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CIO BRIEFINGSWhat CIOs Need to Know and Do
OCTOBER 2016
WWW.HEALTHLEADERSMEDIA.COM/INTELLIGENCE
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Facing significant pressure to shift from
volume to value, providers continue to
search for ways to improve their clinical
documentation. The challenge, of course, is
that no single strategy works for everyone.
There are simply too many variables:
• EHR technology differs, particularly
within consolidating health systems.
• Hospitals and ambulatory clinics have very
different organizational workflows.
• Some clinicians have embraced speech
technologies willingly, while others are
more comfortable with transcription.
• Analytic requirements differ depending
on a provider’s data needs for accountable
care and population health strategies.
In addition to these complex dynamics,
the onerous requirements of clinical
documentation are contributing to an
unprecedented degree of physician burnout.
As a response, organizations are striving to
integrate the EHR with solutions that enhance
the clinical documentation experience for
physicians. There are two key areas in which
healthcare leaders need to invest:
Giving Clinicians a Choice in Documentation Methods
Even as the industry rapidly embraces direct
dictation into the EHR through real-time
speech, many organizations continue to offer
transcription services. In doing so, they’re
allowing clinicians to decide which option
is the best use of their time. Moreover, these
Sponsor Perspective: Building a Documentation Strategy on a Bedrock of Flexibility and Choice
Satish MaripuriExecutive Vice President and General Manager, HealthcareNuance CommunicationsBurlington, Massachusetts
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documentation solutions are increasingly available on
mobile devices, whenever and wherever they’re needed:
in the office, on the road, or at home. By offering
clinicians choice and flexibility in how they document,
organizations are improving the speed and quality of
documentation, while freeing clinicians to focus on
patient care.
Capturing Quality Documentation at the Point of Care
To support care coordination, accurate documentation
should happen in the moment, not days or weeks later.
Organizations are investing in computer-aided physician
documentation technology to prompt physicians
with information that supports diagnosis specificity
at the point of care. They’re also rethinking clinical
documentation improvement programs, using trained
nurses to work alongside and coach doctors toward
more accurate documentation. These strategies make
documentation less distracting for physicians while
allowing them to capture necessary details to expedite
financial reimbursement and improve compliance, care
coordination, and outcomes.
As every organization charts its own course toward value-
based care, there’s no denying the need for integrated
solutions that improve the physician’s experience through
greater choice and flexibility. With the right solutions,
clinicians can meet documentation requirements in a way
that doesn’t disrupt their workflow and allows them to
get back to the patient.
For more information, visit nuance.com/healthcare.
Sponsor Perspective (continued)
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Healthcare IT Strategy
In many aspects of healthcare, we see indications of
change, with movement toward new payment models
and investments in infrastructure to support the
delivery of value-based care. While the direction is
clear, it is also clear that many of today’s providers
lean more toward positioning for change than toward
implementing change.
While nearly every provider is engaged in this
transformation to a degree, not all providers are
evolving at the same pace, and there is variability
between organizations in terms of the level of
commitment to value-based care activities. But no
one wants to be behind the competency curve when it
arrives, and it can be expensive to build competency
for a new model before it is financially viable, which is
why providers remain cautious.
Healthcare Analytics Activity
Healthcare is witnessing the evolution of analytics
from mainly a finance and administration tool to
an expanded role that includes integrating financial
and clinical data—an evolution that continues to
gain momentum. Its use and sophistication, driven
by the steady advance of value-based care and the
assumption of greater downside risk by providers, will
likely accelerate in the coming years.
As the industry moves from fee-for-service to value-
based care, providers will likely find themselves
consumed with analyzing payer- and patient-related
data from diverse internal and external sources.
The need for analytics tools to make sense of these
disparate sources will only grow.
Some of the challenges may relate directly to financial
resources, while others are more closely tied to levels
of expertise. The need to deliver timely analysis is a
challenge for all industries, but it is perhaps even more
acute in healthcare.
Executive Summary:What CIOs Need to Know and Do
What Leaders Are Saying“Key factors are the credentialing of the specialists used to view the patient via telemedicine and the ability of the specialists to be compensated for their time and liability.”—Chief financial officer for a medium hospital
“You need to ensure that the support areas such as imaging and IT are on board from the very beginning and that they are available to troubleshoot when the need arises.”—Chief nursing officer for a small hospital
“We are moving our independent data analytics teams to imbed them within finance and clinical quality to improve the contextual analysis of the information.”—Chief financial officer at a medium health system
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Telemedicine and ED Efforts
Emergency departments are optimized to provide emergency care,
of course. The timing of medical emergencies cannot be predicted,
so EDs must maintain continuous readiness. Their open-door
policy brings patients who need emergency care, patients who worry
that they might need emergency care, and patients who don’t need
emergency care at all.
While the effective handling of patients with emergent conditions
remains a principal focus, to deliver that care, EDs also need
techniques to be effective with nonemergent patients. One new
technique they are considering is telemedicine.
