Porter Research Industry News Porter Research RSS Feed http://porterresearch.com/ <![CDATA[Massachusetts Looks to Medicaid for a Truly Sustainable HIE]]> http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2012/February/Massachusetts_Looks_to_Medicaid_for_a_Truly_Sustainable_HIE.html February 8, 2012
The state of Massachusetts, through its Massachusetts eHealth Institute regional extension center, is taking a unique approach to establishing a statewide HIE, and has enlisted the services of the Massachusetts eHealth Collaborative (MAeHC) - a nonprofit healthcare IT advisory and consultancy firm - to help it move this new model forward.

What started as an idea last summer for a nonprofit HIE quickly evolved into a strategic business plan that stakeholders hope to see result in a live HIE in mid-October 2012.

"The current plan has the state government, actually Medicaid, creating the infrastructure for the statewide HIE, and that's a significant shift from where the plan was even last summer," explains Micky Tripathi, MAeHC's President and CEO. "We reoriented the plan because the federal government is now offering subsidized dollars through the Medicaid program for the creation of HIE infrastructure that would benefit Medicaid network participants first and foremost.

"In Massachusetts, 100 percent of the hospitals and 80 percent of the physicians are Medicaid network providers, so if you build a HIE infrastructure to serve them, you're basically serving almost the entire state right away," Tripathi adds. "As you can appreciate with this kind of infrastructure, once it's created, anyone can use it."

Medicaid Money Hopefully Means Financial Stability
"One of the main drivers of moving the HIE over to the Medicaid side of the house was that Medicaid will subsidize to the tune of 90 percent - meaning that for every 10 cents we put in, they'll put in 90 cents to subsidize the creation of the infrastructure," Tripathi explains. "They'll subsidize something like 50-75 percent of the ongoing maintenance of the infrastructure once it's up and running.

"If we have Medicaid create and run it, that will take care of a lot of the [sustainability] problems," he adds. "It doesn't solve everything, because you still have to cover that last 25-50 percent. Medicaid, like any organization, is happy to pay for the piece of it that is a benefit to them, but if other organizations and people are benefiting from it, they'll be expected to pay their fair share, too. That will be the responsibility of all of us in the state to come up with that fair share piece of it. Right now, it's looking like that will be only something like 10-20 percent of its ongoing cost, which makes the sustainability question a lot easier."

Tripathi and his team estimate that contributions from private stakeholders will be less than a million dollars a year, collectively.

"In the state of Massachusetts, we have $6 billion to $7 billion in health claims every year, so figuring out how you get a million dollars from everyone in the state ... it does feel like it will be a problem that will be relatively easy to solve once there's a real service there," he says.

Medicaid Infrastructure Hopefully Means Provider Buy-In
"The idea of having Medicaid stand it up make a lot of sense from a variety of perspectives," Tripathi explains. "The Massachusetts Medicaid organization is one of the most highly regarded in the country. It's got a very sophisticated IT infrastructure that it didn't outsource like a lot of Medicaid organizations did. And more importantly, you've got people who already log onto the system for Medicaid claims processing. So if you say, 'Oh by the way, the thing you've been logging onto for the last 10 years now has HIE capability,' it starts to make a lot of sense."

Tripathi also feels that gaining provider buy-in will be that much easier because they've become accustomed to paying for HIE. Massachusetts has a few well-established HIEs, including the New England Health Information Exchange.

"They've been sustainable for a number of years," Tripathi says. "They have an $8 million budget, they're a nonprofit, and it's all been paid for by subscription fees from hospitals, health plans and physicians. That's been up and running and by some measure covering 50 percent of the state already.

"I think that's a significant difference, culturally, when you think about other parts of the country - you don't have that," he says. "But because people here are already paying for HIE services, when a statewide one is launched, people already understand its value."

Will Other States Follow Massachusetts' HIE Lead?
"My understanding is that there are three to five states that are going to be pursuing this strategy," Tripathi says. "These states, along with Massachusetts, submitted applications to Medicaid for this, and we've been given every indication that it's going to be approved along with the others. I suspect a lot of other states will jump on it as well - we just happen to be among the first to get into the pipeline.

"It certainly wasn't obvious to me a year ago that this was the right way to do it, but now that is has unfolded this way, it feels like, 'Oh wow, how obvious.'"







]]> <![CDATA[Regional Extension Centers: Moving Physicians Forward with Meaningful Use]]> http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2012/January/Regional_Extension_Centersx_Moving_Physicians_Forward_with_Meaningful_Use.html January 24, 2012
"Making the move to a new system seemed too complicated for a doctor nearing the end of her career," said Jennings, Primary Medical's office manager. "She didn't know if she wanted to invest the time and money into learning something new."

But that was before the office knew about the $44,000 incentive payment they could receive from the Centers for Medicare & Medicaid Services (CMS) for proving the office had fully implemented an accredited EHR and was using it efficiently. The problem, however, was finding the right one.

That's when Ohio Health Information Partnership (OHIP), Ohio's regional extension center (REC), took the lead. Not only did it help Primary Medical identify the best system, Jennings said, but it will also provide step-by-step guidance when the office goes live with its software of choice next month.

"From the provider's perspective, we want to meet meaningful use criteria," Jennings said. "So rather than the piecemeal approach to an EHR system, it's been very beneficial for us to take advantage of the work OHIP's already done and the information it has."

OHIP, also known as "The Partnership," isn't a one-of-a-kind group. Since 2010, the U.S. Department of Health & Human Services' Office of the National Coordinator (ONC) has invested $677 million in 62 RECs nationwide. Their goal is to guide more than 100,000 primary care providers to EHR meaningful use. The on-the-ground assistance they provide is particularly valuable now - it's crunch time for Stage 1 of meaningful use, which requires that eligible professionals meet 20 objectives related to their use of an EHR, as set forth by the CMS. As of last fall, only a small percentage of hospitals had achieved this first stage, and healthcare providers have only until Feb. 29, 2012, to prove they've reached this goal in order to qualify for incentive payments.

Where RECs Are Today
While substantial, REC funding is a drop in the bucket compared to projections in federal health information technology (HIT) growth. By 2016, software company Deltek Inc. predicts federal HIT expenditures will grow to $6.5 billion. But the millions flowing to RECs has been money well spent - many are already achieving their initial enrollment goals.

