Jim St. Clair, XBRL on the new Frontier: Integrated Reporting in Healthcare
Over on Hitachi Data Interactive Blog
HIMSS Launches Blog
From now on, you’ll be able to find the kind of content you’ve enjoyed here at http://blog.himss.org/
HIMSS MBP Leadership Forum, Vanderbilt Center for Better Health, October 6 & 7, 2010
Our Leadership Forum is fast approaching and we invite you to save the date early for this important event! On October 6-7, 2010, our traditional Medical Banking Leadership Forum is changing format somewhat…all attendees will be placed into a stakeholder category and become part of our first G7 Roundtable. Stakeholder categories include: providers, banks, plans, consumers, government, technology firms and employers. This is a one-of-a-kind event to discuss a pressing issue – real time adjudication – and to provide your critical feedback into a national process that we have planned.
We will be assessing at least three aspects of “real time adjudication”:
(1) technological readiness;
(2) health payments interoperability; and
(3) health care reform – administrative aspects.
Note that the New York Times ran an article on this topic last Sunday – “See You In 6 Months. And The Insurer is OK With Your Bill” - http://www.nytimes.com/2010/06/27/business/27digi.html?src=busln. John Casillas responded to the column and received a response back so they are aware of our work and we’ll be updating them on further developments.
The nation’s first G7 Roundtable will be held at the Vanderbilt Center for Better Health in Nashville, Tennessee. We are working with our sponsors and Vanderbilt University to organize a press event just prior to the G7 after which all press will be asked to leave so we can get down to business!
Thank you for saving October 6-7, 2010 on your calendars for our G7@HIMSS MBP Leadership Forum more information to come!
HIMSS Business-Centered Systems Staff
XBRL, the New Language of Financial Reporting, Slated to be Included in the Financial Track of SemTech 2010
ED: This is not a HIMSS Medical Banking Project event but its goals re: transparency run parallel so I'm posting the announcement here.
A distinguished group of industry experts from around the globe will lecture on the benefits and advancements of semantic technologies in the financial sector.
Los Angeles, CA (PRWEB) April 26, 2010 — The SemTech 2010 Conference has dedicated an entire track to focus on semantics in financial services. This track is scheduled for Wednesday, June 23 and will provide an overview of the many ways semantic technologies are being used in the financial industry today, from a 360-degree view of the customer, to meeting stringent reporting requirements, and from fraud detection to risk analysis and credit monitoring.
The Semtech Conference will take place June 21-25, 2010 at the San Francisco Hilton in Union Square. The financial services industry is usually an early adopter of new technologies, and semantics is no exception. Attendees will receive a full day of discussion and instruction, from the basics of semantic software development through to demonstrations of sophisticated solutions that are being implemented in banking and finance today. SemTech program chairman Tony Shaw said, “the program is designed so that both business and IT management can understand the benefits of semantic technology, see examples or existing systems, and get started with their own applications right away.”
The financial industry has a specific set of data management concerns and requirements that make it well-suited for semantic solutions. As Shaw explains, “A key driver of IT within financial organizations is the need to find, integrate and publish widely disparate data across the organization. Semantics handles this task quickly, effectively and affordably. These advantages of semantics can also be extended beyond the individual enterprise more easily than alternative technologies.”
An example is the recently agreed Semantics Repository, from the Enterprise Data Management Council. This is solving real data integration problems within the securities industry, and helping to grapple with the complex information requirements of the global regulatory framework to control systemic risk in the financial markets.
This year’s financial track encompasses many topics and will take an in depth look at:
Searching Semantic XBRL: XBRL is the new language for financial reporting, yet text-based search engines like Google are not capable of searching XBRL documents effectively. With so much financial regulatory attention focused on the potential benefits of XBRL, speaker Ashu Bhatnagar of GoodMorningResearch.com will show how Semantic Web technologies are key to searching XBRL documents to find what the regulators need.
Also on the theme of risk management, Drew Warren of Recognos will discuss how semantics can be used to integrate diverse data and then identify correlations and relationships between data points. This enables advanced applications for Counterparty Risk and Exposure, a key problem that caused the world financial crisis.
