The Blog will discuss the following topics:
- US Health Care and IT
- Process Flow in Health Care Treatment
- Clinical operations and IT
- Different Type of IT Applications in Health Care
US Health Care and IT:
Now a days All Health Insurance companies, Hospitals, Physicians are using different IT Applications to create and Manage their Medical data. US Health Care companies are offering plans to cater all needs like Medicare, Medicaid, Child Plans, Life Term Plans etc. and People are buying these plans (Irrespective of the fact that they are very expensive) because Getting the Medical treatment without the Health Care insurance can be more than just Expensive.
People from all age groups and professions need medical coverage not just because of the cost associated with it but also because of many other factors mentioned below:
1) Health plans offers Preventive Care which helps and motivates in subscribers to follow a healthy lifestyle
2) Complete information on medical providers, Security providers, their ratings, reviews, locations etc. on the fingers
3) EHRs Electronic health records are widely maintained with ease which can track all medical history.
4) All the data related to subscribers claims, EOB (Explanation of benefits), COB (Coordination of benefits) can be accessed online anytime by subscriber
People from all age groups and professions need medical coverage not just because of the cost associated with it but also because of many other factors mentioned below:
1) Health plans offers Preventive Care which helps and motivates in subscribers to follow a healthy lifestyle
2) Complete information on medical providers, Security providers, their ratings, reviews, locations etc. on the fingers
3) EHRs Electronic health records are widely maintained with ease which can track all medical history.
4) All the data related to subscribers claims, EOB (Explanation of benefits), COB (Coordination of benefits) can be accessed online anytime by subscriber
New Trends in Healthcare:
1) Global Insurances:
Now a days, Healthcare companies are targeting business globally, Major companies and many start ups are offering mutiple insurance plans to people traveling across globe so that medical and security services can be provided to the traveler in case of any medical or security emergency.
2) Technological advancements are transforming the entire healthcare industry.
Data Security
Patient privacy issues (including concerns about data breeches) will continue to be top-of-mind for providers, payers, and consumers, especially with ongoing data breeches in the news. Providers and payers will need to step up data security to avoid the type of Health Insurance Portability and Accountability Act (HIPAA) violations that can negatively impact an organization.
Attaining Meaningful Use and Switching to ICD-10
Eligible providers and eligible hospitals will continue to work on meaningful use of EHRs. Fortunately, CMS may issue guidance to shorten the reporting period of certified EHR technology from one year to 90 days.
In addition to the Meaningful Use program, the switch from ICD-9 to ICD-10 took front stage during 2015
Increased Data Demands
Both clinicians and administrative leaders are hungry for data to make decisions and guide their planning. Yet, there always seems to be a missing piece of information, such as which skilled nursing facility a patient was discharged to. For this example, providers either have to make assumptions based on unreliable data or try to get that data through cumbersome processes
An enterprise data warehouse (EDW) is key to overcoming the current data challenges. An EDW enables users of all backgrounds (both technical and nontechnical) to analyze near real-time data easily through analytics applications. As demands for access to high-quality, accurate data continue to grow, workers will want better analytics tools, such as EDWs, so they can improve care and reduce costs.
Patient-Centered Care
The goal is to improve patient satisfaction scores and engagement.
Wearable Tracking Devices
Now 70 million people in the U.S. are using wearable tracking devices to monitor their physical activity, sleep patterns, calorie consumption, and a whole lot more. This is an exciting new frontier with so much potential to improve patient care. It will be fun to see the impact this trend has on improved patient engagement
3) Outcomes will continue to improve
An article in Modern Healthcare that showed improvements in patient safety in U.S. hospitals. In fact, approximately 1.3 million fewer patients were harmed between 2010 and 2013. That represents a 17 percent reduction in adverse events and the prevention of 50,000 deaths. The largest improvement was in CLABSI (central line-associated bloodstream infection), which showed a 49 percent reduction from 2010.