For example, OHIP recently hit its 6,000-physician goal. The Chicago Health Information Technology REC enrolled nearly 1,500 doctors by the end of December 2011, and the New York eHealth Collaborative REC passed its 5,100-physician goal around the same time. Last week, the Kentucky REC also announced it had reached its initial 1,000-doctor enrollment goal.

Currently, there isn't one model for how RECs should be organized or work. Each is designed differently, and ONC is watching to see which are successful.

"A lot of these models will fail, but the ONC is looking for the ones that work," said Gregg Alexander, M.D., a pediatrician at Madison Pediatrics in London, Ohio. "They're looking for the homerun hitters so they can replicate that model nationwide."

Alexander has been involved with OHIP since its inception and is currently a member of the Board of Directors. Early on, he said, OHIP decided to help providers identify the best EHR solution for their offices by offering an EHR selection tool. Originally priced at $1,800, OHIP makes the tool, produced by medical-device manufacturer Welch Allyn, available for $50.

In a further attempt to guide providers, OHIP staff analyzed the available vendors, starred five as preferred, and negotiated 15- to -20-percent discounts off the system's usual fees.

Early skeptics wondered whether RECs would be effective, but many on-the-ground leaders have been pleased with the progress. In fact, many say providers see RECs as a trusted advisor.

"The effectiveness of the RECs, in my opinion, is surprisingly high. I think the challenge in terms of the numbers in showing people meaningful use is not so much an efficacy of the RECs, but rather the complexity of getting people to meaningful use," said Sean McPhillips, Kentucky's REC project manager. "For example, some vendors may not have the immunization interface enabled to help information exchange, and that creates a huge obstacle. Or we had one vendor whose quality reporting module is not working properly for some reason, so all of their quality reports are coming up zero. That means the provider who wants to test for meaningful use right now can't."

Challenges RECs Face
Although the relationship between RECs and vendors has benefitted facilities and physician practices nationwide, that coordination has also been one of the biggest criticisms lobbed at the groups. Some industry leaders worry that rather than giving providers impartial advice, RECs will be little more than promotion mechanisms for certain vendors.

It's a delicate dance for RECs and vendors to avoid this perception, said Tom S. Lee, Ph.D., CEO and founder of cloud-based EHR software provider SA Ignite. By offering support services as a third-party, vendors can add value to a REC without solely pushing its own product offerings.

"Vendors play an important role," Lee said. "RECs can't drive the value of EHRs to 100,000 providers alone, and vendors can provide the information technology support that the physicians will need."

Another significant challenge is funding. Each REC currently has financial support from the ONC; however, that money will eventually evaporate. To supplement these monies, some RECs charge for their services, said McPhillips. For example, Kentucky providers who do not fall under Medicare can purchase the REC's tool kit and six hours of consultation for $500. Additional services are available at an hourly rate.

In some ways, though, the most significant roadblock RECs face is the physicians they're designed to help. As with Jennings' boss, many older physicians closer to retirement resist becoming EHR savvy. However, as they leave practice, Alexander said, EHRs will organically grow to be the dominant patient record system.

Primary Medical Specialist's Experience
From the moment Jennings contacted the closest REC to her office, located in Athens, the practice had a knowledgeable partner who could answer any EHR-related question, provide detailed information about preferred vendors, and secure a discounted price.

"After connecting with the REC, we stopped looking for a vendor independently," Jennings said. "We had an additional layer of confidence knowing the vendor we selected had received a stamp of approval from our REC."

Primary Medical used the Welch Allyn tool to weed through OHIP's preferred vendors, eventually pinpointing the electronic system that best fit their needs. Throughout the selection process, whenever she or a provider had a question ranging from software to vendor contracts, their REC representative provided timely, unbiased feedback either by phone or email. 

The one drawback to working with OHIP, Jennings said, has been how long it took her to find out about the organization. Knowledge of the group isn't widespread.

"I don't know how many doctors know that there's help from the government for this," she said. "But healthcare providers in general need as much help as we can get to select an electronic records vendor that is right for us."

Primary Medical has no plans to sever its relationship with its REC after it reaches EHR proficiency. Instead, the office intends to stay connected to the REC as it faces healthcare's next information technology challenge, the health information exchange (HIE).

What's Next For RECs?
Guiding providers to meaningful use proficiency is a time-limited responsibility. In order to maintain relevancy, RECs leaders are already considering what the groups' next steps might be.

For the Kentucky REC, the next big challenge will be integrating providers into the state's HIE. But there are other opportunities available, such as coding or patient privacy, to help providers and patients span the existing knowledge gap, McPhillips said. The goal, he said, will be to foster a better-educated and empowered patient population that can more actively participate in their own healthcare.

"There's a lot of transformation going on in healthcare today, whether it be health information technology, healthcare reform, patient-centered medical homes ..." he said. "It's a sophisticated industry in which the principle consumer, the patient, is really at a knowledge loss - so the challenge to empower the patient is health literacy. So we recognize that as a huge opportunity that is untapped."







]]> <![CDATA[The Future of Health Information Exchange]]> http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2012/January/The_Future_of_HIE.html January 9, 2012
Without a doubt, health information exchanges (HIEs) - both public and private - will continue to grow, potentially in size and number. The number of HIEs nearly doubled to 230 between 2010 and 2011, with many are in various stages of complexity. This progress has opened up more opportunity for hospitals to purchase HIEs. In fact, 74 percent of U.S. hospitals confirmed their intent to implement the technology in 2011, according to healthcare advisory and research firm CapSite.

"When hospitals become involved in an HIE, they see having access to a greater amount of patient data helps them improve diagnoses and increase the value of healthcare," said Claudia Williams, director of the state HIE for the Office of the National Coordinator for Health IT (ONC). "They also realize there is a cost savings."

These cost reductions could be significant in many cases. For example, Indiana's HIE (IHIE) currently connects 90 clinical settings, 10 million patients, and more than 19,000 physicians. Healthcare Information xChange New York (HIXNY) includes clinical data on 1.9 million patients throughout 17 counties in Upstate New York. However, other states, such as North Carolina, are just beginning to form their exchanges.

