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Health IT NEWS.Direct! is a global Healthcare Information

Technology (Health IT) journal providing research,

news, and business intelligence services. We publish

several market research and strategic industry reports

with key information for top management and decision

makers in the healthcare technology industry. Health IT

NEWS.Direct! is used by leading healthcare technology

companies, hospitals, insurance companies, and

media houses from around the globe.

Dr Grant FraserChief Medical Officer

Medical Wizards Corporation

John Lightfoot

Chief Technology Officer

MedVentive Inc.

Designed and Published

on behalf of Health IT NEWS.Direct! byiLogy Healthcare Solutions

Health ITNEWS.Direct!Global Healthcare IT News, Research and Intelligence

CONTENTS

EditorialCloud computing: Weathering the

healthcare data storm

Amoolya Moses

Review ArticleRedefining healthcare communication

on the cloud

Damir Ljuboja

Industry PerspectivesCloud-based systems: Why they

represent the future of patient careJeff Surges

InterviewIndustry strives for interoperable cloud

solution

Chris Gough

PwC foresees Indian cloud computing

market to be $4 billion by 2015Dr Rana Mehta, Rajesh Ranjan

1

2

7

12

10

Editorial Advisory Board


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Editorial Team

Managing EditorDr B M John

Assistant EditorAmoolya Moses

Research AnalystsDr Raghavendra RaoDr Chinmaya Chigateri

DesignVeeresh MathapatiAbhilash A

All rights reserved 2012

INFORMATION

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Editorial process:www.healthitnewsdirect.com/?page_id=7

Disclaimer

Views and opinions expressed in this publication are not

necessarily those of iLogy. While every effort has been

made to ensure accuracy of the information published in thisedition, neither iLogy and its employees nor its informationvendors accept responsibility for any errors or omissions.

Further, iLogy and its information vendors do not take anyresponsibility for loss or damage incurred or suffered by anyreader of this journal as a result of accepting any invitation/

offer published in this edition.

iLogy reserves the right to use the information published

herein in any manner whatsoever. No part of this publicationmay be reproduced in any form without the written permission

of the publisher.

Mini Reviews

eHealth

eClinicalworks deploys EHR solutions at

Ohio Orthopedic Center of Excellence

Partners and AlliancesAgfa and Dell partner to provide medical

image management solution on the

cloud

Microsoft and GE Healthcare form novel

IT company through JV

Products and Solutions

3M releases new ICD-10 financial

analysis software and service

Insights

IDC reports indicate an evolving HIE

market

Healthcare industry experts suggest

strategies to address mobile device

security and privacy threats

H&HN survey illustrates IT utilization

among 2012 Most Wired Hospitals

NEWSIndian pharma giant, Piramal Healthcare

buys USAs Decision Resources Group

Global perspectives on health IT from

Harvard Medical School thought leader,

Dr Blackford Middleton

15

14

16

17

18

19

21

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July - September 2012

www.healthitnewsdirect.com COPYRIGHT 2012

EDITORIAL

Cloud computing: Weathering the healthcare data storm

Amoolya Moses

Assistant Editor, Health IT NEWS.Direct!

In the recent decade, the healthcare industry has witnessed major

transformations in its dependence on information technology for

achieving efficient workflow, quality care, and efficient use of

investments. Observing successes in other industries, healthcare

has adopted these IT innovations and applied them to suit its

needs.

The frenzy to transform paper-based medical data into the more

efficient electronic form, and the increased need to document

and store data for future analysis has landed the industry with

yet another dilemma of having to store and archive the exploding

data volume. Innovations around managing large data sets and

providing access without limiting it geographically or by devices

have been addressed by cloud computing. The on-demand,

SaaS offers both tangible and intangible benefits in the form of

self-service ordering, large data storage, reduced maintenance,

continuity of services in the event of a disaster, archiving, lower

capital investment and enabling CIOs to enhance quality care with

reduced costs. Taking the benefits of cloud to the next level, many

feel that it can be leveraged to tackle Big Data, and in turn convert

raw information into actionable data.

Keeping alive the concept first visualized by Professor John

McCarthy in the form of computer time-sharing during the early

1960s, cloud computing is now considered the next big thing in

health information technology.

In 2011 KLAS reported mixed responses for the acceptance

of cloud technology in healthcare enterprises. Although 71%of providers had implemented or planned to implement the

1

technology, patient data privacy and control were the two major

factors for the surveyed hospitals staged and cautious approach

to adoption. Analysts GBI Research finds that although cloud

technology has reached the healthcare sector, it may just drift

over developed economies, with North America, and in specific,

the US having the lions share. The industry growth has been

staked at 20.5% CAGR from 2010 to 2017. Despite global

bigwigs like Merge Healthcare, Inc., Carestream Health, Inc. and

CareCloud in the US, Agfa Healthcare of Belgium, and UKs GE

Healthcare contributing to this market section, no single vendor

holds a share of more than 5%, making it fragmented. However,

this sunny forecast can be slowed down by compliance with

government policies, security concerns with hosting patient data,

and interoperability.

This issue of Health IT NEWS.Direct! outlines the various aspects

of cloud computing in healthcare. With Damir Ljuboja from The

University of Texas, Austin, discussing the hypothesis of the

HealthCloud; Jeff Surges, CEO, Merge Healthcare gives us an

overview of cloud computing from the perspective of storing

and accessing imaging data. The issue also features industry

perspectives on the various issues that plague the cloud

computing industry in particular to the delivery of care and how

these can be addressed.

With this comprehensive outlook on the cloud, the team at Health

IT NEWS.Direct! hopes that IT directors at healthcare facilities will

be able to better manage the internal computing environments,

while finding means to monitor and address the drawbacks inorder to leverage the benefits of the technology to its optimum.
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Health ITNEWS.Direct! July - September 2012

www.healthitnewsdirect.com COPYRIGHT 2012 2

REVIEW ARTICLE

Redefining healthcare communication on the cloud

To be a patient in the modern era of healthcare means to be submerged in a vast and

expanding body of medical knowledge. Patients seek the expertise of multiple physicians,

across specialties and between institutions, to ensure that they receive top-of-the-line care for

their ailments. The plethora of medical knowledge easily overwhelms specialists and patients

alike. Medical graduates are taught to know more and more about less and less. As a result,

communication and understanding can become muffled in a sea of increasingly complex

test results and an ever-expanding library of treatment options. With so much focus placed

on details, it becomes difficult to visualize the big picture of patient care.

Along with this fragmentation in healthcare delivery, barriers in communication, recordkeeping,

and patient understanding forestall a unified and effective medical system. Changes driven

by technological advancement and growing public sophistication, demand that this problem

be addressed. The answer lies in the cloud.

Figure 1: Information flow on the cloud

Cloud computing, at its core, provides a network for shared resources, software, and

information that is accessible on demand via the internet (Figure 1). Applied to healthcare

on a wide scale, such a system could be the solution to many modern-day problems. While

bits and pieces of present issues have been addressed by electronic medical records

(EMR) and computerized physician order entry (CPOE), these solutions are local, at best. In

a world of increasing specialization and patient privacy, simple communication is a breath

of fresh air.

Damir Ljuboja

The University of Texas at Austin


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REVIEW ARTICLE

The HealthCloud hypothesis

The solution I propose integrates key aspects of various

international approaches to todays pressing logistical problems

in medical communication and compliance with novel ideas,

to improve outcomes (Figure 2). The HealthCloud providesa multifaceted response to the issues of communication and

recordkeeping, public access to reliable healthcare information,

consulting, patient compliance, and hospital efficiency.

