Over the weekend, I read an interesting article in the New York Times on doctors giving up private practices in America. It seems that the number of physician-owned practices has declined from a relatively stable rate of 70% to below 50% in the course of three years. Who’s buying these practices? Hospitals and healthcare systems (also known as an Integrated Delivery System [IDS] or Integrated Delivery Network [IDN]).

I’m not surprised by the trend. Indeed, I’ve witnessed it firsthand. A couple of years ago, my primary care physician sold her ‘mom and pop’ practice to a large multi-facility, multi-specialty ‘big medicine’ corporation. However, I was surprised by the rate of change: a decline of 20% in three years. 

Clearly, this has wide-ranging implications for the future of health care system. As in any industry, ‘vertical integrations’ and ‘supplier consolidations’ alter its dynamics. If it’s not already done so, it will give providers more power in negotiating with private insurance payers. It could also reshape the relationship between providers and patients, thereby making it less personal and more transactional (a trend we’ve already seen with the rise of the ‘McClinic’ at pharmacies, grocery stores, shopping malls, etc.).

I suspect it will also have implications for health information technology (HIT). Given a shared pool of resources (both financial and human capital), it is reasonable to expect an increase to HIT adoption rates, as well as a general trend toward more robust and complex enterprise-class solutions. As a result, I anticipate that HIT vendors—especially those selling enterprise software to manage practices and electronic medical records—will continue to consolidate as well.          

For more information, I’d recommend visiting the MGMA web site, which includes a series of interesting blog posts on the topic of selling a private practice to an IDS.   

Yesterday, President Obama signed health reform into law. Much of the political debate and media coverage has focused on controversial issues (whether real or imagined) related to public policy. However, while not as scintillating for pundits as the likes of so-called ‘death panels’ nor as ironically amusing as the sight of senior citizens with placards telling the government to “[keep its] hands off of my Medicare,” the legislation incorporated a multitude of less controversial but equally impactful measures. These reforms included fairly significant—though largely overlooked—‘administrative simplification’ provisions that promise to bend the cost curve related to handling ‘paperwork’ for payments.  

To spread the word about these changes, I’ve put together this brief list of online resources that might be helpful for better understanding the implications of health care reform’s ‘administrative simplification’ provisions:

First, you might want to look at the actual legislation (HR 3950), especially section 1104 (starting on Page 28 for those of you playing the at home game). Then again, if you’re not looking to cure insomnia, here’s a summary of ‘administrative simplification’ as provided by Democratic Policy Committee: 

Accelerates HHS adoption of uniform standards and operating rules for the electronic transactions that occur between providers and health plans that are governed under the Health Insurance Portability and Accountability Act (such as benefit eligibility verification, prior authorization and electronic funds transfer payments). Establishes a process to regularly update the standards and operating rules for electronic transactions and requires health plans to certify compliance or face financial penalties collected by the Treasury Secretary. The goal of this section is to make the health system more efficient by reducing the clerical burden on providers, patients, and health plans.   

Second, I’d suggest you read a couple of pieces from Health Data Management in the form of a news article and a related commentary. For my part, I too wonder about whether or not the industry will be able to adjust to the pace of change over the next five years. Certainly, history suggests that delays will be inevitable. So, it’s a fair question to contemplate and something I intend to explore in more detail.

Third, because the legislation calls for the adoption of operating rules for electronic health transactions (which go beyond conforming to basic EDI standards), I’d recommend becoming more familiar with CAQH CORE. VisionShare has been a longstanding supporter of CAQH, participating actively by both helping to draft Operating Rules and implement them in our products.

I’m very excited about HIMSS this year.

VisionShare will be exhibiting at the conference and demonstrating some of the capabilities of our platform to support the information exchanges required by the government’s “meaningful use” criteria. In particular, we’ll show how our Secure Exchange platform may be leveraged to support clinical information exchange in both its “push” and “pull” forms, as well as our ability to support administrative transactions (which are an important, if often overlooked, element of “meaningful use”).

Of course, we’re not just going to show off our shiny new toys (though, that is a lot of fun). Our primary goal is to engage in conversations about your needs and concerns, whether you’re a healthcare provider, HIE, government agency, or fellow HIT vendor. In doing so, we hope to respond in a manner that is actually meaningful with cost-effective, workable solutions based on your needs.

So, stop by and let’s chat. We’ll be at booth #863.

Beyond VisionShare activities, I think the education sessions look good this year.

