Emerging Opportunities in Modernizing Existing Health Systems

You don’t need to go to medical school to figure out the potential bonanza in healthcare technology. Fueled by the Obama administration’s healthcare reform agenda and billions of dollars in federal stimulus money, modernization of the antiquated paper-based recordkeeping system used by physicians, clinicians and hospitals will happen at a frenzied pace in the coming year and beyond.

But let’s correct one of those last statements: paper-based recordkeeping. It’s a bit of a misnomer that the healthcare system is reliant on 19^th century recordkeeping amid 21^st century technology. The truth is healthcare providers and insurers have been using electronic healthcare recordkeeping (EHR) for decades.

Two decades ago I was discharged from the Army into what was essentially a recession. With little education and few skills beyond shooting and blowing up things, I had a difficult time getting a job. After months of searching and interviewing, I landed a gig at Blue Cross/Blue Shield of Massachusetts as a medical claims representative. My job: Troubleshoot and correct insurance claims so they will pay the providers. For eight hours a day, I would sit in a cubical with a massive procedure and diagnosis code manual open on my desk taking calls from physicians’ offices wondering why they hadn’t gotten paid.

Here’s the thing: It was only partially paper-based. Physicians and their billing services would submit claims on paper. Those forms were fed manually entered into a recordkeeping system for processing. Approvals were based on codes that represented diagnoses and medical procedures. Oftentimes the reason claims weren’t paid wasn’t because of some computer error, but rather humans applying the wrong codes that resulted in a mismatch between diagnoses and approved procedures.

By today’s standards, the recordkeeping system I worked on was only semi-automated, at best. Even then, BC/BS recognized the limitations and inefficiencies of its systems. It spent more than $80 million developing custom software and infrastructure for optical scanning of paper claims, CD-based jukeboxes for storage, and high-resolution imaging for eliminating paper. The program was woefully over budget and the provider, EDS, couldn’t make it work to specifications. Eventually, BC/BS reset their expectations to more modest goals to a more manageable system that met many – not all – of their requirements.

The point of my trip down memory lane isn’t to say that medical recordkeeping has always been difficult, but rather that automation and digitizing information isn’t new. There isn’t a physicians practice, hospital, diagnostic lab or insurance company that isn’t employing some form of patient or policyholder recordkeeping. What’s been holding back healthcare technology isn’t recordkeeping, per se, but rather the integration of those records with other systems and the electronic portability of those records across multiple providers.

Part of the reason doctors rely on paper forms and records is because they are extremely portable and easy to annotate. Until the advent of tablets and large smartphones, doctors and nurses’ only option for digital recordkeeping while providing patient treatments have been bulky notebook computers. Integrated recordkeeping with procedure and prescription ordering systems is making care delivery more efficient. In the coming year, vendors and solution providers will begin integrating tablets with back-office applications via virtualization. Virtual desktops on tablets and other devices will extend the reach of EHR systems to every facet of patient care.

The next big revolution is the integration of medical devices with EHR systems. Medical equipment manufacturers such as General Electric and Phillips are already working on including in their purpose-built monitoring and diagnostic equipment machines hooks for integrating with recordkeeping systems. These devices automatically will update patient files with data such as heart rate, blood pressure and medication dose delivery.

Portable devices and integrated appliances are great for record accuracy, but do little to aid in the portability of information across multiple providers. That’s the tricky part of modernizing healthcare systems. Either providers are going to need robust, resilient and easily manageable identity management systems to provide third-party partners access to patient records, or they will need a robust and security distribution system for sharing information. One solution to this monitoring challenge is the development of Key Management Interoperability Protocol (KMIP), a standard for ensuring the protection of data even after it has left the trusted domain.

These are just a few examples of the rich opportunities in healthcare, an industry that represents nearly 15 percent of the U.S. economy. The green field opportunities are enormous, but they are not vacant. What solution providers may find is their expertise is most needed in improving upon systems that have been in place for years.