Nearly half of respondents to a recent HealthLeaders Media survey
use telemedicine in EDs now, and another 11% expect to begin
using it within three years. Among those using telemedicine in their
EDs now, the top applications are for neuro/stroke consults and for
behavioral health consults.
IT Systems and Value-Based Care
IT is expected to play a critical role in the effective delivery of value-
based care, and developing competency in this area is a strategic
priority for most providers.
Within IT, EHR elements lead the list of areas organizations are
committed to developing or have developed as a competency for
value-based care. The top three responses are enhancing provider
efficiency through EHR usability, EHR interoperability, and EHR
standardization among care partners.
Because not moving forward may mean being left behind,
healthcare organizations face serious strategic decisions. Once
a path is identified, the executive team must implement systems
to monitor progress, as well as make strategy adjustments when
needed.
Executive Summary (continued)
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More than one-quarter (28%) of healthcare leaders say clinical IT is the No. 1 strategically important IT area in supporting their pursuit of financial targets over the next three years. A similar share, 25%, say EHR interoperability is No. 1. Although only 11% say data-driven knowledge of patient health factors is the No. 1 IT area of strategic importance, 52% include data-driven patient knowledge among their top three.
Survey Question: Of the following areas of healthcare IT, please rank the top three according to their strategic importance in supporting
your organization’s efforts to reach its financial targets over the next three years. Base = 471. Source: HealthLeaders Media Intelligence
Report, January 2016, Ready, Set, When? The Drawn-Out Shift to Value.
HEALTHCARE IT STRATEGY
Clinical IT
EHR interoperability
Predictive analytics
Data-driven knowledge of patient health factors
Telehealth
Security
Mobile health, mobile technology
Actuarial skills for risk assessment
25%
10%
3%
3%
2%
11%
28%
18%
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Survey Question: Please select the top three data-related challenges your organization expects to face in performing analytics over the next
three years. Base = 350. Source: HealthLeaders Media Intelligence Report, February 2016, The Analytics Challenge: Gaining Critical Insight Into
Risk-Based Models.
The top three data-related challenges respondents expect their organizations to face are integrating internal clinical and financial data (54%), establishing/improving EHR interoperability (47%), and integrating external clinical and financial data (41%).
TOP DATA-RELATED ANALYTICS CHALLENGES OVER NEXT THREE YEARS
Integrating internal clinical and financial data
Establishing/improving EHR interoperability
Integrating external clinical and financial data
Improving data accuracy
Creating full internal/external patient histories
Accommodating unstructured data
Obtaining payer claims data
Obtaining per-unit or per-case cost data
47%
26%
24%
23%
22%
32%
54%
41%
Don’t know 4%
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Responses for claims data—Medicare/Medicaid patient claims data (78%) and commercial payer patient claims data (67%)—take the top two spots for finance-related data drawn on now. The prevalence of payer claims data suggests the importance of analyzing the relationship between patient care and revenue. Internal provider productivity data, which is the third most frequently mentioned data source, provides insight into the cost part of the value formula; it also offers the benefit of provider-specific performance tracking.
Survey Question: Please select the top three data-related challenges your organization expects to face in performing analytics over the next
three years. Base = 350. Source: HealthLeaders Media Intelligence Report, February 2016,
The Analytics Challenge: Gaining Critical Insight Into Risk-Based Models.
HEALTHCARE ANALYTICS ACTIVITY
Medicare/Medicaid patient claims data
Commercial payer patient claims data
Internal provider productivity data
Patient financial data
Chargemaster data
Payer cost data
Care partners’ provider productivity data
Care partners’ cost data
67%
52%
38%
19%
17%
54%
78%
59%
Don’t know 4%
None 1%
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Medicare/Medicaid patient claims data (83%), commercial payer patient claims data (76%), and internal provider productivity data (66%) are the top finance-related data types respondents expect to draw on within three years. All data types are expected to increase compared with finance-related data drawn on now, with the greatest increases found in care partners’ cost data (up 24 points), payer cost data (up 18 points), and care partners’ provider productivity data (up 17 points).
Survey Question: Which of the following types of finance-related data do you expect your organization to draw on for analytics activity
within three years? Base = 350. Source: HealthLeaders Media Intelligence Report, February 2016,
The Analytics Challenge: Gaining Critical Insight Into Risk-Based Models.
TYPES OF FINANCE DATA DRAWN ON FOR ANALYTICS WITHIN THREE YEARS
Medicare/Medicaid patient claims data
Commercial payer patient claims data
Internal provider productivity data
Patient financial data
Payer cost data
Chargemaster data
Care partners’ cost data
Care partners’ provider productivity data
76%
56%
55%
41%
36%
60%
83%
66%
Don’t know 7%
None 1%
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Providers lean toward using a vendor’s proprietary software, or a combination of proprietary software and open-source software, because developing in-house analytics software can be time- and resource-intensive. Their analytics teams may also lack the necessary skill set to conduct software development.
Survey Question: Which of the following best describes your current applications for working with large and/or complex data sets to
reveal trends or specific insights? Base = 326. Source: HealthLeaders Media Intelligence Report, February 2016,
The Analytics Challenge: Gaining Critical Insight Into Risk-Based Models.
