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Tag: EHR

  • The Bumpy Rise of the Tech-Savvy CFO in Healthcare Organizations

    The Bumpy Rise of the Tech-Savvy CFO in Healthcare Organizations

    The good news? The working relationship between technology leadership and financial officers in health systems organizations is improving. The bad news? Chasms between finance and IT remain, and they are common throughout health systems providers.

    Market Research firm Black Book Research recently found, in its “2019 Black Book CFO & Financial Leadership Survey,” that chief financial officers (CFOs) are no longer prioritizing cost-cutting and are becoming more aggressive in their technology spending. Interestingly, 52% of CFOs reported that they are shifting their priorities to financial technology investments, such as the implementation of advanced analytics, as well as 44% who cited increased spending on broader distributed ledger technologies.

    This is a dramatic change over previous years, where financial technology in many healthcare organizations witnessed negligence and budget cuts. “Ninety-one percent of CFOs surveyed agreed that their past organizational CIO and senior IT management did not support a culture where financial technology upgrades and acquisitions were prioritized as initiatives that impacted enterprise health system strategy,” the report found.

    The survey found that 90% of financial leaders and management strongly agreed that CIOs and IT management undervalued the needs of financial digital transformation and their financial tools. Technology leaders instead prioritized and convinced their boards that their electronic health record vendor-related offerings were the best investment going forward.

    The result? When it comes to finance technology in healthcare organizations, the world has become quite bifurcated. Consider this: Ninety-four percent of marginally performing hospital CFOs nationally claimed that they are not prepared to handle new healthcare delivery and payment models with their current financial software. Comparatively, 89% of the top financially performing hospitals in the country report having the organizational technology tools to address modified payment strategies.

    There’s also no rest for the weary financial officer, the survey found. While senior financial officers struggled with the pressures of smaller operating incomes, rising labor and supply costs, shrinking volumes, reduced reimbursements, declining patient volumes and changing healthcare delivery models, 83% report that in the past fiscal year that they received add-on responsibilities that included organizational productivity, strategic technology and innovation growth initiatives.

    “In a noticeable shift since the acquisition of enterprisewide EHR systems led by CIOs, CFOs have become the executive charged with digital transformations to improve competitive advantages, strategic growth and innovation across all customer touch points, while measuring the technologies’ ROI,” said Doug Brown, president of Black Book.

    Indeed, there has been a huge shift in CFO involvement in recent years. In fact, 88% of CFOs report having increased involvement in their health system IT agenda since the implementation of their enterprise EHR, as compared to 14% in 2015.

    But this dramatic rise hasn’t been without friction:

    • 85% of all respondents stated that their current organizational structure prevents enhanced CIO-CFO collaboration. Eighty-nine percent of CEOs interviewed disagree with this statement.
    • 82% of CFOs stated that they have an insufficient understanding of IT issues as the barrier to them not being included in technology selections and approvals prior to 2014.
    • 84% of CIOs surveyed in Q4 2018 claimed the processes and tools in finance are incomparable to IT functions and remain a significant barrier to mutual understanding.
    • 90% of all respondents agree that the absence of key performance indicators that link IT agendas to financial performance greatly limits their success.
    • 98% of respondents strongly agree that it’s the healthcare CFO’s job to ensure their organization fully realize the benefits of technology investments, not the CIO’s job, in 2019.

    While the CFO’s role in technology has grown, largely due to the substantial impact of EHR adoption—and this has caused significant stress between the CFO and CIO in many health services organizations—the working relationship is showing signs of becoming stronger and more collaborative. The report found that the continuing lack in understanding on both parties to converge on strategies, investment mindsets, healthcare customer experience, business models and agendas continue to keep the barriers high for many.

    — George V. Hulme

  • Health Care’s Shift to the Cloud via the Hybrid Cloud, Part 2

    Health Care’s Shift to the Cloud via the Hybrid Cloud, Part 2

    In part one of this series, we looked at how the healthcare industry has changed, requiring integrations and interoperability that were not previously needed.

