Unified Patient Information Management Improving the Way Patient Data is Accessed, Exchanged and Managed

CONTENTS Introduction... 1 The Impact of Poor Patient Information Management... 2 The Solution: Unified Patient Information Management... 3 UPIM Benefits All Stakeholders... 6 A Vision for Connected Care... 7 The U.S. healthcare system has serious problems and inefficiencies. According to the U.S. Department of Health & Human Services, healthcare administration cost the U.S. more than $400 billion out of $2.5 trillion in total spending in 2009. Today, patients are paying more for healthcare out of their own pockets and struggling with understanding benefit plans that require them to play a greater role in their care. Physicians and other healthcare professionals are coping with health reform requirements and quality of care reporting, while also juggling operational and cash flow challenges. Health plans are facing financial pressures, while managing health reform and increased competition. Healthcare IT vendors are also dealing with reform, as well as technology mandates and challenges such as interoperability. The solution to these and many other issues plaguing the U.S. healthcare industry is better patient information management. Much of the high cost of healthcare in the U.S. can be attributed to healthcare providers lack of access to comprehensive patient information, which results in inefficient operations, redundancies in treatment and low-quality care. According to a recent survey conducted by Markle, Markle Survey on Health in a Networked Life, (January 2011) the majority of doctors surveyed indicated a preference for modern communication tools and 75 percent say they want to be able to share patient information with other healthcare professionals electronically. But today, there is no way to easily access, exchange and manage patient information. Information is held, owned or produced by numerous stakeholders across the continuum of patient care, stored in non-integrated healthcare IT systems, written in paper charts and often trapped within individual organizations four walls. Patient information collected by physicians, healthcare professionals, health plans and even by patients themselves is compartmentalized, isolated and incomplete, making it extremely challenging, if not impossible, for stakeholders across the care continuum to get an accurate, comprehensive view of the patient. As a result, care and efficiencies suffer, and costs continue to rise. For years, industry visionaries, leading technology providers, health plans, healthcare provider organizations and even the government have tried to solve fundamental healthcare problems by developing ways to improve access to patient information, and the industry has made strides in reducing costs through electronic communications. In a report titled, Electronic Transactions Between Payors and Providers: Pathways to Administrative Cost Reductions in Health Insurance, (May 2010), Milliman estimates the current level of administrative savings from use of electronic claim transactions compared to paper as $9.2 billion [annually] including both commercial and government payors. But typically these transactions are simply point-to-point communications between two stakeholders, using only the patient information that each party happens to have. What is missing is the factor that will enable all authorized stakeholders across the care continuum to be able to securely view and exchange all available information about a patient, regardless of location or IT systems. Clearly, the industry is in need of a better way to manage patient information. 1

Finally there is an answer on the horizon: a patient-centric approach to healthcare information management called unified patient information management (UPIM). Through sophisticated application and workflow integration, which was previously not possible, UPIM provides single-source access to administrative, clinical and financial patient information from health plans, patients, providers and other sources of data. UPIM improves the delivery, sharing and management of patient data and as a result, improves patient care and decreases costs. UPIM enables much more than simple point-to-point transactions and data exchange. Systems for UPIM not only connect patient information so all stakeholders can easily access and exchange it, these systems also manage the information. Through aggregation, analysis and other functions, UPIM transforms patient information it into meaningful data that can be applied throughout the lifecycle of a patient s care events. The Impact of Poor Patient Information Management In many ways the current IT infrastructure of the U.S. healthcare system is similar to that of the financial industry a decade ago. The financial industry previously operated on numerous disparate and unconnected systems and networks. Often, communication was disjointed and fragmented leading to increased costs and further fractures in an already-fragile system. Today, one can go to virtually any ATM in the world and securely access and exchange financial information. The U.S healthcare system needs to achieve this level of integration, interoperability and seamless information exchange. Today in the U.S., patient information is held, owned and produced by many entities, including primary care physicians, specialists, hospitals, health plans, labs, pharmacies, care management vendors, the government (Medicare and Medicaid), durable medical equipment vendors, patients and others. However, the technology infrastructure supporting the U.S. healthcare delivery system does not enable effective management of this patient information. It is extremely difficult for these different stakeholders to access or share patient information with one another. This makes for poor care coordination, strained relationships among all participants in the care delivery process, increased medical and administrative costs, and a sub-par patient experience. Many of these problems could be alleviated by improved management of patient-related information. A Marlin & Associates study, Next Generation Health Information Networks (HINs) Healthcare IT Market Commentary, (November 2010), says that of the $404 billion in U.S. healthcare administration costs in 2009, $150 billion was spent by health plans and providers on billing and insurance administration-related activities. Health plans face increasing costs, pressures from mandates to report medical loss ratio, plus the perennial challenges of operating care management programs and managing provider and member relations. For health plans, the inability for providers to access and exchange information about the patients that they insure leads to high administrative and medical costs, ineffective care management programs, and poor provider and member relations. 2