Figure 2: HealthCloud physician-patient information exchange

HealthCloud could also provide support for patient self-

management of health by allowing them to gain a greater

understanding of their ailments. On-demand consultations with an

active board of physicians could provide real-time replies to medical

enquiries. Chronic disease management programs operated

by providers could bring together groups of people with similarconditions to provide support and advice. For the sickest patients,

this collaboration can help them stay out of the hospital for longer

than ever before. Patients could more readily assume the role of

With the goal of error reduction in mind, HealthCloud seeks to

merge EMRs with electronic prescribing interfaces, such as

CPOE, across providers (which would also decrease their costof use). Improved software infrastructure and computerized alerts

could prevent patients from receiving medications that may be

harmful (due to interactions with other courses of treatment, for

example). This could be effectively coupled with computerized

decision support to guide clinicians toward safe and cost-effective

treatments. An online system to track patients, their medications

and treatments, referrals, and laboratory/imaging results would

improve the organization of patient data across a fragmented

medical landscape. The burden of documenting and submitting

data to the online HealthCloud database could be lessened

through the use of speech-to-text software. Such a system, if

implemented, could improve the fail-safe measures in place on

the physicians side of the patient-doctor relationship and increase

the efficiency of team-based medicine.

a principal caregiver and monitor their blood pressure, glucose

levels, and other factors that increase the risk of complications.

In order to accomplish this, HealthCloud could offer educationaltutorials and medical tools that could be ordered and delivered

to patients for a fee (e.g. a device to monitor blood pressure that

reports directly to the patients record on the cloud). Reminders

for scheduled appointments, medications, and other interventions

could span across personal computers, mobile phones, and

tablets. This integrated system of communication could lead to

improved collaboration between doctors and patients.

Global communication

In the realm of recordkeeping, global approaches of particular

note are the scannable Taiwanese Smart Cards, that contain

individual medical histories, as well as the United Kingdoms

electronic medical records system, GP2GP. This National Health


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Service Connecting for Health (NHS CFH) project enables the

automatic (but still physical) transfer of individual health records

between the approximately 9,000 general practitioner practices in

the UK when a patient chooses to switch providers.1 EMRs that

automatically transfer between systems across the internet are

a rarity. In 2008, just 20% of clinicians in the United States wereusing EMRs and few of these recordkeeping systems were able

to directly communicate with each other, even within the same

hospital system. Just 4% of doctors were using state-of-the-art,

fully functional EMR systems.2

HealthCloud consolidates all these approaches in order to maximize

efficiency. The proposed system calls for encrypted, standardized

patient records to be kept on hospital, insurer, private provider, or

government servers, which can be accessible via the internet when

needed by physicians or the patient. If implemented on national or

global levels, this could greatly improve communication between

providers from different specialties, institutions, or even nations

and lead to a reduction in redundant and repetitious testing.

This system would be disaster-proof because of online access

and information back-up on redundant servers. Natural disasters

that level cities such as the 2005 Katrina hurricane in New Orleans

or the 2004 Indian Ocean Tsunami would not destroy medical

histories and cause a disruption in care. Residents who endure

these catastrophes could travel to neighboring cities or countries

and find their medical histories readily accessible.

Figure 3: HealthCloud public access model

Public information flow

The accessibility of accurate information is of concern. Corporate

marketing geared at highlighting the advantages of products has

measureable impact on the exactitude and quality of medical

information available through internet search engines. In order tocombat this problem, HealthCloud could feature a consultation

interface that links patient computers and mobile phones to a

managing team of physicians via a patient portal. This system

could allow for the back-and-forth exchange of messages and/

or chat between the two parties in isolation from the external data

made available by medical companies (Figure 3). In doing so,

accurate information could quickly and readily flow into the hands

of the public.

HealthClouds consultation interface could provide answers to

questions or concerns that patients forget to mention during

appointments. A 2002 International Health Policy Survey by the

Commonwealth Fund has found that 31% of sick adults in the US

leave a doctors office without getting crucial questions answered

and 39% do not abide by the physicians advice because of this.3

In an earlier study, 51% of patients surveyed thought that their

primary care physicians had excellent or very good knowledge

about their medical history, and 36% felt that they had excellent

or very good knowledge of their biggest worries.4 By linking the

inquirers to their electronic medical records, each case could be

uniquely considered by the physician team and patients would

have a means of filling in the gaps into their understanding.


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Virtual primary care consultation

Additionally, the HealthCloud could act as a facilitating tool in

family medicine. By integrating an online system that considers

symptoms in a similar fashion as the WebMD interface, the cloud

could generate possible diagnoses and, moving one step further,refer the user to a local specialist (with patient consent). This would

also allow for the identification of high-risk groups of chronic or

infectious diseases and facilitate appropriate responses by health

organizations. Outbreaks could be identified more easily and

accurately than ever before. In order to make this system more

financially feasible, computerized algorithms could be employed

on the cloud, which consider symptom input to generate potential

courses of action. Common questions could be grouped together

in order to minimize the workload undertaken by the managing

body of physicians.

Increased patient compliance

As suggested in Figure 2, the dissemination of dosage information

and medication reminders to patients mobile devices and

computers would increase the likelihood of compliance. Many

patients tend to cease a course of treatment as soon as they

begin to feel better. This is known to result in multidrug resistant

organisms and contributes to the prevalence of disorders that

are difficult to manage, including certain sexually transmitted

diseases and multi-drug-resistant tuberculosis. This aspect of the

HealthCloud could also automatically suggest cross-conditional

treatment that providers may overlook, such as eye exams for

diabetes patients, by identifying target groups based on their

medications and previous appointments.

Improved provider efficiency

Provider efficiency is another area of medicine that HealthCloud

is designed to improve. CPOE systems alone have been noted to

reduce serious medication-related errors by 55%.5 Improvements

in decision support software led to an 83% reduction in the overallrate for medication errors.6

HealthClouds integration of these two systems (as depicted in

Figure 1), along with a prescription fail-safe algorithm, allows

for their combined efforts in the prevention of medication errors.

This online system could reference patient EMRs on the cloud

when doctors attempt to prescribe new medicines and verify the

compatibility of the drug in question with the patients current

ailments, particularly those outside of the providers specialty,

and medications.

In addition to order entry support, the HealthCloud is designed to

increase the availability of patient discharge summaries by linking

them to the individuals EMR. A 2007 study found that summaries

were available to primary care physicians just 51%-77% of the time

four weeks after a discharge, because of which the quality of care

was compromised in about 25% of follow-up visits.7

On the part of the consumer, the subjectivity of symptoms input

remains the biggest concern. Many patients tend to downplay thesignificance of the pain they are experiencing, while others in the

same circumstances amplify it. This could skew the diagnoses

made by the virtual physician team and impact prescribed courses

of action. A possible way of combating this would be to use the

online system as a way of merely categorizing the types of health

complaints users submit before referring them to a primary care

physician. In this way, the online team would act as an initial

evaluation checkpoint whose conclusions are forwarded to a local

physician.

Security

HealthCloud, like any online system, is not without its share of

security concerns. Issues of identity management, physical

accessibility of data servers, availability of access to the network,

and patient privacy are of significant importance.

Commercial companies developing medical record services

assure the public that their data will be stored in encrypted

databases with privacy measures entirely in the control of the

individual. The same concept applies to HealthCloud. Patients

in the system will be indentified by an assigned numerical code,

and to ensure the strictest confidentiality, the code will only be

made obtainable to the individual. Access to the cloud will be

freely available to anyone with an email address and approved

numerical code. Thus, any type of internet access confers

theoretical access to HealthCloud. Those who live without internet

could reach the cloud at their doctors offices, internet cafes, or

in public libraries.

Access control will entail the input of several personal identifiers,

including name, date of birth, and a government-assigned code,such as social security number, in combination with a self-

assignment pin and password to enter the cloud. The patient will

not be referred to by name in any of the online records and no

identity-compromising information shall be placed on the servers.