The World Bank will discuss the use of semantic technologies within its Enterprise Information Architecture for integration of information across the Banks’ multiple repositories and the unification of structured and unstructured information. Denisa Popescu of World Bank Group will further explain their implementation of automated metadata capture using semantics.
From the commercial banking perspective, David S. Newman of Wells Fargo will discuss a range of opportunities and challenges for semantics for requirements including consolidating account information, better financial reporting, and feeding data to business intelligence tools. The Data Projection Model: Based on semantic technologies, the data projection model is like “double entry bookkeeping” for information management. This is used currently within a semantic application at the Internal Revenue Service and this will be the first time it has been discussed in an open forum.
To register for the conference and to see a full schedule please visit, http://semtech2010.semanticuniverse.com
To register for a free press pass please visit, http://semtech2010.semanticuniverse.com/press.htm
SemTech is the preferred industry platform for exhibitors to announce product launches, publishing deals, and breaking news. Attendees will have the opportunity to view products and services from top industry developers. Current sponsors include: Ontotext, Oracle, Revelytix, Inc., Cambridge Semantics Inc., Atigeo, Franz Inc, TopQuadrant, Zepheira, Raytheon BBN, Saltlux, IBM/Ontoprise, IntelliDimension, Talis, Thomson Reuters (Calais), Semantifi, True Knowledge, Clark & Parsia LLC, and Orbis. To become a sponsor or exhibitor please contact Steve Bastasini at email@example.com or (415) 740-5528.
SemTech is the world’s largest conference on semantic technologies. It is the only event focused on the commercialization of semantic technologies, bringing the most recognized names, knowledge, leadership, and innovation in the semantic community together at one location. SemTech is owned and operated by Semantic Universe–the semantic community’s trusted information resource. Semantic Universe is a joint venture between Wilshire Conferences and Semantic Arts. For more information please visit, SemanticUniverse.com, email firstname.lastname@example.org, or call (310) 337-2616.
Standardisation, regulation and recovery of the financial industry
by Alexandre Kech, https://www.swiftcommunity.net/communities/49/blogDetail/20931
Since the outburst of the crisis and its resurgence these days, politics, journalists and people in general request that there be more regulation of the financial industry. Without taking a stand on whether it should or should not be the case, I am convinced that standardisation of communication and identification protocols has a major role to play in helping the financial industry regain some of its lost credibility.
The use of communication standards such as ISO 20022 or identification standards such as ISO 9362 Business Identifier Code (BIC) or ISO 10383 Market Identifier Code (MIC) increases the transparency of data.
The adoption of these ISO standards for all financial communication would enable the transport of standardised data in compliance with standardised processes not subject to interpretation nor manipulation by the bad guys of the industry.
It would enable the creation of international or local reporting facilities usable by any regulators and allow market data to be exchanged in an efficient way among them. The current use of proprietary standards is inefficient and costly.
Martin Sexton, Director of IT at London Market Systems Ltd, once advocated in a mondovisone article regarding MiFID : “Realistically, the only way to ensure that one has achieved this [provide evidence that they have achieved 'best execution' for their clients] and met the directives requirement of market transparency is by the use of industry standards.” I cannot agree more. This is true for any need for transparency.
There is no doubt in my mind that if the whole industry was (forced?) to adopt ISO standards, the industry would save hundreds of millions of EUR or USD (same thing, nowadays, no?) in recurring maintenance costs of messaging and integration platforms and equivalence tables for static data. And you can add a few hundred millions spent on losses due to bad quality non-standard data, on staffing used for manual repair or rekeying of transactions, on implementation and testing (and maintenance) of proprietary standards to connect to “international standards disabled” market infrastructures. You just need to have worked a few years in operations or discussed with implementers to realise it.
Lillian Tham, Chief Operating Officer at Schroders was saying exactly that at a recent SWIFT event: “The only way to decrease our fixed cost infrastructure is to standardise internally and externally.” ISO 20022 is the response to this.
The issue is that those costs are spread across many years and are invisible to short term focused shareholders. They only see the cost of implementing the standards, though a fraction of the profit of most financial institutions last year (a difficult year, it was). And this cost perception issue is not an easy one to overcome these days.