CURRENT APPLICATIONS FOR WORKING WITH LARGE/COMPLEX DATA SETS
Vendor’s proprietary analytics software
A variety of open-source and proprietary software
Our own in-house analytics software
Open-source analytics software and utilities
Other
Don’t know
No analytics-specific software or utilities
24%
2%
7%
10%
6%
33%
18%
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Nearly half of respondents (49%) use telemedicine in EDs now, with 33% planning additional deployment. Another 11% expect to use telemedicine within three years, and one-quarter are still investigating. The benefits of the technology are apparent, and it is just a matter of time until it becomes a standard ED resource.
Survey Question: What is your organization’s status regarding deployment of telemedicine in the ED? Base = 212. Source: HealthLeaders
Media Intelligence Report, May 2016, ED Success: Coordinating Emergent and Nonemergent Care.
TELEMEDICINE AND ED EFFORTS
16%
33%
11%8%
Use already, fully deployed
Use already, additional
deployment planned
Usage planned within three
years
Investigating Do not plan to use
25%
Don’t know
8%
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By far, the telemedicine application mentioned most frequently is specialty neuro/stroke consultations (79%). The second most common use is for behavioral health consults (40%). However, telemedicine has broad applications. Other cited uses are pediatric consults (mentioned by 6%) and burn consults (mentioned by 4%).
Survey Question: What are the principal applications for telemedicine in your ED? Base = 125. Source: HealthLeaders Media Intelligence
Report, May 2016, ED Success: Coordinating Emergent and Nonemergent Care.
PRINCIPAL TELEMEDICINE APPLICATIONS IN ED
Specialty neuro/stroke consults
Behavioral health consults
Remote diagnosis via diagnostics interface
Patient monitoring in lieu of bedside observers
Specialty surgery consults
Pediatric consults
Burn consults
Don’t know
40%
10%
6%
4%
1%
14%
79%
17%
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Slightly more than half of respondents (52%) say they are in the beginning stages of evolving their processes and systems to support their care teams and practices in coordination, communication, and patient outreach efforts. Only 3% say their care processes and systems are fully mature, though a fairly large percentage (33%) say these are evolving to a mature state. Only 11% say they are still evaluating required changes.
Survey Question: How well do your existing processes and systems support your care teams and practices in their coordination,
communication, and patient outreach efforts? Base = 212. Source: HealthLeaders Media Intelligence Report, July 2016,
Value-Based Readiness: Building Momentum for Tomorrow’s Healthcare.
STATUS OF CARE PROCESSES AND SYSTEMS
3%
33%
11%
Our care processes and
systems are fully mature
Our care processess and
systems are evolving to a mature state
We are in the beginning stages of evolving our processes and
systems
We are still evaluating
required changes
52%
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EHR elements dominate the top three IT areas. Respondents say their organization is committed to developing or has already developed a competency for value-based care, led by a tie between enhancing provider efficiency through EHR usability (73%) and EHR interoperability (73%), and standardizing EHRs among care partners (65%). While predictive analytics (42%) receives the lowest response, this will likely change over time as providers continue to develop analytics skills and invest in IT staff to leverage this important tool.
Survey Question: For which of the following IT items is your organization committed to developing (or has already developed)
competencies to prepare for value-based care? Base = 200. Source: HealthLeaders Media Intelligence Report, July 2016,
Value-Based Readiness: Building Momentum for Tomorrow’s Healthcare.
IT AREAS COMMITTED TO DEVELOPING COMPETENCIES
Enhancing provider efficiency through EHR usability
EHR interoperability
EHR standardization among care partners
IT-based clinical decision support
More rigorous data accuracy standards
Prescriptive analytics (predictive plus suggested solutions)
73%
47%
42%
59%
73%
65%
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In the previous figure, respondents indicate that they are especially committed to developing EHR competencies to prepare for value-based care, and this figure reveals that this commitment is paying off—55% of respondents say their EHR standardization among care partners is very strong or somewhat strong, and 55% say this for EHR interoperability. Rounding out the top three for very strong and somewhat strong responses is more rigorous data accuracy standards than required by fee-for-service (51%).
Survey Question: What is your organization’s level of strength in each of the following areas of IT, specifically as it relates to the change
from fee-for-service to value-based care? Base = 212. Source: HealthLeaders Media Intelligence Report, July 2016,
Value-Based Readiness: Building Momentum for Tomorrow’s Healthcare.
IT AREAS LEVEL OF STRENGTH
EHR standardization among care partners
EHR interoperability
More rigorous data accuracy standards than required by fee-for-service
Staff analytics skills to identify patient cohorts
Integrating data sets from various sources, including payers
Staff actuarial skills for financial risk assessment
Prescriptive analytics (predictive plus suggested solutions)
Very Somewhat Somewhat Very strong strong weak weak
15% 40% 31% 14%
14% 41% 33% 12%
7% 44% 40% 9%
6% 41% 37% 17%
6% 33% 41% 20%
6% 30% 39% 25%
3% 30% 44% 23%
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