As a back-up, records identifying which numerical code belongs

to a particular user shall exist on private servers in the HealthCloud

infrastructure. These servers will not be connected to the internet

and are a precautionary measure in case users lose their numerical

identifiers. Documented access to these private files shall only

be granted to a limited number of employees with high-level

clearance. Thus, the system shall avoid using federated identity

management and will instead rely on single sign on through

patient portals.

REVIEW ARTICLE


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Fraud is another user concern, but could be avoided by requiring an

email and verifiable form of government identification (depending

on country of residence) upon user sign-up.

Scalability

The goals of HealthCloud are rooted in granting equal access

to a wide user pool. In order to accomplish this, the systems

functionality must be made plausible on a grand level. Vertical

expansion through the addition of hard drives, servers, and

central processing units will enable the cloud to accommodate

an increasing number of virtual machines by adding resources

within the same logical unit to increase capacity. Horizontally, the

addition of clustering solutions and access points, in combination

with multiple load balancers (server farms), will design the system

in such a way as to handle and distribute heavy traffic, optimally.

To prevent possible complications, software clutter will be kept

at a minimum and an appropriate amount of caching will be

maintained. This will allow for the maximum scalability factor and

therefore lead to improved performance. Although the process for

scaling up is dynamic, the aforementioned approach will allow for

maximum theoretical growth under ideal conditions.

Sustainability

In order to be permanent, a system must promise longevity.

HealthCloud maintains its functional integrity through the

incorporation of weekly data save points. This ensures that patient

records are constantly backed-up in case of emergency failure or

an infrastructural breach. Redundant servers aid in this effort by

assuming control of the cloud during primary server(s) failures.

Often, primary and secondary servers are both functional and

share duties to increase overall throughput. In the event that one

fails, the redundant assumes full command until the primary is

repaired and brought back online. In this way, HealthCloud would

be prepared for unexpected spikes in demand or other sudden

increases in bandwidth requirements.

Conclusion

Health information technology stands at the precipice of change.The demands of an international public on an increasingly isolated

body of physicians, stress the fabric of medical care. The solution

lies in organization and communication. The HealthCloud, albeit

not infallible, proposes a novel paradigm of healthcare delivery

on the cloud.

References

01. GP2GP: why its needed. NHS Connecting for Health. http://www.

connectingforhealth.nhs.uk/systemsandservices/gpsupport/gp2gp/

needed/index_html?url=http://www.connectingforhealth.nhs.uk/

programmes/gp2gp/. Last accessed August 31, 2012.

02. DesRoches CM, Campbell EM, Rao SR, et al. (2008). Electronic Health

Records in Ambulatory Care - A National Survey of Physicians. N Engl

J Med. 359(1):50-60.

03. Blendon RJ, Schoen C, DesRoches C, Osborn R, Zapert K. Common

concerns amid diverse systems: health care experiences in five

countries. Health Aff (Millwood). 2003;22(3):106-121.

04. Lee TH, Mongan JJ. Chaos. In: Chaos and Organization in Health Care.

Cambridge, MA: MIT Press; 2009:18.

05. Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician

order entry and a team intervention on prevention of serious medication

errors.JAMA. 1998;280(15):1311-6.

06. Bates DW, Miller EB, Cullen DJ, et al. Patient Risk Factors for Adverse Drug

Events in Hospitalized Patients. Arch Intern Med.1999;159(21):2553-

2560.

07. Kripalani S, LeFevre F, Phillips CO, Will iams MV, Basaviah P, Baker DW.

Deficits in communication and information transfer between hospital-

based and primary care physicians: implications for patient safety and

continuity of care.JAMA. 2007 Feb 28;297(8):831-41.
http://server/iLOGY$/HITND%20Resources/re%3C56F2%3E%01%20O%01d%20s.pdfhttp://www.connectingforhealth.nhs.uk/systemsandservices/gpsupport/gp2gp/needed/index_html?url=http://www.connectingforhealth.nhs.uk/programmes/gp2gp/http://www.connectingforhealth.nhs.uk/systemsandservices/gpsupport/gp2gp/needed/index_html?url=http://www.connectingforhealth.nhs.uk/programmes/gp2gp/http://www.connectingforhealth.nhs.uk/systemsandservices/gpsupport/gp2gp/needed/index_html?url=http://www.connectingforhealth.nhs.uk/programmes/gp2gp/http://www.connectingforhealth.nhs.uk/systemsandservices/gpsupport/gp2gp/needed/index_html?url=http://www.connectingforhealth.nhs.uk/programmes/gp2gp/http://www.connectingforhealth.nhs.uk/systemsandservices/gpsupport/gp2gp/needed/index_html?url=http://www.connectingforhealth.nhs.uk/programmes/gp2gp/http://www.connectingforhealth.nhs.uk/systemsandservices/gpsupport/gp2gp/needed/index_html?url=http://www.connectingforhealth.nhs.uk/programmes/gp2gp/http://www.connectingforhealth.nhs.uk/systemsandservices/gpsupport/gp2gp/needed/index_html?url=http://www.connectingforhealth.nhs.uk/programmes/gp2gp/http://www.connectingforhealth.nhs.uk/systemsandservices/gpsupport/gp2gp/needed/index_html?url=http://www.connectingforhealth.nhs.uk/programmes/gp2gp/http://server/iLOGY$/HITND%20Resources/re%3C56F2%3E%01%20O%01d%20s.pdf


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INDUSTRY PERSPECTIVES

Cloud-based systems: Why they represent thefuture of patient care

Ive been in the healthcare IT industry for more than 20 years. During that time, Ive seen my

share of trends, fads, buzzwords and hot topics, but if I had to pick the one trend I think will

change the way healthcare providers do business and share information, I would absolutely

pick the cloud. Cloud-based systems can do more than just give providers the ability to store

and share data more easily. It can give the entire healthcare community (including patients)

the power to communicate more freely and actually talk to each other as never before. This

article will explain why I feel that way.

Imaging has always appealed to me. In my opinion, its the most important part of an

electronic health record. When a patient goes to the doctor, the first thing he or she asks is,

Wheres your X-ray? However, the average file size of your basic medical image is about

5 gigabytes (GB). In healthcare, that is an extremely large file. You cant e-mail that as an

attachment, and storage of such files requires staggering amounts of server space that

need to be updated constantly. However, you or I can easily download approximately the

same size of the file every day on YouTube or Netflix. Thats what we do. In fact, I like to say

that Merge Healthcare is the YouTube or Netflix of healthcare.

In 1999 I co-founded a company called Extended Care Information Network (ECIN). At that

time we did not use the term cloud, but we knew that we needed to help our customers

discharge planning in a more cost effective way that made it easier to share information.

At that time we touted the benefits of SaaS, but many of the basic principles and benefits

of todays cloud-based solutions remain the same and more than ever, they represent

the future.

The issues: Where to house all the data and who

manages it all?

Every year, countless dollars and hours are spent archiving diagnostic images. A single

image can need as much as two gigabytes or more for storage, with regulations requiring

these image data to be stored for years. Traditional methods of image and data archiving are

now giving way to an exciting new advance in healthcare technology: cloud-based imagestorage and sharing, which has been proven to help healthcare stakeholders collaborate,

improve the delivery of care, and reduce its cost.

Without the accessibility and scalability of the cloud, C-suite executives face the unenviable

task of managing terabytes or even petabytes of imaging data, which can mean real

inefficiencies that have proven to escalate IT costs. A cloud-based solution can help providers

create a complete patient record that can eliminate inefficiencies, such as patient-borne CDs

and duplicate scans that expose patients to radiation, and enable faster collaboration. This

new efficiency is catching on quickly with a variety of users across the nation. By 2015, it

is expected that cloud storage will account for more than 35% of the six petabytes of new

studies annually captured in vendor neutral archives (VNAs).