Following the adoption of ISO 15022 by global custodians and ICSDs in the dawning of the 21st century, all were able to focus on what is essential; the quality and diversity of the services they offer. It has also became easier for customers to switch from one provider to another. It did remove some of the stickiness of the services some custodians were offering but if they did indeed lose clients, they also won clients. You will find nobody in the global custody business to say that their adoption of ISO standards was a mistake. If it worked for the global custodians, why wouldn’t it work for the whole financial industry, CSDs, CCPs, trading venues, etc? ISO standards will bring their full potential only if implemented by most or all of the Industry. In some cases, partial implementation can sometimes be more costly than no implementation at all.
Alistaire Milne, Senior Lecturer in Banking and Finance (Cass Business School), starts his paper on Standards and competition in post-trade securities processing by: “Standard setting in securities settlement is not just about lowering processing costs and improving cross-border interoperability, it is also a central determinant of competition in central counterparty clearing, in securities settlement, and in associated services, such as securities custody and the management of securities transactions.” I cannot agree more.
For those who would argue that ISO standards are not flexible enough to enable innovation and therefore competition based on better and new services, I would reply that it has been too long since they have looked at an ISO standards. ISO standards, nowadays, have built-in extension mechanism and other features to enable the necessary innovation and competition to take place without jeopardising the need for transparent and standardised financial communication. Most ISO identification standards such as MIC or BIC are updated on a monthly basis, some faster.
Once you have spent some time and money on optimising processes through standardisation, you have the tool box you need for a longstanding, robust recovery and for growth.
You have tools to prevent such a crisis through an effective and fair control of the industry.
You have the tools to enable investment in markets that standards finally made accessible in a cost effective way.
You have all your need for a financial industry at the service of the economy (its historical role). You can quote me on that one.
In another life, I was in the door-to-door selling business. You know what? I kind of liked it (for a short while…) because I believed in the product I was selling. It is the same for ISO standards. The last 10 years, I have been market-to-market selling ISO 15022, ISO 20022 and others. I like it because I am convinced that the standardisation of the financial industry is the key to many of the issues to which it is confronted.
It is not for nothing that so many international or local players such as Target 2, Target 2 for Securities, Jasdec, DTCC, Euroclear, Clearstream, Strate... decided to speak ISO. Global custodians, I have already mentioned, do not need any more convincing.
It is not for nothing that most banks use ISO 9162 BIC as a way to identify themselves globally, that internet uses ISO 3166 for identifying countries, that treasurers use ISO 4217 for identifying currency codes, etc. It is because it brings value, efficiency and cost reduction.
So whenever someone proposes to you a communication or identification protocol, if it is not ISO, say you are not interested and have them call us.
Epic fail: Hospitals aren’t publicizing charity programs
Anne Zieger passed this along.
HIMSS Virtual Conference & Expo, Wed, Jun 09, to Thu, Jun 10, 2010
This virtual event focuses on transformational approaches for achieving meaningful use. The educational program will highlight the innovative approaches, strategies, actions and awareness needed to transform healthcare through three tracks: Facilitating Health IT Adoption and Utilization; Principle and Practice of Usability and Human-Computer Interfaces; and Career Development/Advancement. Please share this event with your connections!
Input on Tennessee's Strategic and Operational plans for Health Information Exchange
From: Dean Flener
Subject: For Public Comment
The Office of e-Health Initiatives would like your input on Tennessee's Strategic and Operational plans for Health Information Exchange. These documents describe Tennessee’s plan to increase the adoption and use of health information technology and health information services among health care providers. The Office of e-Health’s Strategic and Operational plans aim to create a patient-centered health care system with the primary goal of enabling secure access to electronic health care information Click the links below to download and view the documents:
Tennessee's Operational Plan for HIE http://bit.ly/ckUeJw
Tennessee's Strategic Plan for HIE http://bit.ly/9hhapO
Instructions for sharing your comments:
1) E-mail your comments to Office.eHealth@TN.gov.
2) You may share your comments as narrative in e-mail or as an attachment to an e-mail message.
