous
change seen in the competitive and technical scenario. The studyalso reports a major role played by platform-as-a-service in the
HIE market; as vendors consider building a strategic collaborative
ecosystem with other companies.
Lynne A Dunbrack, Program Director, IDC, finds the IT demands,
due to changing reimbursement and care delivery models, and
health information organizations, to be too big to be fulfilled by a
single company. Both surveys show that, vendors are acquiring,
partnering, or developing collaborative care, patient engagement,
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INSIGHTS
and analytical technology, apart from just offering primary HIE
technology, in an attempt to cater to technical and business
demands of accountable care. In addition, the HIE market is
expected to witness a dramatic change over the coming 12 to 18
months, with the entrance of dominant vendors into the market,
which is flooded with small, private companies.
While the study finds platform designs advancing over time
(mostly through self-development) to satisfy the requirements of
clients and alliances in the ecosystem, the packaged solutionswill be developed to cater to specific requirements. The latter are
expected to lower the risks posed by uncertain project timelines,
scope, and costs.
The HIE market, despite many challenges, has witnessed
remarkable growth (an excess of 40%) in 2011, according to a
2012 Clinmark Research report. In concurrence with the present
report, Clinmark finds the enterprise market as a major contributor,
and the HITECH Act and statewide HIE contracts as minor
factors supporting this growth. Healthcare organizations havebeen turning towards HIE implementation, not only for complying
with meaningful use, but responding to pending reimbursement
changes, and shifting from pay-for-services to pay-for-outcomes
model. The new reimbursement models would require healthcare
organizations to better manage patient care and operations across
the continuum of care. Amidst the diverse EHR environment,
providers are increasingly adopting HIE technology in an effort to
access data in EHR silos across the community.
Black Book, a market research company, in their recent survey,also finds evolving reimbursement models and the push to prepare
for accountable care organizations as major reasons (85%) for
HIE adoption. Further, the research also indicates healthcare
organizations HIE spending to grow significantly by 2014, as
indicated by 8 out of 10 provider participants.
With the healthcare industry quickly entering into the post-EHR era,
Clinmark finds that the value of patient data is in a HIE-supported
network, and not in disparate EHR data silos.
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Wireless communication devices are being adopted increasingly
in the healthcare industry. A 2012 Dell SecureWorks report finds 2of 5 US clinicians utilizing tablets or smart phones during patient
encounters. Although mobile devices offer several benefits, it
brings with it privacy and security risks, with 65% of data breaches
occurring on laptops and mobile phones, and 57% because of
theft. These have been cited as chief hindrances for mHealth
adoption by 41% specialists and one-third primary caregivers.
With this, it is imperative for healthcare providers to develop risk
assessment and mitigation plans to tackle security and privacy
threats posed by mobile devices, and avoid penalties, tarnished
reputation, and financial loss. According to the report, the cost forrecovering data following breach involving mobile devices is $258.
Below is the compilation of suggestions made by the healthcare
fraternity, for managing security and privacy with mobile devices.
NCCIC, a U.S. Department of Homeland Security (DHS)-led center
overlooking nation-wide cyber and communications operations,
advocates a layered security mode for securing mobile devices:
Acquire medical devices with fine-grained and well
documented security functionalities, which are safe to
configure on networks
Incorporate ongoing support for vendors to update antivirus,patch, and firmware in the purchase vehicle. Enforcing safe,
effective and legal software and patch upgrading regulations.
Have a practical approach for managing network monitoring
and intrusion detection techniques, external-facing firewalls,
and internal network segmentation that contain the devices
Forbid unauthorized users via access control lists (ACL),
and unsecured and/or unrecognized devices, through
the enforcement of stringent laws, from accessing health
information network (HIN)
Frame guidelines for periodic review, management, and
auditing of network configurations upon change of network
Leverage the principle of least authority in determining the
accounts that require access to particular medical device
components, instead of the complete network
Password protect personal health information (PHI)
Ensure secure communication channels by encrypting and
authenticating both ends of the channel
In an attempt to ensure secure mobile computing, Dell
SecureWorks, provider of information security services, suggests
the following steps to healthcare organizations:
Develop a guidepost: Involves the evaluation of different
modes employed to secure mobile devices, and utilization of
established models for defining a way forward on mobility and
security concerns. The plan, upon considering the needs andimportant sections of the organization, should give an insight
into the areas of opportunity, costs, and expected investment.
Risk assessment: Comprises of recognizing, and assessing
the risks. The procedure plays a pivotal role while switching
between various ownership models or smart phone platforms,
and complying by security and privacy enforcement laws.
Security assessment: Manual and automated approaches
of testing should be applied to analyze the security and
compliance risk imposed by an application, connected
systems, and flow of data between application and system. Data encryption and protection for PHI by availing access to
only authorized users.
Apart from these, below are a few best practices suggested by
various industry leaders, which has been consolidated by ID
Experts, a data breach solution provider.
Providers should consider and mitigate risks involved with
the use of personal devices for work-related purposes,
and facilitate benefits of these devices found lacking in the
organization. With theft and loss of devices being top healthcare data
breaches, geolocation tracking software, a low-cost insurance
policy, has been suggested as a useful approach to trace and
clean data present in devices.
In cases of theft or loss of mobile devices, remote wiping
methods need to be used to brick the whole device, rather
than just deleting the encrypted corporate data, as most of
the personal data stored in the devices have a backup on
the cloud.
USB locks can be installed to prevent unauthorized transfer
of data.
Encryption is necessary.
Introduction of bring-your-own-device (BYOD) and mobile
devices renders electronic PHI vulnerable to data breaches;
hence, organizations should implement cyber liability
insurance as a part of data breach response strategy.
While upgrading BYOD, users must ensure that all private
and sensitive information are successfully deleted from old
devices that go offline.
Ensure technical safeguards such as data segmentation,
encryption, access controls, VPN software remote, data
erasure, etc. are installed in mobile devices before use at a
setting.
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Healthcare industry experts suggest strategies to address mobiledevice security and privacy threats
INSIGHTS
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INSIGHTS
H&HN survey illustrates IT utilization among 2012Most Wired Hospitals
Hospitals & Health Networks (H&HN), a publication of the American
Hospital Association (AHA), has announced more than 200 MostWired hospitals, based on a survey that analyzed IT utilization
at healthcare organizations across four areas: infrastructure,
business and administrative management, clinical integration
(ambulatory/physician/patient/community), and clinical safety and
quality (outpatient/inpatient hospital).
H&HN, in cooperation with McKesson Corporation, CareTech
Solutions, AT&T, the College of Healthcare Information
Management Executives (CHIME), and AHA, conducted the
survey on 1,570 hospitals (~27% of US hospitals); of which, 662
completed the survey. The survey results provide an insight into
the types of technology used by these Most Wired hospitals and
the rationale behind this recognition.
Patient care
Including the existing methods of improving patient care, the
survey has found that tech savvy hospitals are venturing into the
latest in what technology and media can offer for conne