    Having established that the cloud is the way to go and that the hybrid cloud is the stepping stone hospital CIOs are comfortable with, we must ask how DevOps can help.

    DevOps in Health Care

    The legacy HL7 connection technology healthcare facilities use is a great example of how DevOps brings interoperability to health care and the hybrid cloud. “We have a cloud-hosted HL7 interface that can connect to any number of different hospitals and to our system as well. That’s something that would be very difficult to do without a cloud-based HL7 interface,” said Mayank Thanawala, CTO of HealthLoop, a provider of a cloud-based platform to automate follow-up medical care.

    Another challenge hybrid cloud can address concerns the registries that track patient episodes and the bundled payment initiatives that health insurance companies use to pay the hospital systems, Thanawala noted. “The challenge is that hospitals have to get the patient data into the registries in order to receive payment.”

    A hybrid cloud makes it easier to submit data to the registries because it provides an opportunity to connect to the registries using a system that already connects with the EMR system also and contains other data useful for registries and payments.

    Thanawala illustrated registry solutions in the hybrid cloud. The Comprehensive Care for Joint Replacement Program is a large registry hosted by Medicare CMS. Hospitals need data such as diagnosis histories from medical records and patient-reported survey information to submit to this registry. “So, in an example of a hybrid cloud, HealthLoop is a cloud system that uses a web interface to ask the patients the questions and collect the data. Then we use this hybrid cloud-based HL7 interface to query the on-premises EHR (electronic health records) system for all the rest of the data, fill in the blanks, create this file for this registry, and basically solve the hospital’s problem,” he said.

    How DevOps Speeds the to the Hybrid Cloud

    DevOps and the move to containers have helped accelerate health care’s move to the hybrid cloud. “When you deploy a Ruby on Rails API in, say, a Docker container, because of how the container is configured it is going to take care of logging for all of the applications and transactions and putting those in a store that will keep the transactions for the seven-year period that HIPAA requires,” Thanawala said. This automation saves the hospital CIO the step of having the logging set up.

    In the same way, if encryption of data both in flight and at rest is set up automatically in the container default configurations, that’s another matter the hospital CIO doesn’t have to worry about, he said.

    If applications are set up as microservices in containers so that they already perform all these functions when containers are created or scaled up, the hospital and HIPAA requirements surrounding these activities automatically are met. “This lets startups like HealthLoop focus on building app functionality so we don’t have to worry about these other more involved matters,” Thanawala noted.

    Even with health care’s complex move to the hybrid cloud, the modularity, completeness and singularity of applications in container technology as microservices make it possible to configure the containers, use them as building blocks and to build out efficient, scalable solutions in the cloud, he said. “It allows companies such as Catalyze, a medical systems integration and compliance organization, which we use to offer its products in a PaaS (platform-as-a-service) model using compliant containers so that we can simply deploy the containers and not have to worry about building compliance.”

    Saving Time, Effort, Worry

    HealthLoop’s story is a great example of how the automation and modularity of DevOps components such as containers and microservices can make or break new business opportunities, such as taking health care to the cloud and solving interoperation challenges.

  • Health Care’s Shift to the Cloud via the Hybrid Cloud, Part 1

    Health Care’s Shift to the Cloud via the Hybrid Cloud, Part 1

    The changing healthcare scene is dragging hospital systems into the cloud to enable the interoperability necessary for the industry to send electronic medial records (EMRs) and other data to outside systems such as registries that enable bundled payments.

    Because health insurance companies and Medicare only pay for patient episodes rather than for each subsequent treatment regardless of whether they’re medically necessary, hospitals must follow each treatment and take responsibility for them all. This gives hospitals incentive to get treatments right the first time.

    staging-devopsy.kinsta.cloud paints the landscape behind the healthcare industry’s DevOps-enabled move to the hybrid cloud together with illustrations of how DevOps speeds that transition.