3) Please include your first name, last name and organization name. We’re sorry but if this information is not included, we will not be able to consider your comment for response.
4) Please indicate the page number(s) and paragraph(s) where proposed edits or comments should be considered.
5) All comments are due by noon CDT on Friday, May 21, 2010.
6) If you have questions, please e-mail Office.eHealth@TN.gov. After we review and respond to the received public comments, we will post a compiled list of the comments on the Office of e-Health website, http://www.tn.gov/ehealth and to the Listserv. If you know others in our state who would be interested in providing public comment on Tennessee’s Strategic and Operational plans for Health Information Exchange, please forward this message to them. We want to hear from as many Tennesseans as possible.
Governor Bredesen, Mayor Dean, Commissioner Kisber Welcome Anchor Tenant To Nashville Medical Trade Center
Largest U.S. Healthcare Association Focused on Information Technology To Establish Presence in Nashville
NASHVILLE, Tenn. –Governor Phil Bredesen was joined today by Nashville Mayor Karl Dean, Matt Kisber, commissioner, Tennessee Department of Economic and Community Development and the CEOs of Market Center Management Company and the Healthcare Information and Management Systems Society (HIMSS) to announce plans by HIMSS to create a presence at the recently announced Nashville Medical Trade Center. With the announcement, HIMSS becomes the first anchor tenant for the medical trade center, slated to be built on the space currently occupied by the old Nashville Convention Center at 601 Commerce Street.
“I could not be more pleased HIMSS has agreed to a permanent presence at the Nashville Medical Trade Center,” said Governor Bredesen. “Nashville and the state of Tennessee already have a strong reputation in the area of health care information technology development and innovation. HIMSS’ presence here will make our state a center of excellence in this increasingly important area of health care delivery.”
“When we announced the Nashville Medical Trade Center last November, I felt confident that Nashville was the right place for this one-of-a-kind innovation in purchasing for the healthcare industry,” said Mayor Dean “The decision of HIMSS to locate a permanent healthcare technology showcase in Nashville is validation of that confidence. I am certain that today’s announcement will soon be followed by other significant lease announcements with companies in the area of healthcare technology.”
The space occupied by HIMSS at the Nashville Medical Trade Center is expected to become a permanent home for the Society’s Interoperability Showcase, a state-of-the art, interactive demonstration showing how health IT applications share patient data across a range of healthcare settings. The Showcase will be the premier demonstration platform for the latest in healthcare information technology.
“A permanent, year-round destination for HIT activity and innovation would only be possible inside this groundbreaking marketplace,” said H. Stephen Lieber, president and CEO of HIMSS. “By joining the trade center are we able to reach more participants, demonstrate meaningful use more completely, and offer more flexibility than ever before.”
“We are thrilled to announce a sustained alliance with a leading global healthcare organization,” said Bill Winsor, president and CEO of Market Center Management Company. “The HIMSS mission to provide global leadership for HIT complements our efforts to create the complete marketplace for healthcare ideas and innovation. A permanent showcase will capitalize on the significant investment of time and expertise of organizations and companies participating in the HIMSS Interoperability Showcase and other events.”
“This announcement is the result of the strong partnership between Market Center Management Company, the state of Tennessee and Nashville,” said Commissioner Kisber. “Healthcare companies recognize Governor Bredesen has been a leader in the area of e-health development for nearly a decade and with HIMSS’ announcement, Nashville and Tennessee will play an even bigger role.”
A former health care CEO, Governor Bredesen was instrumental in the creation of the Mid South eHealth Alliance in 2006 and that same year, created the Office of e-Health Initiatives at the state level. In 2007, he was appointed to co-chair the National Governor’s Association’s State Alliance for e-Health along with Vermont Governor Jim Douglas. Under Governor Bredesen’s leadership, the state has spent more than $14 million to connect more than 2,000 healthcare providers and pharmacists to promote electronic prescribing systems, making Tennessee one of the five fastest growing states in the country in electronic prescribing practices.