The Path to Standardization
Many providers and payers already see the importance of HIEs, but they cite one overarching problem. Many existing HIEs were designed for individual health systems, with each having unique functionalities and characteristics. The solution - and a big push for 2012 - is HIE standardization, according to Glenn Keet, president of California-based HIE vendor Axolotl.

"The bottom line is that standardization is necessary and important to the future of HIEs to provide for population health and analytics that will improve patient care," he said, noting that standardization is particularly important for public HIEs. "Unless HIEs are standardized, the industry won't be able to reach its goals and impact care delivery the way it wants to."

Work in this area is already underway. In November 2011, seven state HIEs and 11 healthcare information technology vendors collaborating as the EHR|HIE Interoperability Workgroup announced they had agreed to follow the same technical specifications when connecting the HIEs, providers and other partners.

Standardization is also a significant concern for the ONC, Williams said. In December 2011, the office announced HIE standardization would be mandatory, meaning each system must include the same sets of information, allow for lab results transfers, and use the same terminology to avoid any confusion between providers and facilities. According to Keet, the ONC's standardization decree also calls for point-to-point search capability. In doing so, HIEs will be able to both send patient data to another network and accept outside messages.

Additionally, Keet said, private HIEs must consider how providers and facilities will be paid under the impending accountable care model.

A Change in Technology
While standardization is the hot button issue for how HIEs will operate, there are two buzzwords associated with the technology behind the tools. During the coming year, the key topics around HIE usage will be interoperability and open platforms, according to Todd Densley, Director of Strategic Accounts - Healthcare with Ontario-based HIE vendor NexJ Systems. Both concepts will allow providers and payers to leverage patient data to their maximum potential.

"There's often a need for hospital systems or providers to connect to the electronic health records (EHRs) of another institution," he said. "Open platform allows hospitals with different healthcare information technology teams and different HIEs to connect and talk to each other. That interoperability - that ability to transfer data outside your network - is the next area of growth for HIEs."

NexJ created its open platform, NexJ Health Exchange, two years ago to allow facilities and providers with different HIEs and EHRs to quickly and easily share patient data. A second layer, known as NexJ Connected Wellness, is a cloud-based application that lets patients and providers work together to manage chronic diseases and other health issues.

Axolotl also offers HIE solutions that give hospitals and providers near-instantaneous access to patient data. Through its Elysium Express and Elysium Exchange Solutions, Axolotl offers providers HIE-quality access to health information directly through its EHR. These systems also integrate seamlessly with similar products, Keet said.

Even with sophisticated technology, HIE expansions faces challenges this year, said Harold Apple, CEO and President of IHIE. Hospitals must create provisions that ensure patient data remains secure. Perhaps the greatest obstacle to overcome will be designing a method that allows all the disparate HIE formats to talk to each other.

"We must make sure their languages are compatible and that they can speak clearly to one another," Apple emphasized.

Providers' Perceptions
The price tag for some facilities to belong to an HIE can be a steep disincentive for physicians and hospitals. Often, the fee is $85 per month, per doctor. For some hospitals in Colorado, monthly payment can reach $10,000 a month to access the Colorado Regional Health Information Organization (COHRIO), according to the Boulder County Medical Society.

Although a significant cadre of physicians worry about the ongoing cost, using the technology is good for doctors and patients, said Jesse Flaxenburg, M.D., a nephrologist with Pikes Peak Nephrology - a physician practice associated with CORHIO.

"If you have a tool that's readily available to you that will dramatically improve the level of care you're able to provide, why not use it?" he said. "We're in the 21st Century. This isn't the 1800s anymore, and we need to practice like we're in the 21st Century."

HIE access has also helped Good Samaritan Hospital in Vincennes, Ind., provide superior care for its patients, said Charles E. Christian, the hospital's Chief Information Officer. However, he wasn't always certain that his hospital needed an HIE.

"For a long time, I struggled to see what the benefit of an HIE could be for us as a single-hospital facility," Christian said. "But once we were able to hook up to the HIE of other facilities, the added value of getting information to other places and back was clear."

Often, the facility provides emergency care to patients who received open-heart surgery in an Indianapolis hospital, and having instantaneous access to necessary medical files is critical to helping someone in distress, he said.

The Unnoticed Danger
While HIEs hold great promise for improving continuity of care and reducing costs, there is one looming danger as this technology continues to spread, Densley said. There is a movement within healthcare for payers, in an effort to diversify their portfolio holdings as payment models change, to purchase HIEs."

On paper, the payer has all that patient data. There's no existing policy regulating what they can and cannot do with that information, so right now we can't know what will happen," he said. "But we have a situation where the people who are making policy decisions that affect us and our families have all the details of our health histories. That's a situation that could likely go either way."







]]> <![CDATA[Porter Research Announces Partnership with PointClear Solutions]]> http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2012/January/Porter_PointClear_PR.html January 10, 2012
"Porter Research has proven to be very flexible when conducting market research and has a deep understanding of how innovation is helping to improve healthcare," said David Karabinos, CEO of PointClear Solutions. "As we seek to create innovation for our clients, we see great value in adding this kind of market research, to fully understand our clients' business needs, industries and customers. Combining PointClear's product strategy and user experience research capabilities with Porter's market research techniques will enable us to develop comprehensive product strategies and custom technology products for our clients."

"We are excited to partner with PointClear Solutions," said Cynthia Porter, President of Porter Research, which has conducted market research in the healthcare industry for over 20 years. "We see PointClear as being at the forefront of innovating new technology products in healthcare, and are enthusiastic about bringing broader levels of market research, which is core to our business today, to their program."

About Porter Research
Porter Research diligently works to understand and assess each client's unique needs and build a customized business-to-business research program to achieve desired goals. Combining unparalleled experience, proven methodologies and knowledge-based analysis, Porter provides the unbiased results that clients need to make informed strategic business decisions. Over the past 20 years, Porter's research team has conducted over 150,000 interviews with executives in a variety of industries: banking/financial services; consumer goods; high tech; healthcare; life sciences; retail; and utilities. With significant experience working with Fortune 500 healthcare companies, the Porter executive team has built a significant practice in the healthcare technology, provider, payer and life sciences sectors.