One of the driving forces behind improved outcomes is CMS’s emphasis on reducing hospital readmission rates. From 2007 to2011, the all-cause 30-day readmission rate among Medicare fee-for-service beneficiaries held steady at between 19 and 19.5 percent. Once CMS introduced readmissions penalties in 2012, the rate dropped to 18.5 percent. Then in 2013, it fell further to approximately 17.5 percent. The net result is roughly 150,000 fewer readmissions from January 2012 to December 2013. Once the 2014 figures are released, Expect to see even more reductions in readmissions and have already seen significant reductions from the health systems. For example, one health system reduced its heart failure readmission rate by 29 percent. By using analytics and an EDW, the organization was able to capture necessary data elements and then track various interventions quickly and adjust as needed.
4) Collaboration will increase
An important source for trendsetting in the healthcare industry is the annual JPMorgan Healthcare Conference. This year’s presenters showed examples of the importance of partnership and collaboration to survive the shift to value-based healthcare. These new partnerships cross industries and include companies outside of healthcare
Data Security
Patient privacy issues (including concerns about data breeches) will continue to be top-of-mind for providers, payers, and consumers, especially with ongoing data breeches in the news. Providers and payers will need to step up data security to avoid the type of Health Insurance Portability and Accountability Act (HIPAA) violations that can negatively impact an organization.
Attaining Meaningful Use and Switching to ICD-10
Eligible providers and eligible hospitals will continue to work on meaningful use of EHRs. Fortunately, CMS may issue guidance to shorten the reporting period of certified EHR technology from one year to 90 days.
In addition to the Meaningful Use program, the switch from ICD-9 to ICD-10 took front stage during 2015
Increased Data Demands
Both clinicians and administrative leaders are hungry for data to make decisions and guide their planning. Yet, there always seems to be a missing piece of information, such as which skilled nursing facility a patient was discharged to. For this example, providers either have to make assumptions based on unreliable data or try to get that data through cumbersome processes
An enterprise data warehouse (EDW) is key to overcoming the current data challenges. An EDW enables users of all backgrounds (both technical and nontechnical) to analyze near real-time data easily through analytics applications. As demands for access to high-quality, accurate data continue to grow, workers will want better analytics tools, such as EDWs, so they can improve care and reduce costs.
Patient-Centered Care
The goal is to improve patient satisfaction scores and engagement.
Wearable Tracking Devices
Now 70 million people in the U.S. are using wearable tracking devices to monitor their physical activity, sleep patterns, calorie consumption, and a whole lot more. This is an exciting new frontier with so much potential to improve patient care. It will be fun to see the impact this trend has on improved patient engagement
3) Outcomes will continue to improve
An article in Modern Healthcare that showed improvements in patient safety in U.S. hospitals. In fact, approximately 1.3 million fewer patients were harmed between 2010 and 2013. That represents a 17 percent reduction in adverse events and the prevention of 50,000 deaths. The largest improvement was in CLABSI (central line-associated bloodstream infection), which showed a 49 percent reduction from 2010.
One of the driving forces behind improved outcomes is CMS’s emphasis on reducing hospital readmission rates. From 2007 to2011, the all-cause 30-day readmission rate among Medicare fee-for-service beneficiaries held steady at between 19 and 19.5 percent. Once CMS introduced readmissions penalties in 2012, the rate dropped to 18.5 percent. Then in 2013, it fell further to approximately 17.5 percent. The net result is roughly 150,000 fewer readmissions from January 2012 to December 2013. Once the 2014 figures are released, Expect to see even more reductions in readmissions and have already seen significant reductions from the health systems. For example, one health system reduced its heart failure readmission rate by 29 percent. By using analytics and an EDW, the organization was able to capture necessary data elements and then track various interventions quickly and adjust as needed.