About the Tennessee Department of Economic and Community Development
The Tennessee Department of Economic and Community Development’s mission is to create higher skilled, better paying jobs for all Tennesseans. The department seeks to attract new corporate investment in Tennessee and works with Tennessee companies to facilitate expansion and economic growth. To find out more, go to www.tn.gov/ecd or www.investtennessee.org.
Market Center Management Company (MCMC) is an international wholesale trade center and tradeshow management company based in Dallas, Texas. MCMC and its owner, Crow Holdings, own or manage trade centers and tradeshows on three continents – Asia (ShanghaiMart), Europe (Brussels International Trade Mart), and North America (Dallas Market Center, GlobalTex: LA International Textile & Sourcing Fair), totaling more than 10 million square feet, more than any other single international company. Within the MCMC trade centers and tradeshows, customers from around the globe source products directly from manufacturers including home furnishings, gifts, decorative accessories and lighting to textiles, fashion accessories and apparel. The dozens of trade events each year hosted by MCMC are attended by hundreds of thousands of customers from all 50 states and more than 84 countries. MCMC’s Web site is available at www.marketcentermanagement.com. twitter.com/MedTradeCenter.
Contact: Mark Drury (ECD)
Office: 615.532.8880 (office) 615.330.7587 (cell)
Contact: Janel Lacy (Mayor)
Office: 615.862.6020 (office) 615.438.3416 (cell)
Contact: Cole Daugherty (DCMC)
Georgia Automated Clearing House Association 2010 Solutions Request for Speaking Proposals
Jessica Jane Rios twitter.com/jtrundley would love to hear something on medical banking
Articles on Cell Phone Banking and mFinance
SmartPlanet correspondent Sumi Das on Mobile Remote Data Capture
Texas-based USAA bank has developed a mobile application that allows customers to make deposits using an iPhone.
HIMSS Medical Banking Project Meets With World Bank
On April 22, HIMSS Medical Banking Project became one of 300 certified “civil society organizations” from around the globe to gain clearance and participation in the 2010 Civil Society Forum at The World Bank in Washington DC.
The event, somewhat shadowed by a concurrent G6 meeting occurring nearby, provided an excellent forum to meet groups that are working throughout the world to improve systems, infrastructure, problematic regulatory schemes and more. The World Bank brought out its elite – board members, executive officers and others – to meet with the certified CSOs and to explain their priorities and new governance structures that will foster accountability. Among the leading topics were a 15-year review of transparency issues at the World Bank, UN Millennium Development goals and Haiti, where HIMSS MBProject executives spoke directly with multiple regional ambassadors and government officials about the use of mobile healthcare technology to improve disaster response, funding mechanisms and more. The integration of medical banking and mobile technology is enabling a new portfolio of technology that reaches into areas with little to no infrastructure. (Blog Editor’s Note: Follow my related articles here)
In the afternoon, some 100 executives from all over the world met at a roundtable, complete with multiple translators, to address questions directly to the president of the World Bank, Dr. Robert Zoellick. During this time, Dr. Zoellick repeatedly referenced the UN Millennium Development Goals (MDG), that are targeted for fulfillment in five years (2015), and the need to work more aggressively to meet the timelines. Among these goals are improved healthcare for women and children, and others, the efficient use of resources to promote sustainability and more.
Recently, the World Bank joined five other national agencies (UN, WHO, Bill and Melinda Gates Foundation, others) to make a global announcement about the importance of information technology for improving global healthcare. This initiative is a direct result of guidance provided from within the MDGs.
After the session, which was a lively dialogue regarding various interests ranging from clean energy to healthcare to financial policies that included successfully combating fraud and abuse of funds at the World Bank, the participants gathered in a networking reception where officials of HIMSS that were present (John Casillas, SVP, HIMSS Medical Banking Project, and, Juliet Santos, Senior Director, HIMSS Medical Banking Project) spoke to many in the World Bank’s executive team, many of who asked that we make plans for ongoing collaboration.
Working with the World Bank has been a longstanding strategy of the Medical Banking Project and with the new HIMSS MBProject, there is an emerging possibility that this strategic goal will be realized by collaborating to raise awareness of health information technology issues around the world.