About PointClear Solutions
PointClear's focus is on transforming healthcare delivery through technology innovation that improves user experience.  Our competencies lie at the intersection of product strategy, technology and user experience. Our user-centered approach to software development assures that our solutions are accessible, relevant and actionable - driving user adoption, promoting human-centered delivery of professional healthcare, and ultimately creating business value for our clients.  We serve provider, payer, pharmaceutical, public health organizations and the technology market that supports them.







]]> <![CDATA[Can Cancer Treatment be Found in the Cloud?]]> http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2011/December/Can_Cancer_Treatment_be_Found_in_the_Cloudx.html December 12, 2011
This progression is certainly evident in the company's aforementioned announcement - the first of its kind - of a multimillion dollar, multiyear commitment of technology and manpower, which includes partnering with the Neuroblastoma and Medulloblastoma Translational Research Consortium (NMTRC), the Translational Genomics Research Institute (TGen) and the Van Andel Research Institute (VARI).

As part of the Dell Powering the Possible giving program, this partnership will enable medical personnel around the world to "support research to identify and share personalized treatments in days instead of months, and expand the reach and impact of the world's first FDA-approved personalized medicine trial for pediatric cancer," according to a recent Dell press release.

Dell's cloud computing technology will be a critical component of these efforts. Specifically, it will not only help to improve collaboration amongst care providers in different parts of the world, but will also increase TGen's computer gene sequencing and analysis capacity by 1,200 percent.

Porter Research recently sat down with James M. Coffin, Ph.D., Vice President and General Manager, Dell Healthcare & Life Sciences, to learn more about what the cloud will mean to cancer research.

Why did Dell decide to focus on pediatric cancer? Is this a cause that is near and dear to the company's heart?
James Coffin: In general, there are limited resources devoted to researching pediatric cancer. With little commercially or federally funded research underway because of its small patient base, parents and pediatric oncologists have relied largely on "trial and error" in their search for a treatment that will work for neuroblastoma patients from among the hundreds of available adult cancer trials. We believe that this trial can be a real game-changer in the treatment of pediatric cancer, and this is an area where Dell solutions, people and funding can address an unmet need and make a real and lasting impact.

How long has this partnership been in the works? Is there one particular Dell member that was behind it?
Dell has been working with TGen for a number of years, and I have personally known Jeff Trent, President and Director of Research at TGen, for many years before that. This project is an outgrowth of that long-standing relationship.

In terms of cloud computing, do you believe this is a technology that is still on the "fringe?" - one that hasn't been wholeheartedly embraced by providers?
More and more providers are seeing the advantages of moving data to the cloud. Cloud computing eliminates many of the silos that exist in health information management today, while offering significant efficiencies and cost savings in the long term.

With the explosive growth of electronic health data, storage can represent more than 20 percent of healthcare IT budgets. Cloud computing enables organizations to scale seamlessly and only use the resources that are immediately required. In addition, storing data in the cloud opens infinite possibilities for analytics and collaboration that ultimately can lead to better healthcare and improved outcomes.

Why has cloud computing not been adopted more quickly by hospitals and smaller physician practices? Do security and budgetary concerns have a part to play in this hesitation?
Of course, privacy and security are key concerns, but there are many approaches to the cloud that can safeguard data and address HIPAA requirements, from encryption technologies to private clouds that keep sensitive information both protected and accessible. If you ask me if I'd rather have my data stored in a private, secure cloud or on paper at my local hospital, I'll take the cloud any day. During catastrophes like the Joplin tornado or Hurricane Katrina, vital healthcare information is protected and can easily be recovered when needed most.

Will programs like the pediatric cancer research partnership help to change this thinking?
I think so, because this project clearly demonstrates how cloud computing can directly impact and improve patient care. The donated cloud will help increase TGen's gene sequencing processing and analysis capacity, help improve collaboration between TGen scientists and oncologists, and create a knowledge repository for oncologists tackling disease globally.

On a larger scale, we believe that cloud computing platforms could support complex biomedical knowledge exchanges between the healthcare providers, research centers, clinical genomics and molecular diagnostic vendors and pharmaceutical researchers interested in participating in personalized medicine.

pediatric-cancer-infographi
What, exactly, will Dell be donating when it comes to cloud computing technology?
The donated cloud will be powered by Dell PowerEdge Blade Servers, PowerVault Storage Arrays, Dell Compellent Storage Center arrays and Dell Force10 Network infrastructure. Dell Precision Workstations will be used for data analysis and review. Specifically, the cloud will support the personalized medicine trial for pediatric cancer by:
  • Increasing computation and collaboration capacity by 1,200 percent compared to TGen's existing clinical cluster.
  • The cloud's sustained performance is 8.2 teraflops and is growing; estimated maximum performance is approximately 13 teraflops.
  • Reducing tumor mapping and analysis time from months to days
  • Providing a secure, cloud-based framework for the pediatric oncology community to store, move and analyze genomic data effectively and efficiently.
  • Enhancing global access to personalized treatments, which will improve treatments for children fighting cancer above today's conventional "trial and error" method.
  • Supporting collaboration and the development of best practices in the treatment of pediatric cancers.
How involved have the researchers at TGen been with regard to helping Dell decide what sort of technology to donate?
This has been a true partnership from the start. Dell has a team of technical specialists working with TGen to design, implement and help maintain the donated cloud platform at TGen's headquarters in Phoenix, Ariz. Dell will also provide workstations and integrate the nodes that sit at medical center sites with the centralized data center. TGen will develop and use its bio-intelligence tools.

By controlling the prototype and versioning of the systems, TGen will be able to develop and test the integrated solution until it is to the point where it is scalable to tens of thousands of patients, and capable of being replicated across multiple clinical sites hosting trials for a multitude of pediatric cancers.