    The Old World Order in Health Care

    The Old World order for health care dictated that each hospital maintain its own isolated, protected, siloed and closed systems and patient health records, which in the not-too-distant past were maintained entirely in paper documents and charts. “That closed system was a file cabinet,” said Mayank Thanawala, CTO of HealthLoop, a provider of a cloud-based platform to automate follow-up medical care.

    Patients likely would have outpatient visits with their doctors at the local clinic adjacent to the hospital. Interoperability between the hospital systems and the clinic systems amounted to hospital staff faxing over the patient record or chart or sending it over via Sneakernet.

    A transition still occurring to move all that into EMRs/EHRs (electronic health records), although in a similar model as paper, with closed systems tied to the hospital and local clinics. “These are mostly not cloud systems but are rather on premises with largely client-server topologies,” Thanawala said.

    Pain Points Driving Health Care’s Shift to the Cloud

    In the old billing model, the hospital or physician billed the patient’s insurance or Medicare for each individual visit and procedure, treating them as separate, disconnected events even when the patient had the same treatment twice for a single need. “Insurance companies and specifically Medicare are now saying, ‘Hospitals, we don’t really care about all these complications, we care about the overall cost. If your patient had to go to the emergency room and had to have you perform the same surgery over again, that’s on you. We’re only paying for that initial surgery,’” Thanawala said.

    The result is that the hospital must know whether the patient had additional care or the same care twice for the same need, where they had the procedure or treatment and what that was. A closed system, electronic or paper cannot address these requirements. “That is driving the need for interoperability between systems across different organizations, which is driving the shift to the cloud to handle that need,” Thanawala noted.

    Delays in the Industry’s Shift to the Cloud

    There is a breadth and complexity to health care that requires a great deal of cloud infrastructure, which is creating delays in the industry’s move to the cloud. Health care and HIPAA regulations demand tight, auditable security, which is easier to achieve with the current on-premises systems. “There’s not a lot of confidence in cloud security. It’s getting better, but hospital CIOs have great responsibility and want to be the kings of their domains where security and control are concerned,” Thanawala said.

    At the same time, and because it can be problematic for hospitals to update workflow technologies, the cloud must support legacy connections such as HL7 that are not going away. “HL7 is designed to work within a network. Once you talk about cloud systems accessing HL7, you are talking about site-to-site VPNs for security and developing to embedded older technologies such as versions 8 or 9 of Internet Explorer,” he said.

    The fact that the data so heavily affects people’s lives, including life-or-death situations, makes the proper scalability, security, stability, uptime and privacy, as well as all the other goals of the cloud and DevOps, doubly important. “It adds another level of scrutiny and pressure to the move to the cloud,” Thanawala said.

    Take, for example, auditing, which touches every piece of healthcare data with such intensity. “From a systems perspective, you have to start thinking about auditing systems and tracking all transactions seven years back, which puts a lot of pressure on logging systems and databases,” he noted.

    As for uptime, if a healthcare system goes down, how does it affect life-or-death situations in that moment?

    How Health Care’s Transition to the Hybrid Cloud is Unique

    “The hybrid cloud gives the hospital CIO the ability to maintain control over what they need to control and still look to the cloud to enable the integration and interoperability with outside systems,” Thanawala said. This is important because of the many factors that make transitioning to the cloud unique in the healthcare industry, including:

    • Users in hospitals blame their systems—systems the CIO is responsible for—for any number of challenges and errors.
    • Healthcare facilities don’t really have to scale in the cloud quickly, because in health care there already is a defined patient population and facilities won’t have a large number of new users signing up that it can’t handle.
    • Service providers must convince hospital CIOs that collaborating with cloud technologies, including opening up VPNs and ports where necessary, is worth the risk.

    Digging into DevOps

    In part two of this series, we’ll explore how DevOps helps to enable the hybrid cloud in health care.