Technology

At the center of the supply chain, health plans and their IT systems are uniquely positioned to guide the "retail market" interactions. To do so, however, health plans must rethink their traditional roles.

As healthcare stakeholders weave their way toward the President's vision of providing every American with an electronic medical record by the year 2014, a growing number are taking the intermediate step of creating personal health records (PHRs).

Some industry behemoths such as the UnitedHealth Group and the Blue Cross Blue Shield Assn. (BCBSA) have decided to keep the member financial services in-house, creating their own banks. Other payers are developing relationships with multiple banks to offset the giants' economies of scale with flexibility and portability, allowing members to keep their money in the same bank even when they change health plans.

While new breeds of consumer medical devices-as well as healthcare-oriented variations of existing devices, such as cell phones, computers and televisions-might hold enormous promise, stakeholders across the industry agree that formidable technical, regulatory, security and reimbursement obstacles continue to stand in the way. The current healthcare delivery model is under pressure, which has many anticipating an alternative model of care that places greater emphasis on technologically advanced in-home care and monitoring.

Today, healthcare payers and providers endlessly wrestle with three alligators-rising costs, inconsistent quality, and the uninsured. These alligators seem to grow larger and stronger with every passing year.

As healthcare costs continue to increase, information has become its own currency. Payers want to identify high utilizers of services; purchasers demand to know how their money is being spent; and providers seek information on patients' status. Even pharmaceutical companies want in, and consumers who are expected to pay for more of their healthcare want to know about the data available to them.

A joint collaboration between a small hospital in Indiana and an Indianapolis-based picture archiving and communications systems (PACS) and complete radiology provider enabled the small hospital round-the-clock access to radiologist services. Upon its opening in October 2006, the Monroe Hospital in Bloomington, Ind., joined forces with the PACS and radiology provider to supply the facility with radiologists to cover all of the hospital's general and subspecialty radiology services through both on-site and remote radiologists.

With the increasing trend toward consumer-directed healthcare, providers can add another specialty to their list: bill collector.

Effective maintenance of patient records, registration information, human resources documentation, and reimbursement forms are critical to the IT success of the four-hospital Saint Clare's Health System, in northwestern New Jersey. The hospital system, which houses more than 475 active beds, serves 23,000 inpatients and 250,000 outpatients annually.

With the increasing trend toward consumer-directed healthcare, providers can add another specialty to their list: bill collector.

In 2007, healthcare providers will face identity and access management challenges that will directly impact compliance, security and audit issues.

The administrative simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) require the Department of Health and Human Services (HHS) to establish national standards for electronic healthcare transactions. This includes assigning healthcare providers a National Provider Identifier (NPI), a 10-digit numeric provider identifier that will be used in standard electronic transactions, such as healthcare claims. As of a legislated date of May 23, 2007, each participating provider will have one and only one NPI, regardless of practice locations or settings.

The most significant pressures facing payers evolve constantly, though they rarely change radically from year to year. While payers strive to lower administrative costs and improve efficiencies, manage healthcare costs and grow the business, recent years have seen substantial change in how they address these issues.

The high-profile health policy issues for the new Congress are to reduce Medicare prescription drug prices and expand federal government funding for embryonic stem cell research. Congressional leaders want to enact legislation that will permit the federal government to negotiate drug prices (see Newswire), a move that eventually could alter the role of private plans in providing healthcare benefits to seniors.

There is no doubt about it-transmitting claims and other healthcare information electronically saves time and money.

There's no doubt that the United States is in a transition when it comes to the use of health information technology (HIT). President George W. Bush's executive order for increased use of HIT and health information exchange (HIE) to improve quality and cut costs in August served as a reminder.

The deadline draws near for the healthcare industry to comply with one of the final regulations mandated by the Health Insurance Portability and Accountability Act (HIPAA) in the ongoing industrywide effort to get all arms on the same electronic page.

For years, health plans have struggled to achieve one of their primary objectives: the ability to influence their members' healthcare habits and choices.

Among large physician practices and acute care facilities, physicians and healthcare executives widely recognize the value of electronic medical records (EMRs). However, physicians at small or individual practices are just beginning to use the technology, noting high implementation costs as a deterrent.

Washington, D.C.-Robert Kolodner, MD, has been named by the Department of Health and Human Services (HHS) as the interim national coordinator for health information technology, assuming the position vacated by David Brailer, MD, PhD, who resigned in May.

Doctors' handwriting has always been a source of jokes, but it's not so funny when poorly written prescriptions lead to medication errors. Electronic prescriptions have the potential to save lives by negating errors in deciphering prescriptions and alerting physicians to adverse drug interactions before they write a prescription.

Initially used to transcend problems of distance and location, telemedicine employs cameras, microphones and other medical monitoring devices, which are connected via a telecommunications network in the evaluation, diagnosis and treatment of patients from remote locations. The observational devices can be anywhere, which allows for the technology to be used in diverse settings or to treat prisoners, soldiers and the homeless.

Winona Health, a locally owned and operated nonprofit organization in Winona, Minn., had an outdated and cumbersome technology infrastructure, which hampered its ability to serve its community. With more than 900 employees at Winona Health and its affiliates, Winona's financial and billing systems couldn't keep up with the firm's growth or increasingly complex reporting and tracking requirements. Of particular importance was automating Winona Health's human resources and payroll processes-employee hours were being logged manually, making the maintenance of labor law requirements for overtime, weekends and holidays time-intensive.

The healthcare industry, both nationally and globally, has just scratched the surface of possible uses for telemedicine with potential efficiency enhancements on the horizon as well as a future where homes would have "health security systems," according to some leaders in telemedicine.

Every year, the poor quality of provider data costs healthcare payers an estimated $26 billion and sabotages their quest for efficient operations. Even the most highly automated plans remain vulnerable to the drain on resources caused by inaccurate provider data, rightly called "the Achilles' heel" of healthcare.