4) Collaboration will increase
An important source for trendsetting in the healthcare industry is the annual JPMorgan Healthcare Conference. This year’s presenters showed examples of the importance of partnership and collaboration to survive the shift to value-based healthcare. These new partnerships cross industries and include companies outside of healthcare
Process Flow in Health Care Treatment
The Health care treatment can be classified into two categories:
1) Scheduled Treatment
2) Emergency Treatment
Scheduled Treatment
The scheduled treatment is the one in which the Subscriber (The Person who has bought the Plan) takes the Prior appointment from the Insurance company and avails the treatment from the doctor. The Flow of the same can be as follows:
1) Subscriber takes the Doctors (Usually Assigned PCP) Appointment from the Insurance Company.
2) PCP (Primary Care Physician) examines the Subscriber and if required he refers him to Specialist or the Hospital, This process of referring is called as Referral,
3) Hospital or Specialist provides the treatment to the subscriber (Owner of the Plan)
4) Hospital or Specialist files the claim with the Insurance company
5) Insurance company adjudicates or process the claim as In Network Claim.
Emergency Treatment
The emergency treatment is one in which Subscriber (Owner of the plan) gets treatment in condition which needs immediate health care treatment like Heart Attack. This does not require any referral or authorization from the insurance company (Honestly, These are not at all possible in emergency cases). The Flow of the same can be as follows:
1) Subscriber is taken to the nearby hospital, Clinic etc.
2) Hospital or Specialist provides the treatment to the subscriber (Owner of the Plan)
3) Hospital or Specialist files the claim with the Insurance company
4) Insurance company adjudicates or process the claim as In Network Claim (All emergency claims are processed as In Network Claims)
Clinical Operations and IT :
Health care Companies are getting more and more inclined towards use of latest Technology in order to improve the Performance of their systems. The Concept of "Clinical operations and IT" is getting special attention now a days from all Health care companies, “Clinical operations and IT” Refers to the "All the Clinical activities spanning from Creating the appointments for Members(Subscribers of health Plans), Noting their Diagnosis information and mapping the Services provided in order to cure the problem, Marking the Services as covered or Not Covered (As per the eligibility of the Member). All these activities are combined in a single Clinical record or Medical Record. The Information contained in a Clinical record or Medical Record could be following:
1) Dates: All the dates like Expected admission date, Expected Discharge date, Actual Discharge date, Treatment taken date.
2) Diagnosis Information
3) Physician and Hospital Information: Information related to the Provider like Which Provider gave the treatment to the member(Subscribers of Health Care Plans).
4) Services Information: Information about all the treatment services provided to the Member (Subscribers of Health care Plan) in order to cure
5) Decision Information: Notifying that Whether the Services provided were covered or Not as per the Plan of the member (Subscribers of Health care Plan)
6) Assignment Information: All theses Clinical records or Medical Record are assigned to at least one Clinical Business User (Employee of Health Care Company).
Different Types of IT Applications in Health Care:
Numerous Applications are being used by Health care Professionals now a days, Following are some of the examples:
1) Physicians are using Web Portals to get the History of Health Information of the member from the Health Insurance Companies databases
2) Physicians are using the Web Portals to submit the claims for the Services they provided to the member (Subscribers of Health care Plan)
3) Physicians and Members (Subscribers of Health care Plan) are using the Web Portals to see the status of their Claims.
4) Web Portals that educate the members of their health issues, Actually these Web Portals also acts as a source for Reducing the Health Care cost to the Insurance companies (If People fall ill, Insurance Companies pays otherwise They need not to pay)
5) Claim Processing applications: All the Health Insurance Companies use the automatic Claim adjudication engine that adjudicates the claims after verifying the Information in the Claim.
6) Middle ware Applications that translates the Information from one form to another so that data can be used by different applications (Irrespective of the platform)
7) The Latest trend are the Mobile applications, People tend to keep their Health information handy with them everywhere they go. Scenarios like this and Many other will be catered by the Health care Mobile applications.