Miller-McCune’s recent SWIFT articles
SWIFT and American Espionage By Michael Scott Moore –> Europe’s newly empowered Parliament’s first muscle flex involves privacy and tracking terrorist finances.
The New Trans-Atlantic SWIFT Agreement By Michael Scott Moore –> Will it give European intelligence agencies access to U.S. banking records?
Anyone Noticing A Trend?
A quarter of office workers would steal sensitive company data if they thought it would help a friend or family member secure a job, says Cyber-Ark Software.
More Than Half of Fired Employees Steal Data
Most fired workers steal data on way out the door, survey shows
Report: 88 Percent of IT Workers Would Steal Data If Fired
Matt Mullenweg Riffs on Starting a Bank
I often get asked something along the line of, “If you weren’t leading Automattic, what would you work on?” There’s not a single answer to this question; the answer changes day to day. But I think if you asked me today, I’d say I would like to start a bank.
Social Media and Medical Banking
Something to point out: HIMSS has - as of 3/23/10 - over 1,700 fans on Facebook, over 4,600 Twitter followers and close to 27,000 members in its LinkedIn group [started May 2008]. These communities were built slowly over time with a focus on quality interactions starting from zero.
HIMSS11 Call for Proposals and Reviewers Now Open
The online proposal form and reviewer application are available through May 24. Individuals interested in submitting conference education proposals should spend time reviewing the many available online resources including information on intended audiences, various topic categories and evaluation criteria.
Annual HIMSS Conference reviewers are the backbone of the entire Annual HIMSS Conference education process. Reviewers are the first to see proposals submitted to HIMSS through the call for proposal process. Reviewers and their recommendations are incredibly important to the Annual Conference Education Committee and the role that they play in the proposal selection process. Finally, reviewers are an important resource for presentations that are selected to move forward to the annual conference; they act as coaches during the presentation preparation process and as moderators for the presentation during the conference.
This is an opportunity to make a mark on the 2011 Annual HIMSS Conference & Exhibition. Share expertise and an organization’s real-world experiences with health IT. Become part of the largest health IT conference and exhibition in the world.
For more information on submitting an education proposal for HIMSS11, contact HIMSS Manager of Annual Conference Education Debra Clough at 312-915-9559.
Banks enter the healthcare landscape
John Casillas notes:Esther Dyson, one of Foreign Policy’s “2009 Top 100 Global Thinkers,” called medical banking a top lever for change in healthcare. Giving a nod to the idea, the global HIMSS organization and Medical Banking Project united in 2009 to form a new, non-profit, industry-neutral platform with global reach. From its formal introduction into the marketplace by MBProject in 2001, medical banking has entered the dialogue of numerous industry forums and survived repeated Senate mark-ups (see Section 1104 of H.R. 3590). Yet, while our cry has been heard, implementation is far from over.
CDHPs, HSAs will play a greater role in mHealth
A recent post of mine begins:
My assumption is that over time mHealth will grow to more heavily interconnect with consumer driven health plans and healthcare savings (and related) accounts. Two sessions at the recent HIMSS 8th National Medical Banking Institute provided current information which I think Mobility Blog readers will find valuable.
Other such posts listed at the Conmergence Blog Work tabby.
Authors@Google: Thomas Goetz
March 08, 2010 — THE DECISION TREE stems from Goetz's unique experience as an editor at WIRED and as a student working on a Masters in Public Health. Goetz was struck by the unfortunate disconnect between the public health world and the tech world. Wasn't there was a way to combine the promise of technology with the rigor of public health in order to engage people more predictably, strategically, and effectively with their own health, he wondered? In the book, Goetz looks at the tools and technology available to us now from DNA analysis that can predict future health issues, to social networks that can keep us abreast of the latest treatments. Goetz balances the science and ideas in the book with stories of real people who are utilizing these tools allowing us to see the opportunities and possibilities in action. The Decision tree is an organizational system that maps out our options, factors in all relevant info (family history, our habits, conditions, etc), and guides us toward the best possible health care choices. A Decision Tree has the power to turn the chaos of medical science into a system that makes sense by prioritizing facts and evidence over instinct and tradition. It puts the patient in the central role as decision maker not the doctor, insurance company, or hospital administrators.