The Impact of Poor Patient Information Management Health plan High administrative and medical costs, ineffective care management programs, poor provider and member relations Provider High operational costs, administrative inefficiencies, increased chance for medical error, difficulty complying with industry regulations Patient Redundancies, hassles, financial surprises, treatment errors IT vendors, healthcare product and service providers Ineffective clinical programs, interoperability issues, unsatisfied customers Mounting administrative hassles and operational costs continue to be a burden for physicians. The annual cost to manually process administrative transactions is $70,000 per physician, according to a Milliman report, Electronic Transaction Savings Opportunities for Physician Practices (January 2006). Incomplete patient information increases the probability of medical errors while outdated IT systems and lack of in-house IT expertise cause concerns over regulatory compliance and leave less time to focus on patient care. According to Thomas J. Handler, M.D., research director, Gartner, Clinicians in practices of various size and specialty are struggling with delivering quality care to their patients while simultaneously managing a continuous stream of complex inter-related processes, such as patient scheduling, billing and accounts receivable, health plan communications and maintaining regulatory compliance. Patients are not immune to issues resulting from poor information management. In fact, patients may have the most to lose from lack of information-sharing and care coordination between physicians and healthcare professionals, and much of the costs accrued by health plans and providers get passed to the patient in one way or another. According to the American Federation of Labor- Congress of Industrial Organizations, the average family premium could reach $24,000 annually by 2016. The Medical Group Management Association reports that patient out-of-pocket expenses also continue to increase. By 2012 patient financial responsibility is estimated to reach 30 percent of medical practice revenue. In too many cases, patients experience low standards of care paired with increasing costs. Lack of patient information can lead to redundancies in care and medical errors. And the patient medical experience continues to suffer. Patients often spend much of the little time they have with their busy caregivers repeating medical history, and must deal with administrative hassles and financial headaches throughout the care delivery process. Healthcare IT organizations are experiencing challenges of their own, which are compounded by the widespread inaccessibility of patient information. While there has been a significant push within the healthcare industry to increase adoption of healthcare IT systems among providers, it still remains relatively low. And when the systems are in place in individual provider offices, the lack of connectivity between them presents a significant barrier to utilization: If providers cannot easily exchange patient information between colleagues, the perceived value of technology suffers as does quality of care and care management programs. The Solution: Unified Patient Information Management Healthcare leaders understand the industry s shortcomings all too well and have been working to solve these problems. Recently, innovators in the healthcare IT industry have collaborated to introduce a patient-centric approach to health information management: unified patient information management. Unlike locally or regionally connected medical record systems, UPIM encompasses all patientrelated information: clinical, administrative and financial. Systems for UPIM pull together this patient information from multiple sources into a centralized 3

point where it can be securely accessed and shared by physicians, clinicians and other authorized healthcare professionals. Through integration of applications and workflows, UPIM achieves collection, integration, analysis and exchange of patient-related information, throughout the full scope and lifecycle of a patient s care encounters. UPIM is both a broad technology vision and a specific technical approach to integration, connectivity and information-sharing. This approach to patient information management is achieved through a technology infrastructure that enables the movement of patient data across applications, workflows and stakeholders, and merges it into a common user interface to present a single, comprehensive view of the patient. UPIM enables information to pass easily from one organization and IT system to the next. No single organization or hub owns or controls the data, and because UPIM is web-based, the cost to move patient information between stakeholders remains low. A platform for UPIM provides the critical foundational infrastructure elements and capabilities such as interoperability middleware, integration and HIE toolsets, robust security architecture, common user interface and navigation and secure messaging features. On top of this foundation sits various administrative, clinical and financial applications, as well as decision-management tools, such as disease-management applications or evidence-based medical guidelines. UPIM integrates these applications and tools through the toolsets built into the foundational architecture. 4

