Where There is Change, There is Opportunity

As I was coming into Vegas, it occurred to me that never before in my 20 plus years of lab it experience have I seen so much change occurring in such a short period of time. We have ACOs coming at us, ICD9 to 10, there is the 4010 to 5010 conversion happening soon, the HITECH Act, stimulus funds, bending the healthcare curve, meaningful use for both ambulatory and acute, wild fires in Arizona and have I mentioned ACOs? We’re also seeing new and strange bedfellows coming around. Insurance companies are getting into the HIE and connectivity business, Quest has an ‘open connectivity strategy’ with Medplus and an EHR 360.

But on the other hand, I don’t think I’ve ever been so optimistic, too! All and all, the hospital and reference markets are doing very well.

If you look at the laboratory market in its entirety, 22% is the national, Lab Corp and Quest. They are organized. They seem to be everywhere telling their and your clients they can connect to an EHR in two weeks for practically free. But here is a surprising statistic; 54% of the lab market is hospitals, the rest is reference specialty labs and 5% POL. But the nationals at 22% are not nearly as big as what I would have guessed and, here is the kicker, they are not growing organically, it’s thru acquisition! Hospital labs are growing organically, so something is going right! Here is another statistic I picked up from an insurance company presentation. People in their 20s and 30s use on average two lab tests a year! People in their 50s, 60s and 70s use over eight! The sea is going to rise as all of us young baby boomers get a tad older.

But there is competition and change, and where there is change, there is opportunity. Let’s take the EHR market for a moment. It’s expected to grow from a 20-80% adoption rate in just a few years. Seventy percent of all EHR data is lab! Seventy to eighty of diagnosis are in part based on laboratory data! So what good is an EHR without the very valuable services the laboratory service market provides? Docs want the data in there, the EHRs want the data, insurance companies want the data and so does the government and, of course you know, it is in part tied to the subsidies.

So in our own analysis, we have determined that a physician on average trades with 2.8 laboratory service providers each and many have more than this. Physicians will want this data electronically, including orders and, if they don’t get it, they may decide to go elsewhere. So here is the opportunity and the threat. Without a strategy and connectivity, your clients might go elsewhere to get it, but with a strategy you can secure, clients who might otherwise leave and you may be able to expand you market share (organic growth) from those labs that are not so well prepared. As an aside, there are there are around 375 to 400 different EHRs out there and we haven’t seen a consolidation yet, we actually are meeting new ones still.

Okay, here is the crass commercial. At Halfpenny, we connect to EHRs, to approximately 128 different EHRs today. We provide this connectivity day in day out and are good at it. We are ‘the’ strategy for some organizations and others we augment or are a backup to existing IT initiatives. We also push results to hand held devices, now orders too, and provide LOINC mapping. Okay, I am done. Anyway, my encouragement is to develop a strategy if you don’t have one and or you might consider a backup position too … and if interested, we’d love to talk with you.

 

When Splitting Up is for the Best

Centralizing. One-stop-shopping. Consolidating. Sole sourcing. Streamlining. All of these actions have one common denominator; unifying a set of activities under one umbrella. Why not? It’s easier, more convenient, and should be cost effective, right? Maybe, but perhaps not when it comes to hospitals, labs, and physicians needing their lab orders to be routed to more than one testing laboratory for various legit reasons.

Ordering lab tests can be a complex process, even within a health network. Oftentimes a single lab order should be divided into two or more requisitions. The reasons can be many. The physician’s office can perform one or more of the tests in the office. The insurance company requires the separation. It’s most cost effective to send one of the tests to an outside lab. The order needs to go to a third-party subcontracted by the first lab. The provider prefers to bill insurance companies directly in order to obtain markup revenue, regardless if test is or is not conducted in their office. Hence, this is definitely an instance when splitting up is for the better.

Since test results from labs due influence nearly 70% of all healthcare decisions made today while representing only 2% of total healthcare costs, hospitals, labs, and physicians should have the choice and flexibility of splitting a requisition when needed. But let’s throw another monkey wrench, so to speak, into the mix while we’re at it. Does the hospital, lab, or physician office have an existing electronic health record (EHR) system in operation to automate and streamline the clinician’s workflow, reduce any errors and offset costs? What happens when there is an EHR system in place? What happens when there isn’t? How does an EHR system facilitate splitting an order? Better yet, how do you split a requisition without an EHR system?

Questions, questions, and more questions. Well, here are some answers.

The best action is to provide hospitals, labs and physician offices with a simple way to divide a single lab order into two or multiple, with or without an EHR system. A foolproof method to automatically split orders right from the start, during order entry and based rules on sample type, storage temperature, testing location, test type, order location, billing status, CPT code, order choice priority or type, insurance, physician preference and/or other measures.

Halfpenny Technologies (HTI), a leading provider of healthcare connectivity and integration solutions, offers hospitals, labs and physicians the means to split a single lab req into two or more requisitions with or without an existing physician EHR system. This capability is not only priceless, but essential as most physicians utilize multiple labs and route their test orders in accordance with the patient’s insurance, type of tests required, billing practices, or their own preferences.

Here’s how Halfpenny generates split requisitions. With an EHR system, Halfpenny receives the lab order from the EHR and automatically splits it according to rules controlled by authorized users and then prints specific labels, requisitions, and/or manifests as needed and routes the orders to the correct testing laboratory based on the hospital or physician’s workflow requirements. When the results are received, Halfpenny re-bundles and forwards them into the appropriate patient record within the EHR.