What hospitals in the US will be part of this program at the outset?
Current members in the NMTRC participating in the personalized medicine clinical trial for pediatric cancer include:
  • National Cancer Institute, Bethesda, MD
  • Helen DeVos Children's Hospital, Grand Rapids, MI
  • Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, Saint Louis, MO
  • Rady Children's Hospital San Diego, UCSD School of Medicine, San Diego, CA
  • Medical University of South Carolina, SC
  • Arnold Palmer Hospital for Children, M.D. Anderson Cancer Center, Orlando, FL
  • Levine Children's Hospital, Charlotte, NC
  • Connecticut Children's Hospital, Hartford, CT
  • Doernbecher Children's Hospital, Oregon Health & Science University, OR
  • Children's Mercy Hospital, Kansas City, MO
  • The University of Texas, M.D. Anderson Cancer Center, Houston, TX
The NMTRC is currently bringing on additional medical centers, and more are planned aas the trial expands. We hope to have at least one international clinical facility in the first year (in Luxembourg, UK, Canada or Germany). Additional international sites will be added in subsequent years.

As the healthcare industry moves towards more of a team approach to patient care, Dell's commitment to using cloud computing technology highlights the benefit healthcare IT can bring to new, coordinated care models - inside or outside of the United States. Hopefully, moving from desktop to cloud will be of immediate benefit to the 100,000 children in the United States that are diagnosed with neuroblastoma each year, and of lasting benefit to an industry that is just figuring out how to embrace a holistic view of healthcare.







]]> <![CDATA[Accountable Care: Let the Work Begin]]> http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2011/December/Accountable_Carex_Let_the_Work_Begin.html December 12, 2011
The Centers for Medicare & Medicaid Services (CMS) released its final rule on accountable care organizations (ACOs) in October, detailing how its version of an ACO - the Medicare Shared Savings Plan - should be structured. If facilities choose to enroll in this program, they must offer services to at least 5,000 Medicare recipients for at least three years. Providers and clinical settings are also free to design and implement their own collaborative care model that uses a network of physicians and facilities to provide coordinated care.

Past attempts at managed care have failed, and there is still a chance the U.S. Supreme Court could declare ACOs unconstitutional. But that hasn't stopped some in healthcare from working toward more team-based care. They are advocates of a new form of healthcare - one that ultimately focuses on the health of the patient rather than the bottom line. They are betting that the changes that come with accountable care, repealed or not, will help to usher in and get providers comfortable with this more team-based approach.

"The path forward to accountable care seems brighter and more achievable to many health systems, community providers and small practices," said Justin Barnes, Vice President of Marketing, Industry, and Government Affairs at Greenway Medical Technologies Inc. "There is flexibility within creating a model for accountable care; and, with the final rule, many care providers are seeing that accountable care is the future of where healthcare is going."

Barnes was also central to the formation of  the Accountable Care Community of Practice, a group of healthcare information technology providers committed to helping providers and facilities successfully design and implement either a formal ACO business model or less formal accountable care strategy.

Although this care model is getting significant attention, Barnes said, much still needs to shake out before it can be declared a success. In the meantime, many providers are putting the pieces that will support it - healthcare IT, shared-risk plans and provider networks - in place.

Mentors can Make the Difference
However, pivoting from a fee-for-service delivery model to one that prizes teamwork and increased quality at a lower cost isn't necessarily intuitive. Many hospitals - large, small, urban and rural - need guidance, said Julie Sanderson-Austin, RN, a quality management professional with the American Medical Group Association (AMGA).

"The ACO model and even accountable care are very different animals," she said. "It's clear that this isn't business-as-usual and that the change to healthcare is significant."

To support facilities moving toward team-based care, the AMGA launched its learning collaboratives program last year. The goal, Sanderson-Austin said, is to help hospitals design ACO models that fit their specific needs by pairing facilities just embarking on accountable care conversations with mentor institutions that are further along in implementation.

Defining and Addressing Challenges
Hospitals just approaching accountable care voice some of the same concerns and encounter similar challenges, Sanderson-Austin said. For many, the biggest problem is integrating their data across care settings to offer patients a complete continuum of care. Having an electronic health record (EHR) connecting the hospital to its outpatient clinics is a good start, but it isn't enough.

"It's great to have an EHR that connects to ambulatory sites, but it has to be connected to your other sites, as well," she said. "Otherwise, how are you going to get data from your nursing homes or home health agencies? If your patients either have to or elect to go to a nursing facility, you need a way to access their information for any possible future care needs."

The initial capital investment needed to acquire good technology or build fluid health information exchanges can also present substantial problems, especially for smaller facilities, said Erik Johnson, Senior Vice President of consulting firm Avalere Health.

Although physicians are slated to play a vital role in any collaborative model, they can also be a significant sticking point for administrators looking to re-vamp how their facilities provide services. Even hospitals that began looking to a more team-based approach years ago have struggled to bring any changes to fruition.

"Improving engagement between physicians and hospitals continues to be an up-at-night problem for hospital executives," Johnson said. "It's difficult to get this kind of alignment."

The Greenville Hospital System University Medical Center (GHSUMC) encountered this problem when it first considered its own type of ACO roughly a decade ago. According to Chief Medical Officer Angelo Sinopoli, M.D., convincing the doctors was an uphill battle.

"It took 10 years for physicians to embrace the model," he said. "The concept is foreign because physicians train as individuals and are not accustomed to working in teams."

However, administrators repeated the facility's long-term goal and worked to educate the doctors on the benefits of working with other providers. Eventually, Sinopoli said, the physicians became champions of the hospital's new care model.

Laying the Groundwork
Even though these challenges exist, hospitals can lay the groundwork for accountable care success, said Eric Bieber, M.D., President of the Accountable Care Organization at University Hospitals in Cleveland.

"Creating a collaborative care system that works well requires a high-functioning, multidisciplinary team to work across the organization," Bieber said. "This team will be responsible for negotiating how the different groups within the hospital come together and divide risk."

In January, University Hospitals launched its own accountable care model - a self-insurance plan that covers approximately 24,000 people. The facility is still in the process of identifying what works well and what doesn't, but Bieber said institutions looking to follow in his hospital's footsteps should bring together representatives from human resources and the legal department, as well as case managers, to discuss best strategies.

Industry management consultants at Kurt Salmon Associates also recommend hospital administrators focus on a few fundamental changes to position their facilities ahead of the curve.

Perhaps the biggest shift for hospitals, according to Kurt Salmon consultants Kate Lovrien and Luke Peterson, will be that pivot from concentrating on what the facility provides to honing in on what the community needs. With the ultimate goal of preventing inpatient admissions, the hospital is no longer the center of healthcare.