Along with images, providers continue to bring in more corresponding studies, which

then grow in size once they are stored, as they are updated and modified. In addition,

7

Jeff Surges

CEO

Merge Healthcare


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these studies and images need be managed and organized. As

data warehouses grow and grow, additional staffing and training

within hospitals and health networks are required, just to keep

track of everything and problem-solve. This type of training is not

a one-time expense, but rather an ongoing cost to stay on top of

system updates. Hardware must be purchased and maintained.Continued investment is needed for basics such as memory,

speed and updated operating systems, to name but a few. Finally,

healthcare data may be managed on private networks that are

often times inaccessible from other platforms.

Then, there are basic housekeeping issues, such as reports

and worksheets, which have to be filled out manually for each

patient. In many settings, a provider has to make the effort to

match up a specific report with a specific image on CD, or even

video cassette. The paperwork can pile up fast. A provider may

have his or her own style for dictating reports, so uniformity can

also become a real issue. Finally, the increasing amount of paper

archives in addition to data warehousing can create storage and

management problems. The likelihood of misfiled or misplaced

reports can grow, which may require further staff to manage and

organize the growing reams of paper.

Through our daily dealings with providers and other customers,

it has become clear to us that the current system is becoming

more and more unwieldy and does not serve the best interest of

patients. Just the cost of servers to house all these data can easily

balloon to an unsustainable level.

Image sharing

The simple task of image sharing in a timely manner has

become a real issue of cost and efficiencies within healthcare

delivery. The most glaring example is the CD. Even in todays

technologically advanced world, patients continue to bring any

vital images corresponding with their care to the hospital on a

CD, which may cause frustration among in-house specialists and

referring physicians if they are ever lost or damaged while beingtransported from one place to another. There are times when a

CD is unreadable, which may cause a delay in care. In many

cases, providers and specialists still rely on the video cassette

and corresponding players to view critical images.

A provider may be unable to share an image quickly with a

colleague or specialist due to incompatible viewing systems,

resulting in a loss of efficiencies. If several providers need to

view the same image and exchange critical information relating

to care for that patient, such a process can take days or even

weeks, because they are unable to view images simultaneously

from different locations. They cannot share images over a mobile

device. If a provider needs to view an image, and that image is only

stored on a CD in a single place, then he or she needs to physically

leave his or her office, walk or drive over to the lab or office where

the image is located, and view it there. In all these cases, time to

treatment is delayed significantly.

Duplicate scans

Finally, duplicative scans and tests are an increasing cost issue.

Annual healthcare costs of as much as $100 billion have been

attributed to diagnostic imaging tests. Of these, an estimated

35% are of duplicates. This is the equivalent of $35 billion in

unnecessary costs. Time and money can be spent just on locating

a crucial image, as opposed to simply going to a cloud-based

solution where images are stored securely and in one place.

For example, a patient may go in for a procedure and need

imaging work done. A radiologist, instead of being able to access

a single HIE for this patients complete set of images, may be

forced instead to play detective and hunt down these images,

which may be stored in a variety of different formats in several

different places. Its easier just to order a new scan, but this is

exactly how costs absolutely add up over time.

In fact, it is estimated that a single-clinician practice spends, on

average, about $17,000 a year associated with traditional methods

of exchanging patients health information.

The cloud: A game-changerIn a cloud-based storage system, images are securely stored in

multiple locations. They are accessible anytime and anywhere, via

a standard web-based browser. As health systems storage needs

grow, providers and managers can simply add capacity to the cloud

as opposed to adding onsite storage hardware, management, and

bandwidth. That way, managers are only paying for the capacity

they actually need. In a cloud-based infrastructure, images and

data remain secure and meet all regulatory requirements.

Furthermore, physicians and specialists can also share imagesworldwide through the cloud, and in many cases, such a service

is free. Image sharing offers an easy-to-use and efficient means

of quick image sharing, which result in faster diagnoses and

treatment for patients. Efficiencies are greatly increased.

Examples of efficiency

A cloud-based system can also marry reports to images and keep

them all in one place, which can solve many filing and storage

issues. Once these images are on the cloud, it can be viewed

by everyone and does not necessitate the need to burn them on

a CD. This would be important if a patient changes his or her

physician. When a patient goes to a provider for follow-up, he or

she can pull out these images quickly, instead of having to rely on


13/32



INDUSTRY PERSPECTIVES

9

memory or ordering a duplicate scan. All these time efficiencies

definitely lead to better patient care, as they decrease the time

patients need to spend in the hospital.

Emergency rooms and trauma centers can also potentially benefit.

Doctors can receive and review images from trauma centers inoutlying areas long before patients who have suffered an accident

arrive, providing extra time to process, prepare a diagnosis, and

get ready to treat. Also, the burdensome process of transferring

and importing a CD with an incoming trauma patient can now

become a thing of the past. Unnecessary steps are eliminated in

the process, such as duplicative scans. More educated decisions

on whether a patient transfer is necessary can be made, because

physicians are able to view the patients images ahead of time

to determine if he or she is not in a critical enough state for the

transfer to be necessary.

Emergency room doctors like such a system because it helps

them better manage patient flow, and the staff greatly appreciates

the clouds ability to help them make decisions more quickly.

Switching to cloud-based systems also creates greater staffing

efficiencies, through improved flexibility in how hospitals staff their

services. IT specialists would no longer be needed to help with

the uploading, reading (and in some cases, locating) of CDs.

Through cloud-based solutions, costs in that area can be reduced

and resources diverted to more value-added IT projects. Finally,

hospitals can save money on the number of contracts needed for

maintenance and archiving. These are hard costs that managers

can realize right away just from switching to the cloud.

Issues of security

When considering whether to implement cloud-based storage

and image sharing, hospital and health network executives need

to make sure such an infrastructure is absolutely 100% secure.

Its a noteworthy issue. Recent surveys have shown that 91%of physicians feel open-access systems designed for sharing

medical images can be beneficial to patients; however, 70% are

worried about the security aspect. When selecting a cloud storage

system, decision makers should choose a system that features

the following, so that the security of images, and corresponding

studies and reports are paramount:

Extensive experience with applications, healthcare providers,

and patients

Physical and application security

Compliance with HITECH, HIPAA, and other federal

policies

Highly available and technically innovative datacenter

environment

Datacenters distributed geographically to ensure disaster

recovery following a major event

Presence of a technical network operating center and full-time

year-round staff for managing any data loss or crises

The benefits of cloud-based solutions continue to evolve, allowing

hospitals and health networks to remain responsive to change

across the healthcare continuum, which can undoubtedly lead

to greater efficiencies, reduced costs, and ultimately better

patient outcomes. Better patient outcomes are why I got into the

healthcare industry in the first place.


14/32



INTERVIEW

Industry strives for interoperable cloud solution

Q: We have observed that the adoption of cloud computing among healthcare

providers has increased. In your opinion, are there processes or technologies that

healthcare organizations still use off the cloud that you think should migrate into

the cloud?

A: Today, many organizations are struggling with the exponential growth of the data that

they need to store, secure, and maintain. The situation is a bit more dire in healthcare than

in other industries due to data retention requirements. Depending on who you ask, data

storage requirements in healthcare are doubling every 12-24 months, with medical imaging

as the largest contributor to this trend. For some organizations, more than 50% of overall

storage capacity is dedicated to medical imaging.

This application domain is ripe for migration to the cloud. We are starting to see the

beginnings of this with cloud-based vendor neutral archives (VNA), where image archives

can be hosted on the cloud, abstracting away the specifics of a given vendors PACS solution.

This can provide a healthcare organization with greater flexibility to switch PACS vendors as

solution offerings and business needs change over time. Perhaps most importantly, scaling

the infrastructure to support the ever growing set of data is accommodated by the cloud

platform; which was designed and optimized for scale from the beginning.

Q: Can you please provide an example as to how cloud computing has made a

significant impact in a healthcare organization?

