ICD-10, data security distracting from decision support, interoperability?

As healthcare organizations concentrate on ICD-10 conversions and data and system security issues, what's happening with decision support and interoperability concerns? Are they taking a back seat? How do healthcare organizations keep these on the front burners, too? Health Management Technology asks a panel of IT experts for their insights on how to ensure decision support and interoperability maintain a highpriority level.

"It's easy to get lost in 'initiatives de jour,' or projects of the day, month, or year. However, we must place the lives of patients as the reason why decision support and interoperability take precedent. The first step is to set explicit goals and engage with healthcare organizations, partners, and experts to build an infrastructure of evidence-based steps - perhaps even focusing on preventing harms and avoidable deaths. Don Berwick, M.D., said it nicely when he challenged U.S. hospitals to reaching the bold goal in the Institute for Healthcare Improvement's 100 Million Healthier Lives campaign: 'Some is not a number; soon is not a time.' Dr. Berwick's message relates today as we consider ways to raise the priority of decision support and interoperability efforts."

- Susan Niemeier, R.N., BSN, MHA, Chief Nursing Officer, CapsuleTech

"Hospital IT departments face great challenges in the next few years, and we are at risk of stagnating on the interoperability issue. I think the greatest push for connecting data and developing decision support systems will come from the economic, quality, and efficiency gains required in the coming years. There is no question value-based reimbursement and the care delivery models such as medical homes will be dependent on data stored in various health databases.

"We are reaching limits for innovating on staffing and supplies costs. The only realistic area to push innovation is on the technology front. Most healthcare systems and practices will be unable to change EHR vendors due to the expense and disruption that result from such a decision. Even for those who are currently considering or have undergone a merger, most will realize the problems remain. Looking for an innovative way to address these needs and working to design systems that are able to expand to the unforeseen needs of the future will provide the competitive advantage and, most importantly, address the needs of our patients in a costeffective and acceptable manner."

- Donald Voltz, M.D., Department of Anesthesiology and Medical Director of the Main Operating Room at Aultman Hospital in Canton, OH

"It's critical to focus on care and patient experience in order to bring decision support interoperability issues to a higher level. Without interoperability or decision support that enhances the patient experience, the promises of health IT will not be realized. Interoperability and decision support are so important that to worry about downstream issues is putting the cart before the horse. Showing the impact that these tools have on patient outcomes would be the best way to raise these issues to a higher level. Until clinicians and patients are involved in the design process, the care transformation process will not be complete."

- Thomas Van Gilder, M.D., Chief Medical Officer and Vice President, Informatics and Analytics, Transcend Insights

"All these things contribute to the clinical mission of care providers, but they also fit neatly into two major buckets: remaining financially viable and avoiding legal exposure. We need to make sure people understand them all that way. Navigating through the ICD-10 conversion is about making sure you can send a claim/ bill and keep cash flowing. Likewise, interoperability-enabled information sharing and collaboration between partners is a critical success factor for shared-risk payment arrangements and for delivering better, safer - and less litigious - care. Similarly, data breaches are costly and lead to lawsuits. Decision support contributes to more timely interventions and to better outcomes for patients covered by shared-risk payment arrangements; both are important for financial health and avoiding legal exposure from patient safety issues."

- Kathleen Aller, Director of Business Development for HealthShare, InterSystems

"ICD-10 is a great example of the criticality of strong decision support. Deferring on decision support will be a mistake, as the impact of the event is unpredictable, and will demand fast reactions to unfolding events regarding clinician, administration, and payer performance. We're planning to broadly share real-time industry data during ICD-10 conversion to help drive decision support and increased transparency."

- Jason Williams, Vice President, Business Analytics, Financial Solutions, McKesson RelayHealth Financial

"Regulatory mandates, such as ICD-10 or Meaningful Use, and risk management issues, such as data security, are priorities because failure to perform will result in significant financial repercussions. Decision support and interoperability become relevant priorities when investments in these functions can be clearly linked to the enterprise's financial performance. As alternative payment models become a larger share of total revenue over the next few years, systems will prioritize consistency, quality performance, outcomes measure, and a commitment to the lowest total cost of care - requirements that HIE and decision support enable. System leadership that can 'see over the wall' and recognize the strategic imperative of investing early, before fee-for-service margins get even lower, in technologies that will prepare the enterprise for value-based compensation will thrive."

- Larry Schor, Senior Vice President, Medecision

"Vendor products have been ready for ICD-10 for several years now, and most providers have had ample opportunity to retrain their staff or move to a revenue cycle management service. So the main concern about the ICD-10 transition will be whether there are any delays in payment on the part of insurance companies not being ready to handle the codes. As we move into new payment models where physicians and hospitals are being paid for outcomes, we will see that the business case for decision support and interoperability is going to drive interest and resources to focus on more use of decision support and broader sharing of data. The market will support the business needs of clients, and payment reform will change the business case from counting coding points to supporting accountable care-based reimbursement."

- Sarah Corley, M.D., FACP, Chief Medical Officer, NextGen Healthcare

"The best method is to leverage an existing infrastructure to achieve interoperability and open it with applications in support of decision support, independently from the infrastructure. Without this approach, healthcare would go back to do over and over the infrastructure via popular practices like 'rip and replace.' Rip and replace [approach] resets the health IT organization to ground zero, making it fall behind more in terms of providing clinical decision support to providers and not concentrating on other issues, such as ICD-10 and security."

- Thanh Tran, CEO, Zoeticx

By Rick Dana Barlow, Editor-at-large