"There needs to be a dramatic change in organizational culture from the inside-out thinking of 'my care, my time, my location' to the outside-in thinking of 'right care, right time, right location,'" Lovrien and Peterson wrote in a statement about ACO preparations, adding that this altered view constitutes a vision change for many facilities, and to do it well, administrators must secure buy-in from their board and staff members.

In addition, a facility's business model must change. Under accountable care, success will no longer be measured in patient volume or the amount of services provided. Instead, efficiency and efficacy will be based on how well facilities control their costs while providing superior quality. Lovrien and Peterson seem to agree with Bieber - outlining how responsibilities will be divided and shared is a critical step. This move will give the hospital a clear organizational model, bolstering the ambulatory care system and streamlining the continuum of care across settings. The result, they said, will be improved quality and cost control.

Physicians must also turn from being the biggest hindrances to accountable care to being the most enthusiastic foot soldiers in the ramp up to the new care model, they said.  With their knowledge of the interplay between clinical activities, healthcare economics, and provider-patient engagement, doctors can strengthen the bonds across care settings.

Lastly, success will also come easier if hospitals tailor any EHR system to quality measures that are unique to the populations they serve.

Whatever strategies hospitals choose to employ, all facilities would be wise to start giving serious thought to what their accountable care model might look like, Bieber said. Waiting for Congress to announce a directive would be a waste of time.

"Regardless of the result of the elections in November 2012, there's real support on both sides of the aisle for accountable care concepts," he said. "It would behoove all organizations to begin to think about a system that focuses on maintaining wellness and managing chronic disease."







]]> <![CDATA[Healthcare's Consolidation Continues]]> http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2011/November/Healthcarexs_Consolidation_Continues.html November 22, 2011
The 1990s were rife with disastrous attempts by hospitals to purchase medical groups. For the last three years, however, mergers and acquisitions (M&A) among healthcare entities have grown steadily. And, in today's atmosphere of coordinated care and accountable care organizations (ACO), pooling resources could help providers meet the needs of a burgeoning patient population, especially with regard to financing new healthcare IT systems.

Whether it's a partnership between health systems, a hospital and physician group, vendors, or payers, the majority of industry experts agree building these ties strengthens the healthcare system. Expanded clinical resources, updated health information technology, and streamlined payer structures all serve to improve the quality of care.

"We're seeing a move toward the mega-health system as the one-stop-shop for all care needs," says Mark Reiboldt, vice president of financial services for The Coker Group. "All segments of healthcare are affected by the same drivers. They're pursuing integration to enhance their resources and value."

The Rise of the Deal
Initial 2011 reports indicated M&A levels lagged behind 2010. However, a recent issue of The Health Care M&A Monthly, a newsletter produced by business intelligence publisher Irving Levin Associates, identified a late-blooming uptick in this year's deals that surpasses 2010 numbers. Currently, 132 hospitals have finalized $6.9 billion in deals. The median value of each consolidation also spiked, rocketing from $12.9 million in 2009 to $35 million in 2011, says Reiboldt, who's company provides financial advisory strategies and solutions to healthcare organizations.

"Three or four years ago, most of the deals we saw were distressed. Healthcare groups of all sorts were entering into deals just to survive," he says. "We're no longer seeing partnerships occur for pennies on the dollar."

According to Dow Jones reports, medical device companies experienced some of the most substantial growth this year. A 15-percent rise in deal activity to 68 mergers brought $857 million into this sector and placed it above biopharmaceuticals (which garnered $715 million in 78 deals) for the first time since 1998. Medical information technology companies also fared well, finalizing 24 deals for $207 million.

Still, the M&A wave hasn't yet reached its apex, and Reiboldt says he anticipates greater consolidation in 2012 and 2013 for two main reasons. As more buyers venture into the market and view healthcare as a sound investment, market deal values will continue to climb. Also, the Centers for Medicare & Medicaid Services (CMS) begins accepting ACO applications in January. By giving physicians and hospitals joint responsibility for patient care, the ACO model pushes clinical environments to link, fostering a larger, more diversified patient base.

Offering Patients More
If healthcare reform survives its legal challenges, the industry faces a simultaneous influx of more than 30 million people, and many hospitals and health systems are scrambling to gather the necessary resources to meet future clinical needs. In many cases, this means fusing with a nearby facility, such as the October merger of Olympic Medical Center in Port Angeles, Wash., and Swedish Medical Center in Seattle.

Under the 20-year agreement between the facilities, Olympic patients will have access to Swedish specialists, including endocrinologists, cardiologists, neurologists and sleep medicine experts, at the 80-bed Olympic site. Patients can elect to receive care on the Swedish campus if Olympic doesn't offer a service. However, there is no mandate that they do so. Overall, this move gives Olympic's patients greater access to quality care and controls the facility's expenditures.

Olympic retains its independent, community-owned status. But, according to Olympic's CEO, Eric Lewis, the complexity of healthcare reform regulations prompted his hospital to pursue the merger.

"If a hospital as small and rural as Olympic Medical tries to go on its own, it's going to have significant financial problems," Lewis says. "We now have a large, prominent and well-respected partner that will work with us to ensure our community is properly cared for."

For Olympic, access to Swedish's existing electronic health record (EHR) technology - an EPIC system - was crucial. According the Lewis, Olympic was too small to buy an expensive EHR system on its own, and connecting with Swedish helped Olympic fulfill a critical healthcare reform requirement. The facility also joined Swedish and other large Seattle-area healthcare systems in a large buying group to have greater negotiating power with vendors and payers.

Clinical and economic advantages aren't limited only to hospital-hospital mergers. In many instances, hospitals gain much by acquiring physician-owned medical groups, Reiboldt says. The same acquisitions occurred 20 years ago with hospitals providing the entire purchase price upfront. Ultimately, those partnerships failed, but the purchase process is different now. 

"This time, the partnership is true. Hospitals are willing to take all the risk, but the bulk of the value of the deal comes with the future performance of the physician group," he says. "These deals don't provide large sums up front. Instead, the deals are structured to pay out over three to five years."