A: South Florida Medicine is a multi-specialty practice that was experiencing several

challenges related to the rapid growth of their business. They decided to centralize their

practice management platform across their multiple locations using a software-as-a-service

(SaaS) solution offered by CareCloud. This decision resulted in significant positive impact

for their organization:

It is now easier for them to scale/grow because they no longer need to manage the

hardware and software associated with their practice management solution.

As new practices are added to the organization, they can be integrated very quickly;

simply given access to the centralized, cloud-based solution. South Florida Medicine can leverage expertise of external organizations. For example,

to take advantage of cutting-edge security capabilities and best practices that allow

them to better keep sensitive information secure and satisfy regulatory requirements.

Together, these benefits can enable healthcare organizations like South Florida Medicine to

focus on improving patient care, or growth rather than on keeping the lights on.

Q: In the healthcare industry, which is the most preferred service model that

vendors adopt: software-as-service, platform-as-service, or infrastructure-as-

service models?

A: Software-as-service (SaaS) is by far the most heavily adopted cloud service model in

the healthcare industry, and I expect this will continue to be the case for the foreseeable

future. Infrastructure-as-a-service (IaaS) is getting some traction in large healthcare

10

Chris Gough

Lead Healthcare,

Cloud Computing Architect,

Intel


15/32



enterprise organizations that are building private clouds. This is an

evolutionary step that enables these organizations to realize some

of the benefits of cloud while still getting good return on existing

datacenter investments. Both platform-as-a-service (PaaS) and

IaaS are compelling service models for healthcare organizations

that have software development operations. Large enterpriseorganizations are taking a pragmatic, phased approach to cloud

adoption with Test & Dev as the typical phase-1 environment

that uses IaaS or PaaS in a multi-phase cloud adoption strategy.

I should mention, however, that the life sciences industry is an early

adopter of IaaS, and uses this service model quite extensively

for research and development. This is due to the fact that this

industry is not as heavily regulated as the payer/provider space

and because typical applications/workloads lend themselves very

well to the pay-as-you-go model offered by large public cloud

providers.

Q: What are the newer trends that we could be witnessing

with respect to cloud computing in healthcare?

A: Today, the largest obstacle to cloud adoption in healthcare is

security and privacy. This is due, in part, to the highly regulated

nature of the industry. Intel is working very diligently with McAfee

and a host of other partners to ensure that cloud environments are

just as secure as their in-house enterprise IT counterparts. Over

the next several years, you will see security come to be viewed as a

significant benefit of adopting cloud solutions rather than a barrier

to entry. Even today, for many healthcare organizations (especially

organizations that lack a large, dedicated IT staff), there are many

security benefits that can be realized by moving to a well-managed

cloud environment.

Q: We are again in a situation where we observe a large

number of distributed and competing cloud platforms that

organizations are using. This situation, similar to those

faced in legacy, in-house systems has the same challenge

of limited interoperability among them. How do you think wewill be resolving this challenge in the future?

A:Yes, we are seeing vendor lock-in reemerge as a top IT concern

with the emergence of cloud. In order to solve this problem, what is

needed is a set of open, interoperable standards that can support

the key use cases and requirements of enterprise IT departments,

both inside and outside of healthcare. Intel has a long history of

promoting and creating open, interoperable, standards-based

solutions, and I believe this will be required to maximize the long-

term, sustained success of cloud computing.

In order to help make this vision a reality, Intel works very closelywith an organization called the Open Data Center Alliance (ODCA),

serving as the technical advisor. This organization comprises

more than 300 enterprise organizations around the world that

are dedicated to speeding up the migration to cloud computing.

The ODCA identifies key enterprise use cases and requirements

for cloud, and works with the vendor community to ensure that

emerging solutions address these requirements. In addition, the

ODCA collaborates closely with industry standards bodies to make

sure that these use cases and requirements can be addressed in

an open, interoperable, standards-based manner.

Q: Please add a note on the estimated market scenario

expected in 2020 for cloud computing in the healthcare

domain.

A: We are already seeing a cloud first approach for smaller

companies and start-ups that dont see a value proposition in

building their own datacenter from the ground up. In this timeframe,

healthcare enterprise organizations will be taking the same

approach. Hosting and maintaining applications on-premises will

start to become the exception rather than the rule.

As open, interoperable cloud solutions emerge, there will be many

key benefits for healthcare organizations:

Lower cost

Ability to select best in class solution components from

multiple vendors

Less complex and more feature rich-solutions for high

availability and disaster recovery, spanning multiple

datacenters and geographic regions

However, the highly-distributed nature of future cloud solutionswill also introduce some new challenges. For example, I suspect

that data sovereignty issues associated with cross-border flow

of sensitive information will come to the fore. As a result, there

will be an increasing need for solutions that can restrict data and

application execution to approved geographic regions to ensure

patient privacy and regulatory compliance.

INTERVIEW


16/32



PwC foresees Indian cloud computing market to be $4 billion by 2015

Q: The benefits of cloud computing is being propagated across the industry. What

are the factors that a healthcare organization needs to keep in mind before adoption?

A: Its very important for the healthcare fraternity to know what the function of IT is in

healthcare: cutting cost or providing better value to the business. This will determine what

types of applications need to be moved to cloud, what type of SLAs to be ensured, and

what type of security mechanism to be kept in place.

Patient data privacy would be critical for hospitals planning to get on cloud. Then there is

data integration, where there is a definite need to create a strategy for syncing the data,

i.e., data residing in various clouds need to be integrated with the data in the company.

Q: What are the drivers for the adoption of cloud technology in healthcare?

A: The use of the cloud technology brings with it several benefits and these are same for

cloud adoption across the healthcare sector as well. These are driving the uptake of cloud

in the healthcare sector:

For a large unorganized sector, with small hospitals for whom it is not viable to install

in-house hardware and software, cloud solutions are very cost effective.

It is difficult to find qualified staff for maintenance and up-gradation of IT systems which

can be taken care of automatically by cloud technology.

It is useful in increasing a number of multi-location chain of hospitals because scalability

is easier with cloud.

It facilitates reduced capex on building ones own IT assets, as IT cost is managed as

operational cost on pay per use basis.

It helps remove cost and complexities of managing sophisticated IT infrastructure

in-house, which requires huge capital cost to plan for the peak capacity and skilled

manpower to maintain it.

Q: Could cloud be the answer to Big Data in healthcare? Do you feel the two can be

incorporated for an advantage?

A: Definitely! This is a trend to keep a watch on, as cloud-based analytics is already in the

market. However Big Data is more core to business than IT, and integrating it with cloud

will be a big leap.

Q: Data security, interoperability, and regulatory compliance have been identified as

the road bumps to widespread adoption of cloud in healthcare. How can a healthcare

organization overcome these issues with the use of cloud?

A: The regulatory need of privacy and security of the patient record should be a key

concern before adopting cloud services. However this can be tackled through proper need

assessment and transition planning that will help the healthcare organizations to take the

right decisions.

Dr Rana Mehta

Leader Healthcare

PwC India

Rajesh Ranjan

Leader Emerging Technologies

PwC India


17/32



INTERVIEW

Cloud interoperability standards are evolving by consortiums

of standards and definitions. Currently there is a lack of cloud

interoperability standards understanding between the cloud

providers and platform. However, since healthcare has established

standards of HL7 and DICOM protocols, this will continue to be a

functional protocol residing on top of the cloud platform.

Q: Will there come a time when cloud technology will be

advocated by the government for implementation?

A: Definitely yes! This is a great opportunity for state governments

to extend the reach and provide better heath-related services.

Cloud can be used to implement HIS, which will uniquely identify

a patient and store its health records across all government

hospitals in any state. Our firm is already advising some of the

state governments on this.

Q: Who are the major cloud players? What are the key

differentiators?

