Few things have impacted the US healthcare industry like the Health Insurance Portability and Accountability Act (HIPAA). Since it was signed into law in 1996, healthcare providers, payors, and vendors alike have been deeply impacted by HIPAA’s goals, which include ensuring the portability of insurance coverage between jobs, simplifying the administrative function of receiving and paying for healthcare services, and protecting the privacy of patient information. To address the last two points, both Congress and the healthcare industry have agreed that standards for the electronic exchange of administrative and financial healthcare transactions were needed to improve the efficiency and effectiveness of the healthcare system as well as to protect the integrity of information.
Since then, national standards for electronic healthcare transactions have encouraged electronic commerce in the healthcare industry that will simplify processes and result in savings by reducing the administrative burdens on providers and payors. Until HIPAA, healthcare providers and plans that conducted business electronically had to use many different formats for electronic transactions (about 400 different codes exist for healthcare claims alone), which often led to confusion and unnecessary delays in reimbursement. With the national standard for electronic claims and other transactions, providers can submit the same transaction to any health plan in the United States, and the plan must accept it. Likewise, health plans can quickly send standard electronic transactions, such as remittance advice and referral authorizations, to providers. These national standards are helping to make electronic data interchange a preferable alternative to paper processing, an outdated process that, for years, has been holding back the productivity and efficiency of the healthcare industry.
Although these elements of HIPAA—especially those related to health payors—are very focused on the United States, the issue of standardizing both clinical and financial healthcare information is one that has gained worldwide prominence, specifically when talking about developing national health information infrastructures to reduce medical errors. Electronically connecting providers, payors, pharmacies, laboratories, and physicians so that complete electronic medical records (EMRs) are accessible anytime, anywhere could help eliminate errors, increase efficiency, and improve care in any country. For example, the Institute of Medicine (IOM) estimated in 1999 that between 44,000 and 98,000 patients in the United States alone die each year due to preventable medical errors. The group recommended that information technology (IT) solutions be established to help reduce avoidable mistakes, such as illegible handwriting and miscommunication. Last year, the US Department of Health and Human Services commissioned the IOM to design a standardized EMR; this year, President Bush called for broader implementation of EMRs in his State of the Union address. Given the number of medical errors that can be prevented, lives that can be saved, and cost savings that could accrue, the movement toward a standardized EMR has grown strong in the United States and in developed countries around the world.
Global organizations, such as DICOM, HL7, IHE, and ICD 10, are dedicated to creating healthcare standards so that information can be communicated electronically without regard to the IT system used. It is essential that industry leaders, like Siemens Medical Solutions and others, commit to developing flexible systems that can easily accommodate the standards of any country.
For example, a standard user interface that provides one common language, look, and feel for all medical imaging tasks, applications, and systems anywhere in the world (ie, a Windows for healthcare) could have an enormous impact on improving the quality and efficiency of care. An obvious benefit would be the reduction in training time for clinical teams that are often understaffed and have little time to spend learning new software systems. Imagine a radiologist who must be proficient in multiple software systems to view results depending on which technology an exam was conducted in—CT, MRI, X-ray, and more. All of these systems might have different commands, icons, and platforms that can become confusing with an abundance of patients but a shortage of staff. It’s easy to see how much time is wasted deciphering multiple systems and how diagnosis errors are overlooked. Having a common user interface means less time learning a variety of software systems and more time focusing on patient care.
Another benefit of a standardized system is the quick access to complete patient information from anywhere within a hospital, a home office, via a PDA, and the like. This 24/7 access saves time that would otherwise be wasted collecting records, and it leads to more informed clinical decisions. From a technical perspective, a solution that standardizes all imaging equipment and IT systems helps radiologists fully leverage the value of radiological data. A radiology department might have an effective combination of imaging modalities, but a common platform allows these modalities to communicate—an ability that heightens the sharing of data across modalities and results in a reduced risk of errors and improved workflow.
The concept of using technology to help improve workflow in healthcare is still new but has rapidly become a theme in the industry. Healthcare has traditionally lagged behind the rest of the world when it comes to adopting IT; however, in the past decade, healthcare has taken cues from the manufacturing and finance industries that are seeing significant productivity and quality improvements by marrying sound business processes with the right technology. There are now IT solutions built with a workflow engine—a tool used often in manufacturing—to proactively facilitate processes and help ensure that the right clinical and administrative tasks are completed when they should be. Furthermore, these IT solutions can be built upon a standard software look and feel, similar to the medical imaging systems, extending benefits of standardization beyond the radiology department and into the entire organization.
In this age of increased government involvement in healthcare, the new generation of IT solutions are designed to help healthcare providers comply with standards regulations, such as HIPAA, which undoubtedly will lead to faster reimbursements and improved workflow. But as we all know, technology alone—no matter how well adopted—is useless without the right processes in place. Process improvements combined with the right technology solutions will help us realize the ultimate goal of higher quality care and lower costs in healthcare around the globe.
Tom McCausland is the president and CEO of Siemens Medical Solutions USA (Malvern, Pa).