A hospital purchase of a surgical group is among the most beneficial pairings because it provides a smooth transition for patients. Rather than refer a patient outside the system to another facility, providers can easily recommend a partnering surgeon and, in many cases, facilitate scheduling the appointment.

Hartford Healthcare created this type of patient environment in October when it acquired Connecticut Surgical Group, a practice with more than 40 physicians in 12 locations. The institution, now known as Hartford Specialists, has 68 doctors and offers tertiary care, as well as colorectal, thoracic, podiatry, urology, and general surgery services. 

Similar to the Olympic-Swedish merger, the Hartford deal expands services and brings all associated physicians under the umbrella of a single EHR. The partnership is also significant, says Hartford Hospital CEO Jeffrey Flaks, because it increases the organization's footprint in the marketplace.

Vendor and Payer Consolidation
As with provider mergers, healthcare reform is also the impetus behind vendor and payer joint ventures. The drive for greater cost savings across the industry is pushing companies together as they attempt to strengthen their expenditure control services.

Based on Porter Research data, M&As among vendors and payers swelled by 50 percent in 2010. The trend is still moving toward increased consolidation, says Vik Torpunuri, CEO of CentraMed, and vendors must combine their strengths and resources to help providers meet healthcare reform requirements and standards. CentraMed emerged from the merger of software-vendor Analytix on Demand (AOD), of which Torpunuri was founder and CEO, and business intelligence-vendor Integrated Revenue Management Inc. (IRM).

"Hospitals must integrate technology into their systems in order to survive, but many are 10 to 20 years behind the times," Torpunuri says. "Vendors that combine software expertise with the knowledge to help providers manage their clinical and financial data relieve a huge burden for facilities.

"In this case, AOD fused its capabilities with those from IRM to create a system to connect a patient's clinical information across his or her travels in the healthcare system - from doctor to hospital to lab to skilled nursing facility, Torpunuri says.

Vendors aren't the only organizations acquiring other vendors, however. Payers are also being aggressive in bringing vendors into the fold. The competition is intense, and the goal is to increase market share and bolster the number of enrolled beneficiaries, Reiboldt says.

For example, the 2010 acquisition of Axolotl, a health information exchange (HIE) vendor, by Ingenix, an EHR and revenue cycle management entity owned by benefits company UnitedHealthcare, opened the door for greater information flow beyond internal hospital users. Using Axolotl's technology, Ingenix (now known as OptumInsight™) has been able to help healthcare clients - even those competing with UnitedHealthcare - share patient data in more secure, expedient ways.

At the time of the merger, Ingenix CEO Andy Slavitt said the partnership would ultimately serve providers and patients to strengthen the healthcare system.

"HIEs are bringing us closer to the point where all the healthcare professionals patients select to oversee their care can connect to share information and optimize outcomes," he said. "We will work with Axolotl to continue to meet the needs of the multiple HIE stakeholders and to expand its technologies that serve healthcare communities."

Finding a Successful Partnership
While a partnership between two healthcare entities can be beneficial, that doesn't mean all mergers will work. There are certain characteristics company leaders and hospital administrators should look for the find the right fit, Reiboldt says.

Potential partners should both be willing to assume some risk in the deal and compromise. But the most important aspect of a mutually beneficial deal, he says, is that each side respects the role of the other organization."I always tell clients to observe whether the CEO or the administrators are truly embracing the partnership," he says. "It has to be something that's completely engrained into culture of the deal or it won't be sustainable."







]]> <![CDATA[Duke & Verizon: Unleashing the Potential of Healthcare IT]]> http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2011/November/Duke_Verizon.html November 8, 2011
"We have a serious intent in the healthcare market," says Sam Bastia, General Manager of Global Strategy and Corporate Development at Verizon, "and we want that intent to be greater than a 20-second commercial that you see on T.V. I think there's a real shared synergy between what Duke can do from a domain perspective, and what we can do from a network perspective."

The Nuts and Bolts
Well-known, of course, for its wireless services, Verizon is seeking to ramp up its activities in the healthcare space by partnering with a prestigious institution like Duke in order to affect real change in the way healthcare is delivered. Under the multiyear agreement, the partners will focus on technical and business collaborations, as well as the establishment of a scientific advisory board that will review partnership initiatives. Verizon Connected Healthcare Solutions will provide computing infrastructure to perform analytical processing and modeling, as well as staffing and resources for technical development. Duke will provide personnel from across university departments, intellectual property and other research necessary to the partnership's sponsored initiatives.

"We have significant problems in the United States around the cost and quality of healthcare," says Kevin Schulman, MD, Director of the Health Sector Management Program at the Fuqua School of Business at Duke. "We're struggling with ways in which we can address that, and the idea of starting with a population of 100 million people to see if we can use technology to develop consumer tools for better health management, and to get better value out of healthcare, is a tremendous opportunity."

Predicted Projects
The partnership's first three years, after which both parties will have the option to renew, will focus on a variety of projects that will be scoped and staffed independently of one another. Mobile health solutions focused on prevention are at the top of the To Do List.

Consumer rather than clinical applications will be first out of the gate, according to Schulman. "The nice thing about consumer is that the consumer is an independent entity that you can touch today," he says. "When you start thinking about clinical solutions, connecting patients with doctors, moving medical records around, then you have to think about interfacing with infrastructures. Obviously that's another necessary component of all this, but that's a bigger problem to tackle."

"Early next year we should have an announcement about what the collaboration has built in that space," says Schulman. Related mobile health applications and consumer healthcare education tools are also on the drawing board.

"The great opportunity here is to take Verizon - one of the largest infrastructure organizations in the country, if not the world - and help them understand how they can focus it to address the core issues of quality and cost at the individual patient level, at the provider organization level, and at the transaction level," he adds.

It's no stretch of the imagination to think that a Duke/Verizon coordinated or accountable care pilot organization just might come to fruition.

"Verizon is paying $4 billion a year for healthcare, and those costs are expected to go up at least 9 percent this year," Schulman explains. Verizon's captive market of customers and employees offers up a ripe opportunity for the partners to develop and test cost-saving healthcare technologies that can then be shared with large employer organizations.  "They have the scale to really make a significant impact on healthcare in a way that we've never seen," he adds.