A: There are big MNCs like Google, Amazon, Microsoft as well

as Indian names like Tata, Reliance who provide cloud-based

services. Most of their offerings are similar in nature; however,

they can be differentiated on the basis of offerings for large and

small enterprises and some also specialize in specific industry

domains.

Q: What stake does the Indian market have in cloud

computing?

A: The Indian cloud computing market is currently at 900 million

USD and is projected to grow up to 4 billion USD by 2015. The

growth potential in the areas such as IaaS and SaaS are huge

and the Indian SMBs including healthcare players are poised to

move directly to the cloud to reduce cost on infrastructure and

manpower to manage applications in-house.

Q: What is the future for cloud technology in healthcare?

A: The future of cloud will be about integrating patient information

across the healthcare providers and payers, and adopting CRM

and analytics services on cloud. It will also have great potential

for government adoption so as to meet the goal of healthcare

for all.

13


18/32



eClinicalworks deploys EHR solutions at Ohio OrthopedicCenter of Excellence

eHEALTH

In an attempt to increase the efficiency and reduce the time lag

in delivering services, Ohio Orthopedic Center of Excellence has

chosen eClinicalWorks, an ambulatory clinical solution provider,

for its electronic health record (EHR) solution to be used by 59

providers, located at various regions.

Established in 1965, Upper Arlington, Ohio-based Ohio

Orthopedic Center of Excellence offers an array of services

such as spine surgery, total joint replacement, hand surgery,

ambulatory surgery, sports medicine, and digital imaging. TheCenter zeroed in on eClinicalWorks for an EHR system in view of

the companys ability to facilitate the provider in complying with

the meaningful use criteria, aid in R&D, and streamline reporting

by using a fully integrated platform.

Customized for over 50 specialties and sub-specialties, the

EMR will be licensed by the orthopedic center for the following

components:

Unified EMR/PM: Embedded with quality measure and

registry reporting, and e-prescribing, it enables physicians toseamlessly communicate with peers, access patient-related

information, and also qualify for meaningful use incentives.

Integrated with a practice management (PM) system, it aids

in achieving optimized workflow from the time of patient

admission until billing.

eClinicalWorks Patient Portal: Allows patients and

physicians to exchange various information such as lab

reports, reminders, educational material, medical history,

appointment schedules, paying bills, refill prescriptions via

a secure network, anytime, and anywhere. eClinicalMessenger: Uses voice-over-internet protocol

(VoIP) technology to promote the sharing of data between

provider and patient via voice messages and SMS texts.

Enterprise Business Optimizer (eBO): A financial and

clinical analytics tool.

The solutions suite also includes eClinicalWorks Electronic Health

eXchange (eEHX), eClinicalWorks P2P, and eClinicalMobile.

Headquartered at Westborough, MA and operating at New York

City, Pleasanton, Chicago, and Alpharetta, eClinicalWorks caters

to more than 370,000 medical professionals, 180,000 providers,

in physician groups, health centers, hospitals and communities,

correctional health centers, regional extension centers, and the

U.S. Department of Health (DoD). The vendors solutions are

certified by the Certification Commission for Health Information

Technology (CCHIT) Office of the National Coordinator

Authorized Testing and Certification Body (ONC-ATCB; 2011-12),

and Child Health (2008 and 2011-12). Reporting revenues of over

$200 million for 2011, the company has been featured in Inc.

5000 list of the fastest-growing companies by revenue, and in

the 2011 vendor assessment report on US ambulatory EMR/EHR

for midsize and large practices by International Data Corporation(IDC), a market research company.

Significantly driven by the meaningful use incentives, researchers

from Harvard and the University of California at San Francisco

(UCSF) have noted that despite the increased rate of EHR

use (90% and 71%), functionalities to achieve meaningful use

have been utilized to a minimum (2% and 30%, respectively).

Also repor ting increased acceptance, athenahealths recently

released annual Physician Sentiment Index (PSI) findings differ

on the benefits provided by EHRs. From 2011 to 2012, the surveyfound that the number of respondents relating the electronic

record to better care delivery not only dropped, but a greater

association was made to the worsening of patient care. Apart

from this, a majority of physicians (44%) felt that EHRs were built

not keeping the physician in mind, and achieving meaningful

use is a burden (75%). For physicians who choose to dif fer, as

of April 2012, CMS has paid more than $5 billion in incentives

to 94,097 providers, and there are currently more than 132,000

primary care providers working towards achieving meaningful

use.

Frost & Sullivan, in a 2011 report, has predicted the US market

to shoot up to $6.5 billion in 2012, a steep increase from $973.2

million of 2009. Furthermore, anticipating a $8.3 billion US market

share by 2016, Millennium Research Group has reported over 750

companies that have entered into the market space in a matter

of two years, offering solutions that have some form of EMR

features. In addition, an estimated average 12% per annum rate

in growth through 2016 has questioned the long-term viability of

these products in the market. Also suggesting increased market

saturation in the near future, Frost analysts opine that vendor

displacements will become a natural effect of changes in provider

management and ownership.


19/32



Agfa and Dell partner to provide medical image managementsolution on the cloud

PARTNERS AND ALLIANCES

Round Rock, TXs Dell will provide its cloud platform to host

its clinical archive portfolio and Greenville, SC-based Agfa

HealthCares Imaging Clinical Information System (ICIS). This

partnership has been inked in an attempt to enable offsite

expansion, facilitating access to archived information, and provide

comprehensive electronic medical records (EMR) that supports

the management of images.

Agfa, a part of Agfa-Gevaert Group, among its many deliverables,

focuses on including medical images into EMRs, in accordancewith an imaging strategy that outlines both the clinical role of better

health outcomes, as well as the business role of streamlining

operations and facilitating insurance reimbursements. Its suite

of solutions under this vertical, which are included in the current

collaboration, include ICIS, a workflow-centric clinical platform

that enables a longitudinal imaging record, IMPAX Data Center,

a scalable enterprise-wide or regional imaging management

solution, and XERO Technology Viewer, a web 2.0-based platform

that enables real-time image access. Although ICIS was already

accessible on private clouds at client data centers, its currentavailability as a completely managed service on the cloud,

extends the choices of clinical information system for providers,

simplifies image viewing, management, and archiving, facilitating

the establishment of an image-enabled EMR.

According to the agreement, Agfa HealthCares US clients can also

access Dell Cloud Clinical Archive, a solution to retrieve archived

information at times of system downtime or natural calamity, and

Dell Cloud Clinical Recovery, which acts as a secondary archive to

an existing onsite archive, allowing disaster recovery and businesscontinuity.

The cloud-based portfolio, by simplifying image archival

and management, allows healthcare providers to focus their

investments on supporting care, strategic services, and technology

development, and its cost predictability helps increase return on

investment.

Apart from Agfa, Dell has inked similar deals with Siemens

Healthcare, and NextGen Healthcare and Puerto Rico Hospital

Supply, enabling the presence of healthcare solutions on the

cloud. Dell, through its cloud-hosted clinical archives, supportsdata in more than 800 clinics, 5 billion diagnostic imaging objects,

and over 72 million clinical studies.

Healthcare data constitutes 30% of the global data, according to

a 2008 survey by Ponemon Institute, an education and research

organization. More recently, BridgeHead Software, a provider

of healthcare data storage management solutions, found that

63% of the surveyed providers attributed this increasing volume

of healthcare data primarily to imaging information. In order to

address this, healthcare organizations are deploying disasterrecovery and data archival tools for effective information

management. Disaster recovery has also been mandated by

Health Insurance Portability and Accountability Act (HIPAA)

Security. A data management survey by BridgeHead has

found disaster recovery as a top area of interest for healthcare

IT investments, with 55% planning to have it as one of their

top 3 investment areas. In support of data management, the

industry has taken to cloud computing technology, which offers

healthcare organizations a centralized means to store, exchange

and retrieve medical images, while enabling archiving anddisaster recovery.