Dear 8MBI@HIMSS10 Attendees
First of all I want to thank you very much for taking time to join our effort. I appreciate it and I hope you derived value. If not, I would like to know. Let me know what you would change too. This is free form – send me an email. I will acknowledge all replies and we will factor your suggestions into our 2011 planning process.
Our vision is simple: design an efficient healthcare financial network. By accomplishing this we can as an industry convert some $35 billion in wasted dollars so providers can offer better care, or expanded care, in their communities. To do this we must evolve and facilitate sustaining models. I want to say that again. Our efforts must focus on sustaining models. That is truly the only way to grow this area that, while having great social goals, must survive the ebb and flow of commerce and competition. This is one good reason why we are developing a new, neutral, G7 Roundtable of engagement. We need great “move forward ideas and solutions” that integrate the good work done to construct building blocks (privacy, technical standards, specialty payment systems, etc) into efficient end-to-end healthcare financial networks.
Our short term focus must now move from learning about how the HIMSS global engine can propel our movement (what we covered at the Institute) to discrete case studies of medical banking innovation in the marketplace. We need to focus on the pragmatic while at the same time evolving thought leadership. HIMSS Medical Banking Project will keep this new paradigm of activity and ideas in front of our membership. One way we’ll do this is by merging content areas in medical banking, financial systems and payer administration…and we will seek to develop resources targeting medical consumerism as well (globalization of healthcare, medical tourism, account-based plans, etc). The “tsunami” of 5010/ICD10 transformation is also a key forward focus as are other areas (mHealth, community care platforms, fraud and abuse, etc).
We look forward to, and frankly need, your continued engagement. Please join HIMSS MBProject if you’re not a member today. Our membership plan has changed dramatically in terms of cost and a whole new layer of benefits! We need your input ALL YEAR LONG, not just at the Institute! Thanks so much again for spending time with us in Atlanta!
Senior Vice President
HIMSS Medical Banking Project, Business and Financial Information Systems
230 East Ohio Street, Suite 500
Chicago IL 60611-3270
www.mbproject.org / www.himss.org
HIMSS...providing HIT leadership through knowledge and education for the betterment of healthcare. Go to www.himss.org to see how.
Eighth National Medical Banking Institute Speaker HandoutsProvided by HIMSS Medical Banking Project at http://www.himssconference.org/mbhandouts/
Bootcamp - Feb 28
The Health Data Transaction Ecosystem
Banking Systems and the Healthcare Revenue Cycle
Privacy & Security Issues and Updates
The Landscape for "Health-Wealth" Programming
Institute - Mar 1
Operationalizing Privacy & Security
Leveraging New Resources in Medical Banking
Institute - Mar 2
New Credit Risks in the Era of ARRA
Medical Banking Metrics
Senior Bankers Roundtable
SWIFT: A Transformative Platform for Healthcare?
A HIMSS web site recap is available here.
Comment Period Closing on Proposed Rule for Medicare and Medicaid EHR Incentive Program/Meaningful Us
As part of the HITECH Act in 2009, The Centers for Medicare & Medicaid Services (CMS) administers the Electronic Health Record (EHR) incentive programs under Medicare and Medicaid. CMS prepared a proposed rule on the EHR incentive programs for public comment. This proposed rule includes the definition of meaningful use and other requirements for qualifying for incentive payments.
The comment period for this proposed rule closes on March 15, 2010. CMS welcomes your comments which may be submitted through http://www.regulations.gov. For additional information on the proposed rule, visit http://www.cms.hhs.gov/Recovery/11_HealthIT.asp on the Web. Here you will find fact sheets, presentation materials summarizing the proposed rule, and links to the proposed rule itself.