"That is an important point," says Bastia. "We're one of the largest health-insured entities in the world. We've got close to 1.5 million insured lives, so the cost of health insurance to our company is a very real thing. The 9 percent and $4 billion a year adds up in a hurry. So we not only have a goal for prevention that way, but also a goal for wellness for our employee base.

"It's a big population - a test population that we can get some meaningful data out of," he says. "We can use this test population to really test the efficacy of some of the things that we do together. However the ACO paradigm evolves, one thing I'll guarantee is that it's going to be a heck of a lot more connected than it is today. We want to make sure that we're a part of that. We want to do something meaningful in this space - more so than any of our competitors. You don't see telco companies setting up relationships with research professors and universities much."

Next on the Drawing Board
Both Schulman and Bastia anticipate incorporating additional partners in the future who can bring something to the table of mobile health applications, while still thinking about solutions at a national level."Some of our projects will be pilot tested here," says Schulman, "but that's not a prerequisite. It's no secret that as an academic medical center, we're part of the cost. It's the same way Verizon is a payer. We don't want the limiting step to be solutions that only work for us. We want to step outside the parochial view of Duke as a provider organization and really address this national need."

Learn More: In this Verizon Business podcast, Dr. Peter Tippett, Vice President and Chief Medical Information Officer, Verizon Connected Healthcare Solutions; and Dr. Kevin Schulman discuss the Verizon/Duke collaboration on health IT initiatives. Listen Now







]]> <![CDATA[Healthcare Vendors' Perceptions: AHIMA 2011]]> http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2011/October/Healthcare_Vendorsx_Perceptionsx_AHIMA_2011.html October 19, 2011  
"The health information technology world has changed rapidly over the past few years," says Thomas Gordon, "with more facilities transitioning to EHRs and achieving Meaningful Use, preparing for the IDC-9 to ICD-10 change, and maintaining the accuracy of data collection for core measures and other quality indicators. At AHIMA 2011, I had the pleasure of sitting down with our members and hearing how they feel about AHIMA and what we can do to support them in their roles. I plan on building a cohesive team that will work together to put the tools in place to measure our future successes."

Porter Research spoke with a number of healthcare vendors at the AHIMA show in Salt Lake City to find out how they are helping HIM professionals reach those future successes.

Jump to interviews with:


HealthPort's Rita Bowen, Senior Vice President of HIM and Privacy Officer, and Steve Emery, Director of Product Management, discuss the challenge healthcare information management professionals are facing in the way of constant payer requests for RACs, and the company's recent news of being the first to successfully transmit records from healthcare providers via the CMS esMD gateway for information exchange.




Steve Bonney, Vice President of Business Development at BayScribe discusses the ways in which the partnership between BayScribe and Perfect Search Corp. are helping healthcare information management professionals overcome current challenges.




Michelle Martin, Group Vice President of Healthcare at KForce Healthcare discusses the "perfect storm" the healthcare industry is currently facing in terms of staffing, as providers struggle to implement or upgrade EMR systems while transitioning to ICD-10.




Angela Carmichael, HIM Product Development Specialist at J.A. Thomas & Associates, discusses the need for healthcare information management professionals to take a seat at the table during ACO discussions, and the role clinical documentation will play in successfully adopting this new type of care model.



Visit the Porter Research You Tube channel to view additional video interviews with:
Visit the AHIMA 2011 photo gallery at our Facebook page to see more images from the show.







a]]> <![CDATA[Billian Publishing Launches HITR.com]]> http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2011/September/Billian_Publishing_Launches_HITR.html September 28, 2011 ATLANTA, Sept. 28, 2011 -- Billian Publishing Inc. announced today the launch of its latest affiliate HITR.com -- a healthcare IT benchmarking and social networking community for healthcare providers and vendors. HITR, which stands for Health Information Technology Research, offers meaningful research targeted towards stakeholders of healthcare IT. This complimentary, Web-based tool offers its members easy-to-understand customer satisfaction scores for nearly 40 IT systems and 300 vendors. Through its unique survey and social networking platform, HITR.com can identify timely research topics, conduct custom research through the HITR audience, and make the results of that research actionable to HITR's members.

hitrspBenefits to Healthcare Providers

Providers can use HITR.com's survey tool to evaluate potential vendors, benchmark employee satisfaction with IT systems within their own healthcare facilities, and compare themselves with their peers at other institutions across healthcare IT, financial and quality performance data. After taking surveys, provider members can access rewards in the form of financial and quality performance comparison data on peer facilities -- a benchmarking tool that can help to further establish best practices at hospitals.

Benefits to Healthcare Vendors

Healthcare IT vendors can use the anonymous feedback submitted to HITR.com to rank their products against competitors, and better tailor offerings to providers' needs. Vendors can also engage with providers via several of the site's social networking features -- including blogs, groups, discussions and job boards -- to gather additional input to aid in product development and management.

Members Understand the Value of HITR.com

"There is a lot of activity in healthcare IT right now, and having insight into others' experiences and impressions is invaluable," says Michael Roberts, Director of Network Services at Highlands Regional Medical Center, and member of HITR.com. "Before large IT purchases are made, there are countless conversations with vendors and referrals. A site like HITR can significantly simplify that process by offering one place to tap into unbiased feedback from colleagues on a broad spectrum of IT systems and vendors."

"Candid feedback from the people using the system in our facility let's me know where trouble might lie," adds Roberts. "Patterns of low ratings might indicate additional training needs. It can also draw attention to functionality that might be lacking in a given system, and help better steer us in future purchases."

Healthcare providers and vendors can join the HITR community by registering at HITR.com.

About Billian Publishing Inc.

Atlanta-based Billian Publishing Inc. is parent company of Billian's HealthDATA, Porter Research, and HITR.com. Billian's HealthDATA is the leading provider of comprehensive market intelligence on the healthcare industry, covering facilities across the continuum of care - from Hospitals to Long-Term Care. Billian's dedication to providing high-quality data via products like the Portal, coupled with partner company Porter Research's custom healthcare market research services, provides customers with healthcare business intelligence about multiple markets in scaleable formats.

Contact:
Jennifer Dennard
Social Marketing Director
jdennard@HITR.com
2100 RiverEdge Pkwy, Ste 1200
Atlanta, GA 30328
678-569-4872









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