20/32



Microsoft and GE Healthcare form novel IT company through JV

The shift from sporadic individual patient care to continuous

population management has given rise to the need for greaterinsight into care delivery, integrated care processes, and the

engaging of patient experiences. These in turn mandate a transition

towards new payment models that require the providers to connect

disparate silos of care and integrate data. In an attempt to address

this need, IT giants GE Healthcare and Microsoft Corporation have

entered into a 50-50 joint venture to form a new company called

Caradigm, which is aimed at providing the healthcare fraternity

with real-time intelligence that it can use to enhance the quality of

healthcare rendered and patient experience.

The idea which was incepted in December 2011, has now reached

completion following the establishment of a firm set of goals, and

steered by a strong leadership team to enable the company to

achieve its outcomes. The leadership team for the new company

has been established by constituting a team of executives from GE

Healthcare, Microsoft, Care Innovations (an Intel and GE company),

and Philips Healthcare. Michael Simpson is spearheading the new

establishment as CEO, Neal Singh as CTO, Lauren Salata as CFO,

and Michael Willingham as regulatory affairs and quality assurance

executive. Obtaining regulatory approvals from the initial list of

countries, the company is located at City Center Bellevue, Bellevue,

WA, and operates from Andover, MA; Salt Lake City, UT; Chevy

Chase, MD; with centers across the globe as well.

Through this new venture, Caradigm intends on developing

and marketing collaborative clinical applications and an open,

interoperable healthcare intelligence platform, which aims to

improve population health management systems, thereby

reducing costs and enhancing outcomes of care delivery. The new

company will serve as a platform for software vendors to develop

customized and demand-driven solutions for the industry, and

leverage and connect these applications to Microsoft HealthVault,

which will remain with Microsoft as a cloud-based service.

Caradigm will also host collaborative clinical applications directed

towards achieving the long-term goal of developing a healthcare

performance management suite aimed at better population health

management. Backed by a common vision of a connected,

patient-centered health system, the parent companies bring to

the table complementary expertise:

Microsofts know-how in creating ecosystems and platforms,

and solutions including Microsoft Vergence: single sign-on, context management

software

Microsoft Amalga: health intelligence platform for the

enterprise

Microsoft expreSSO: single sign-on solution for the

enterprise

GE Healthcare, its experience in administrative and clinical

workflow solutions including

GE Healthcare eHealth Information Exchange: health

information exchange

Qualibria Quality Management Solution: clinical decision

support application

Through this collaborative effort, GE Healthcare and Microsoft

hope to address pressing concerns of the healthcare sector,

such as healthcare-associated infections and chronic disease

management, and global challenges to quality care, including

access to patient-critical information and healthcare costs. This,

they plan to achieve by focusing on interoperability of health

systems, accountability and performance of healthcare delivery

systems at all levels of care and in every country.

In support of GE chairman and CEO, Jeffrey R Immelts belief

in the potential of the combination of leading companies with

complementary capabilities to meet a common vision, GE

Healthcare embarked on a previous JV with Intel Corporation for

the establishment of Care Innovations LLC. The combining of

Intels Digital Health Group and GE Healthcares Home Health

business, Care Innovations was incepted in January 2011 to cater

to home health monitoring and the telehealth sector.

For Microsoft, many analysts consider this move as an exit from

the clinical market, except for HealthVault, with the previous sell-off

of its Amalga HIS to Orion Health in 2011. This is augmented by

the conditions in this JV, wherein Microsoft contributes through

its intellectual property, and the rest of the business is handled

by GE. Although, Microsoft has held onto to HealthVault in this

JV, analysts, Chilmark Research, wait to see whether it can be

converted into revenue generating sustainable business for the

company, or ends like the recently closed Google Health.


21/32



PRODUCTS AND SOLUTIONS

3M releases new ICD-10 financial analysis software and service

3M Health Information Systems, a provider of health IT solutions

and services, has announced the inclusion of an analysis tool and

consulting services into its International Classification of Diseases

Revision 10 (ICD-10) transition planning solutions suite. This

has been designed to assist providers in estimating the ICD-10

transitions financial impact on each, diagnosis related group

(DRG), hospital department, and on an organization as a whole.

Offered as a component of ICD-10 code translation tool, the

financial impact analysis tool evaluates ICD 9-derived DRG claimsalong with the base payment rate of an organization, and details

the probable reimbursement that could be derived if the same

DRGs were generated from ICD-10 codes. The financial impact

tool also detects the DRGs that will remain as is and those that

will change.

ICD-10 financial impact analysis consulting service, includes

executive-level reports, onsite record review, data analysis,

and education to enable providers make informed decisions

on educational requirements, and operational and personnelenhancements. Services are also provided for improving clinical

documentation, along with a web-based curriculum, the ICD-10

Education Program.

According to 3M, by evaluating the financial impact, healthcare

organizations can review contracts, project receivables, and

incorporate training programs and enhancement of documentation

where they are most required. With this, Ray Terrill, the senior vice

president at 3M believes that they can transform the transition to

ICD-10 as a strategic advantage by purging probable oversightand risks.

The latest addition adds to Salt Lake City, UT-based 3M Health

Information Systems wide array of ICD-10 transition solutions and

services that help clients enhance documentation and coding,

identify potential risks, map and convert systems, translate codes,

and educate employees. For more than 30 years, the company

has been catering to over 5,000 hospitals, globally, through more

than 100 coding experts. With more than 15 years of expertise in

managing ICD-10 products and services, 3Ms code translation

tool was chosen, in 2011 by CMS, to assist in the conversion of

applications, systems, and reports from ICD-9 to ICD-10. It was

also licensed to Medicare Administrative Contractors (MACs) and

carriers, and Fiscal Intermediaries (FIs). 3Ms association with

CMS goes way back to 1995, when the company was contracted

to provide ICD-10 General Equivalence Mappings (GEMs),

Procedure Coding System (PCS), and the initial conversion of

MS-DRGs to ICD-10.

Apart from 3M, many vendors such as Healthcare Informationand Management Systems Society (HIMSS) and Jvion, CSC,

and Edifecs have come up with ICD-10 financial impact analysis

solutions to aid providers in making the transition.

The U.S. Department of Health and Human Services (HHS) has

proposed a ruling mandating the healthcare industry to shift from

ICD-9 to ICD-10 by October 1, 2014. Regarded as a massive

task, the implementation of ICD-10 is said to affect almost every

operational system and process of the providers revenue cycle

and payors administrative procedures.

While gearing up for the switch in the coding systems, several

concerns related to planning, implementation and cost associated

with the process, dearth of skilled coders and trained staff, and

reduction in overall productivity daunt the healthcare fraternity,

according to a recent article published in the journal Perspectives

in Health Information Management. Although the migration to ICD-

10 may initially offer many challenges, it is anticipated to provide

significant benefits over a period of time. The research article finds

ICD-10 to reduce cost as it allows for improved cost analysesand data integrity, enhanced monitoring of health outcomes,

and reduced fraud and abuse. With the requirement of better

documentation, according to Milliman, a consulting and actuarial

organization, the new coding system will result in more precise

coding and payments in return.

In conclusion, it has been suggested that healthcare entities

can successfully make this transition by understanding both, the

challenges, benefits, and related costs of implementation, and

choosing an appropriate adoption strategy.


22/32



IDC reports indicate an evolving HIE market

IDC Health Insights finds the health information exchange (HIE)

market landscape to be evolving, through two market reports

that have analyzed HIE vendors. Sixteen vendors providing HIE

platforms, including tools for development, educational and

professional services, an extensive partner network, and published

APIs; and 10 vendors for packaged solutions were evaluated

through these two studies.