When there is not a physician EHR system, Halfpenny will implement one of its own proprietary solutions, ITF-Portal® or ITF-GoDoc® MobileOE, to facilitate the order entry directly and split the req utilizing the same rules described above. Either way, the split successfully occurs and the results can be combined and incorporated into an EHR system if available or viewed within one or both of the HTI solutions.

Splitting up a req to be routed to the correct testing laboratory is not only in the best interest of hospitals, labs, and physicians, but in the long run it’s also in the best interest of the patient who receives better care and better patient services. It saves valuable time, unnecessary costs and precious manpower. If you are still sole sourcing your lab orders to one facility, look a little further to the many benefits and advantages of splitting up a requisition. You might realize that breaking up is not so hard to do after all.

What is the Right Connectivity Strategy for My Outreach Program

and how about them U of A Wildcats; I think they have a real chance this year in the NCAA!

Let’s review the environment. In many areas of the country, the penetration rate of physician of EHR/EMRs will drive from a lowly 20% to nearly 80%. This adoption rate is fundamental to the changes necessary to drive more effective and efficient healthcare. But let’s also be honest, too; it is also driven by funding from good old Uncle Sam. These physicians and physician groups will also want to comply with meaningful use criteria to qualify for stimulus funding to underwrite their costs of entering the new electronic medical record and health record era.

Meaningful use criteria, as many already know, in stage one, two and three begin and then accelerate sophisticated use of these systems. Early stages mandate the storage of discrete data like lab which comprises nearly 80 to 90% of the potential data within an EMR. Let also not be modest; laboratory diagnostic data represents probably the largest data source for diagnostic efforts of physicians. No bias here! Later stages mandate Order Entry so drug-to-dug, drug-to-disease interactions can be checked, and – drum roll, please – laboratory ordering which eliminates errors, reduces manual data entry, (there is a solid ROI behind clean orders and getting paid, but that’s another blog) and promoting quality and efficiency across the spectrum of care.

It only makes sense. Reality check number one; there are at least 375 different EMRs out there that we know about. We are learning about new ones on the pace of a couple per month. It is the Wild West, and it sort of feels like a there is a stampede coming over the hill doesn’t it?

If you are one of the 75% of hospitals laboratories in America with an outreach program or are a reference lab, you could be facing this stamped and that’s actually not the worse part. The worst part is they are all DOCTORS!!!!! (By the way, I hope our Chief Medical Information Officer does not read this blog, but I couldn’t help throwing that analogy in. You should see him when he is mad; he turns all sort of funny shades of red and purple! Anyway…) So, you are facing the stampede and wondering what’s the right strategy. Okay, let’s start with the options.

Option 1. My IT department controls an Interface Engine. Why can’t I just connect my orders and results to it, and let them connect to all the different EMR’s? Sounds simple, right?

Here are a couple questions to ask yourself.  Does your IT department have a lot of extra time on their hands? Have they already completed the ICD9 to ICD10 and 4010 to 5010 conversions? Are they prepared to handle the stampede? Can they deal with 375 different EMR systems? Are they good with doctors?

Option 2. I could use the physician access system/portal vendor I am currently doing business with! Sounds good, doesn’t it? If you are using one of them, they probably already have some connections out there. You have used them for quite some time. You like them or maybe not.

Okay, here are a couple questions to ask yourself. Are they prepared to handle the stampede? Can they scale to the demand you have and all of their other customer’s needs, too? Is EMR connectivity a sideline or are they really in this business with both feet? How is there service now? What might it be like when things get really crazy?

Option 3. Use the local HIE. This one usually comes from corporate. “We don’t want you wasting time building interfaces to EMR’s, because we have that covered with this here strategic relationship with the state’s HIE!”

Okay, you have got my pattern figured out. Here are some questions to ask yourself. Who is faster at building interfaces to my clients’ EMR, the HIE or my competitor? Can you afford to wait? Does the HIE initiative take care of the special requirements and workflow of lab order and result processing? How are the specimens going to be received? Will I be able to get paid with the information they are sending? How will MRN, Event, Episode or Account Numbers be associated with the order when transmitted to the LIS? Will the physician be presented with ask-at-order-entry-questions? Will an ABN get printed, signed and will the transaction contain an indicator of same? Is the HIE technology biased in any way that might prevent it from interfacing really well to all my customers EMRs?

(Note to reader: some HIE technology vendors are also EMR vendors and may not play nice with other EMRs or heavily influenced by your competitor. You get the picture. Their goals may not coincide with your goals to protect and grow your business.  At the worst case, you might want your own strategy in place or at least a backup!)

Option 4. Find a vendor who does this for a living: just this.

Big Finish – I hope you find the rather weak attempts at humor and analogy not too distracting. There is merit within each option and other’s I haven’t mentioned, but I pick on each pretty hard for a purpose. There is a are large demand for connectivity now and we expect it to grow.  Your strategy and options deserve careful consideration and potentially a multifaceted approach. If you already have a strategy, great, what’s your back up plan? If you don’t have a strategy, it’s probably time to start the process.  I welcome any and all comments, thoughts, concerns as long as they are positive and constructive, for the rest I’d like to introduce you to our CMIO; he’d love to hear from you!!!!!

(Note to reader: Our CMIO, Dr. Gai, is actually an incredibly smart, nice, and visionary individual. His face doesn’t turn red when he gets mad either. I’ve never actually seen him mad, and I enjoy his company. I just made all this up to see if he would read my blog!)