UPIM supports integration between systems such as electronic medical records, practice management systems, health plan and patient communications portals, and more. This enables IT vendors and service providers to plug their applications into the platform, which manages the data and system interoperability and information exchange. End users physicians and healthcare professionals need only one log in, which enables them to navigate between all the applications and systems running on the platform and to access the data that is passed between them. By virtue of its unique application and interoperability capabilities, UPIM also enables workflow integration, which some might argue is the most valuable benefit. The seamless transfer of patient information between administrative, clinical and financial applications allows the same seamless transfer of information between workflows, the business and clinical processes that support a provider office. Workflow interoperability enables stakeholders to get and receive information about processes particular to their organizations, specialties, roles and needs. To ensure that patient data is meaningful and available to the right physician at the right time, UPIM acts as an intelligent filter that helps the provider make sense of patient data. Systems for UPIM are intuitive; they know why a physician or healthcare professional is requesting a particular piece of information, and will contextually provide all the related patient information that could be helpful to the user at that juncture. For example, a physician who would like to prescribe the most cost-effective medication for a patient requests that patient s benefits details from a health plan communications portal. Along with delivering back the benefits information such as co-pays and coverage to the provider, UPIM could add value by also delivering a patient-specific clinical alert from another application or data provider. Together, these two pieces of administrative and clinical information from disparate sources can inform the physician s encounter with that patient, and improve quality of care and the patient experience. It is important to note that a system for UPIM can look different from organization to organization. For example, while a general practitioner s office may have various administrative and clinical applications, such as practice management and electronic medical records, a provider billing office is more likely to have a host of administrative and financial applications, such as eligibility checking and EFT, and no clinical applications. 5

UPIM Benefits All Stakeholders Health plan Reduced administrative and medical costs, improved member and provider relationships, competitive advantage Provider Improved quality of care, operations and efficiencies, and revenue cycle management. Patient Improved care delivery experience with much less hassle, empowered to better manage own care Healthcare IT healthcare product and service providers Quick deployment of products and information, increased adoption, improved clinical programs UPIM Benefits All Stakeholders UPIM encompasses the entire lifecycle of patient care, more than a single patient interaction or electronic transaction and more than the patient s relationship with a single provider. UPIM enables all authorized stakeholders across the continuum of care to access all information that is available about a particular patient and relevant to their role, regardless of the user s location. Thus, UPIM is relevant and beneficial to physicians and clinicians, and also to financial and administrative staff. Stakeholders benefit from UPIM in multiple ways: Patients. Whether before, during and after an office visit, UPIM gives physicians and their office staff the most comprehensive, up-to-date view of a patient, including medical, administrative and billing information. This ensures that the care delivery experience whether with physicians or office staff will be of significantly higher quality with much less hassle. UPIM eliminates redundant or unnecessary treatments and paperwork; enables providers to make better, more informed care decisions and recommendations; and eliminates financial surprises for the patient. Additionally, UPIM can provide access to consumer-facing tools that empower patients to better manage their own care. Physicians and healthcare professionals. UPIM improves quality of care and operational efficiencies. Convenient one-stop shop access to patient-related information gives providers and office staff more time to focus on care and less on administrative and financial tasks. UPIM can enable improved care coordination and outcomes through streamlined capturing and sharing of clinical information. Plus, UPIM systems are often available as low-cost, web-based, software-as-a-service (SaaS) solutions that reduce financial burdens and alleviate compliance concerns. Health plans. By sponsoring and supporting UPIM technologies, plans can improve relationships by demonstrating commitment to members, employers and providers. Systems for UPIM can enable a reduction in administrative costs by increasing utilization of electronic health plan-provider transactions, a channel that has already shown cost savings for health plans. UPIM helps control medical costs by supporting improved care coordination and care management. And, UPIM can help health plans gain competitive advantage by enabling broader and enhanced offerings for employers and members, such as wellness and disease management programs. Healthcare IT vendors and service providers. The application integration capabilities of platforms for UPIM enable service providers to easily plug in their technologies and quickly get their products and the valuable patient information they deliver out to provider offices. Once becoming part of UPIMbased environments in all types of care settings, vendors have broader reach to providers and patients and a deeper reach into the physician practice, which ultimately leads to increased adoption and more success with clinical programs such as care management. 6

A Vision for Connected Care Until the fundamental challenges of accessing, exchanging and managing patient information are addressed, quality of care will suffer and healthcare costs will continues to rise. Across the industry many sincere efforts are underway to solve various aspects of the patient information management problem, but only a unified approach on a large scale will make a significant difference. The answer is a unified patient information management model that offers caregivers centralized access to administrative, clinical and financial patient information from multiple sources - health plans, patients and providers. This approach delivers the same holistic view of the patient across caregivers to improve the overall quality and efficiency of healthcare. UPIM is more than a vision: the technologies and methods to implement systems for UPIM are available today. With collaboration and the proper motivation, the healthcare industry can make UPIM a widespread reality. 7