The IDC MarketScape: U.S. Health Information Exchange

Packaged Solutions 2012 Vendor Assessment study finds the HIEmarket to be fragmented, with vendors offering products of varied

origins, including composite applications, integration engine

platforms, clinical messaging, portals, managed network services,

and information management. It was also seen that the enterprise

industry forms the fastest growing market, in account of its ability

to support collaborative care and demonstrate meaningful use.

Released consequently, the IDC MarketScape: U.S. Health

Information Exchange Platform Solutions 2012 Vendor

Assessment found that the HIE market continues to evolveas the attention is shifting towards the conversion of data into

actionable information for collaborative care or accountable

care initiatives, from enabling connectivity for data exchange and

using technology meaningfully. As a consequence of this shift,

additional vendor consolidations have been reported. This has

been demonstrated by seven MnAs and the emergence of new

vendors, like telecommunication and payor organizations, since a

2010 analysis by IDC. In view of such activities, the HIE packaged

solutions study proposes a dynamic market with continuous

change seen in the competitive and technical scenario. The studyalso reports a major role played by platform-as-a-service in the

HIE market; as vendors consider building a strategic collaborative

ecosystem with other companies.

Lynne A Dunbrack, Program Director, IDC, finds the IT demands,

due to changing reimbursement and care delivery models, and

health information organizations, to be too big to be fulfilled by a

single company. Both surveys show that, vendors are acquiring,

partnering, or developing collaborative care, patient engagement,

18

INSIGHTS

and analytical technology, apart from just offering primary HIE

technology, in an attempt to cater to technical and business

demands of accountable care. In addition, the HIE market is

expected to witness a dramatic change over the coming 12 to 18

months, with the entrance of dominant vendors into the market,

which is flooded with small, private companies.

While the study finds platform designs advancing over time

(mostly through self-development) to satisfy the requirements of

clients and alliances in the ecosystem, the packaged solutionswill be developed to cater to specific requirements. The latter are

expected to lower the risks posed by uncertain project timelines,

scope, and costs.

The HIE market, despite many challenges, has witnessed

remarkable growth (an excess of 40%) in 2011, according to a

2012 Clinmark Research report. In concurrence with the present

report, Clinmark finds the enterprise market as a major contributor,

and the HITECH Act and statewide HIE contracts as minor

factors supporting this growth. Healthcare organizations havebeen turning towards HIE implementation, not only for complying

with meaningful use, but responding to pending reimbursement

changes, and shifting from pay-for-services to pay-for-outcomes

model. The new reimbursement models would require healthcare

organizations to better manage patient care and operations across

the continuum of care. Amidst the diverse EHR environment,

providers are increasingly adopting HIE technology in an effort to

access data in EHR silos across the community.

Black Book, a market research company, in their recent survey,also finds evolving reimbursement models and the push to prepare

for accountable care organizations as major reasons (85%) for

HIE adoption. Further, the research also indicates healthcare

organizations HIE spending to grow significantly by 2014, as

indicated by 8 out of 10 provider participants.

With the healthcare industry quickly entering into the post-EHR era,

Clinmark finds that the value of patient data is in a HIE-supported

network, and not in disparate EHR data silos.


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Wireless communication devices are being adopted increasingly

in the healthcare industry. A 2012 Dell SecureWorks report finds 2of 5 US clinicians utilizing tablets or smart phones during patient

encounters. Although mobile devices offer several benefits, it

brings with it privacy and security risks, with 65% of data breaches

occurring on laptops and mobile phones, and 57% because of

theft. These have been cited as chief hindrances for mHealth

adoption by 41% specialists and one-third primary caregivers.

With this, it is imperative for healthcare providers to develop risk

assessment and mitigation plans to tackle security and privacy

threats posed by mobile devices, and avoid penalties, tarnished

reputation, and financial loss. According to the report, the cost forrecovering data following breach involving mobile devices is $258.

Below is the compilation of suggestions made by the healthcare

fraternity, for managing security and privacy with mobile devices.

NCCIC, a U.S. Department of Homeland Security (DHS)-led center

overlooking nation-wide cyber and communications operations,

advocates a layered security mode for securing mobile devices:

Acquire medical devices with fine-grained and well

documented security functionalities, which are safe to

configure on networks

Incorporate ongoing support for vendors to update antivirus,patch, and firmware in the purchase vehicle. Enforcing safe,

effective and legal software and patch upgrading regulations.

Have a practical approach for managing network monitoring

and intrusion detection techniques, external-facing firewalls,

and internal network segmentation that contain the devices

Forbid unauthorized users via access control lists (ACL),

and unsecured and/or unrecognized devices, through

the enforcement of stringent laws, from accessing health

information network (HIN)

Frame guidelines for periodic review, management, and

auditing of network configurations upon change of network

Leverage the principle of least authority in determining the

accounts that require access to particular medical device

components, instead of the complete network

Password protect personal health information (PHI)

Ensure secure communication channels by encrypting and

authenticating both ends of the channel

In an attempt to ensure secure mobile computing, Dell

SecureWorks, provider of information security services, suggests

the following steps to healthcare organizations:

Develop a guidepost: Involves the evaluation of different

modes employed to secure mobile devices, and utilization of

established models for defining a way forward on mobility and

security concerns. The plan, upon considering the needs andimportant sections of the organization, should give an insight

into the areas of opportunity, costs, and expected investment.

Risk assessment: Comprises of recognizing, and assessing

the risks. The procedure plays a pivotal role while switching

between various ownership models or smart phone platforms,

and complying by security and privacy enforcement laws.

Security assessment: Manual and automated approaches

of testing should be applied to analyze the security and

compliance risk imposed by an application, connected

systems, and flow of data between application and system. Data encryption and protection for PHI by availing access to

only authorized users.

Apart from these, below are a few best practices suggested by

various industry leaders, which has been consolidated by ID

Experts, a data breach solution provider.

Providers should consider and mitigate risks involved with

the use of personal devices for work-related purposes,

and facilitate benefits of these devices found lacking in the

organization. With theft and loss of devices being top healthcare data

breaches, geolocation tracking software, a low-cost insurance

policy, has been suggested as a useful approach to trace and

clean data present in devices.

In cases of theft or loss of mobile devices, remote wiping

methods need to be used to brick the whole device, rather

than just deleting the encrypted corporate data, as most of

the personal data stored in the devices have a backup on

the cloud.

USB locks can be installed to prevent unauthorized transfer

of data.

Encryption is necessary.

Introduction of bring-your-own-device (BYOD) and mobile

devices renders electronic PHI vulnerable to data breaches;

hence, organizations should implement cyber liability

insurance as a part of data breach response strategy.

While upgrading BYOD, users must ensure that all private

and sensitive information are successfully deleted from old

devices that go offline.

Ensure technical safeguards such as data segmentation,

encryption, access controls, VPN software remote, data

erasure, etc. are installed in mobile devices before use at a

setting.

19

Healthcare industry experts suggest strategies to address mobiledevice security and privacy threats

INSIGHTS


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INSIGHTS

H&HN survey illustrates IT utilization among 2012Most Wired Hospitals

Hospitals & Health Networks (H&HN), a publication of the American

Hospital Association (AHA), has announced more than 200 MostWired hospitals, based on a survey that analyzed IT utilization

at healthcare organizations across four areas: infrastructure,

business and administrative management, clinical integration

(ambulatory/physician/patient/community), and clinical safety and

quality (outpatient/inpatient hospital).

H&HN, in cooperation with McKesson Corporation, CareTech

Solutions, AT&T, the College of Healthcare Information

Management Executives (CHIME), and AHA, conducted the

survey on 1,570 hospitals (~27% of US hospitals); of which, 662

completed the survey. The survey results provide an insight into

the types of technology used by these Most Wired hospitals and

the rationale behind this recognition.

Patient care

Including the existing methods of improving patient care, the

survey has found that tech savvy hospitals are venturing into the

latest in what technology and media can offer for conne

hitnd q3 final

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