Despite what’s always a frenetic pace for me, I’ve made sure to carve out time for particularly interesting sessions. I’m especially attracted to talks about the economic sustainability (really, long-term financial viability) of health information exchange, which has been something akin to our industry’s quest for the Holy Grail (though, to date, less fun than the Monty Python version).

I’m also interested in sessions related to the future of the Nationwide Health Information Network (NHIN), as well as real-world examples of the thorny, yet important problems it seeks to address (e.g., coordination of care for our wounded warriors). Of particular note, I’m hoping to hear more about the “NHIN Direct” initiative, which was announced earlier this week. It aims to provide lightweight versions of NHIN standards and services, thereby lowering the barriers to adoption by smaller providers. As more details are to be released next week, I’ll save my color commentary for later.

Finally, I’m looking forward to the “networking” aspects of this mega conference—catching up with old colleagues and friends, as well as meeting interesting new people. Since I was in Egypt during last year’s conference, this will be my first visit to HIMSS since 2008 (in a pre-ARRA/HITECH world). Given these changes and the ongoing debate over healthcare reform, I’ll be interested in gauging how the overall vibe of HIMSS has changed (or not) and hearing what people are most excited about.

In my professional career and academic research, I’ve been fascinated by the successes and (all too often) failures associated with investments in information technology. While we’ve largely debunked Robert Solow’s famous quip that “you can see the computer age everywhere but in the productivity statistics,” I’ve never met an experienced IT professional that couldn’t regale you with one or (often) more stories about project failures of Hindenburgian proportions.

In short, failure happens.

What does this have to do with health information exchange?

One year ago today, President Obama signed into law the American Recovery and Reinvestment Act (ARRA) of 2009. As you probably know (unless you’re my mother, who might be reading this blog too), this economic stimulus package included provisions known as the Health Information Technology for Economic and Clinical Health (HITECH) Act, which provided massive public funding for investments in health information technology.

From my viewpoint, the tidal wave of dollars has already altered the landscape of this industry sector. It’s introduced new terms to the lexicon, such as ‘meaningful use.’ And, it has reinvigorated hope for widespread clinical information exchange, which languished for years in the doldrums of successive rounds of CHINs, RHIOs, and HIEs.

Yet, gargantuan investment alone won’t ensure ‘success.’ Remember: most dotcoms didn’t fail because they lacked capital. No matter how much we enjoyed canine sock puppet television advertisements or the promise of grocery orders being delivered via vans, the operating models of such enterprises wasn’t sustainable.

We run that same risk today in trying to push forward health information exchange. In fact, we still lack (as a profession or society) a clear definition of HIE success beyond somewhat vague notions of ‘transforming healthcare.’ And, if we look to the wisdom of crowds, consensus seems to be that ‘meaningful use’ isn’t sufficient—in and of itself—to get the job done.

Given that, how we can we really make health information exchange meaningful? 

I have a few suggested principles:

First, we should look to what I call the ‘Return on Health Information Exchange’ (RoHIE) investments. That is to say, HIE can only be ‘successful’ if the benefit it provides exceeds the cost of its delivery over the long-term.

Second, we should maximize benefits by focusing on the most valuable ‘use cases’ first. As a starting point, we should build consensus around those that are most likely to improve patient outcomes and/or reduce healthcare delivery costs. 

Third, we should expect HIT/HIE vendors to innovate in order to drive the expenses associated with health information exchange as close to zero as possible. As the product leader at VisionShare, that’s certainly one of my objectives.   

By optimizing both sides of the cost-benefit equation, we maximize the probability of ensuring that we engage in a truly ‘meaningful’ exchange of health information.

 To that end, I intend to focus my writing on…

• Health information exchange as an action verb (rather than a static noun) to better understand and explore the need and demand for such ‘exchange,’ as well as explore the workflow implications of providers.
• Use cases (rather than underlying technologies) that can transform healthcare by improving patient outcomes and lowering care delivery costs.
• Perspectives of providers and other stakeholders, including (and especially) those representative of the ‘silent majority’ rather than repeating the messages and concerns of the ‘chattering class’ of HIT pundits.
• Return on Health Information Exchange (RoHIE) – tangible methods and approaches for maximizing, assessing, and evaluating outcomes, as well as ‘case stories’ that demonstrate successes (and failures).      

One final note: I’ll always welcome your comments and feedback (favorable or not) on my views. Dialogue is the most effective means of building consensus. Besides, this blog isn’t called a ‘Meaningful Exchange’ for nothing.