Call for Topic and speaker proposals, Smart Card Alliance Annual Conference, May 17-20, 2010
Educational conference tracks are still being finalized by a multi-industry conference steering committee, led by a members of the Smart Card Alliance. The Smart Card Alliance committee is seeking new topics for consideration for this year’s conference program consistent with its theme of “Smart Cards in Action: Issuers and Users in Payments, Identity, and Mobile.” The proposed topics should involve the issuance and usage of smart cards and alternative smart technology (i.e., UICCs, smart tokens, embedded chips) that fall into one of the following categories:
- Identity management and security implementations
- Payments and emerging payments implementations, Open or Closed Loop models
- Mobile and NFC-enabled access and payments implementations
- National or international government–issued citizen ID programs
- Pilots based on emerging smart card and related technologies and applications
The conference steering committee favors vendor-neutral, educational presentations that focus on the real-life applications of payments and digital security technologies and systems.
Proposals must be submitted using the online form below. The deadline for proposal submission is Monday, March 8, 2010.
For additional information contact please contact Randy Vanderhoof at email@example.com.
Very Helpful Folks at HIMSS10 Meet the Bloggers Session #3
Twitpic by Brian Ahier
Cesar Torres, Manager, All Things Webbie, Healthcare Information and Management Systems Society, has a thread on linkedin.com asking for follow on thoughts about HIMSS10 in general. Here are some responses:
Gwen Darling, HealthcareITCentral.com [Healthcare Informatics magazine]:
HIMSS10 8th National Medical Banking Institute Opening Panel: The Healthcare Financial Network of the Future
Moderator: Sheila Schweitzer, Vice President, HIMSS MBProject Advisory Council; Chief Executive Officer, Ingenix/CareMedic, St. Petersburg, FL
Co-moderator: Zahoor Elahi, Vice President and General Manager, Health and Financial Network, FIS Government, Education and Healthcare Solutions, Dallas, TX
Ralph Bernstein, Senior Vice President, Healthcare Payment Solutions, US Bank, Minneapolis, MN
D. Dean Mason, Chief Executive Officer, HSA Bank, Sheboygan, WI
Justin Freeman, Senior Vice President, Treasury Management Product, Manager - Lockbox and Healthcare Products, Wells Fargo, Dallas, TX
Charlie Martin, Chairman and Chief Executive Officer, Vanguard Health Systems, Nashvile, TN
John Mattison, MD, Assistant Medical Director, Chief Medical Information Officer Regional Director, Kaiser Permanente, Oakland, CA
Ernie Clevenger, Chief Executive Officer, CareHere! (former president, SIIA, former persident, WEDI), Brentwood, TN
David M. Gruppo, Business Development Executive, IBM Research, Hawthorne, NY
1) How can providers and payers come together to form an electronic payment process that is transparent, fully accountable and efficient?
# # # #
2) In the absence of healthcare reform what should the industry be doing to revolutionize the healthcare financial network? Do consumers play an important role in this (consumer demand)?
# # # #
3) How can banks partner with healthcare groups to advance the “health-wealth” paradigm for the consumer?
Standards important. How to achieve? Who maintains? CORE standards example not widely adopted (failed?) MasterCard|Visa model came up with a mapping approach--Which works well for their business case. Incentives (why). Need a process. (Cost of money example; who gets the float?; play the game to get paid; friction costs because of the adversarial relationships). Data showing the difference between cost and price of procedures. Adjudication at time of service would help with catching fraud.
"CEGIS" (sp?) FSA adjudication
Health behaviors data collection (PHRs) to enable analytics to drive the culture of health management (like pension fund managements tools)
Dean Health is a key financial asset
Radiologists would be a good case study of providers
HIMSS G7 Strategy -- assumes 3 year project
John Casillas on Designing the Healthcare Financial Network of the Future
At HIMSS10, John Casillas reviewed the Leadership Forum at the Vanderbilt Center for Better Health to answer the question:
The Network has been built and its 2012. What does it look like? What are the characteristics?
Top Level Findings:
1) Far greater visibility across all transactions
2) A common effort organized by a neutral body
3) Required to create standards/best practices
4) A quasi-government body to enforce standards
5) Healthcare Federal Reserve-type system
6) Standards must be mandatory for using the Network
7) All players must share the value of the Network
8) A persistent effort is needed
To coordinate the stakeholders as new, emerging functional requirements of the Network are isolated and payers come together to form an electronic payment process that is transparent, fully accountable and efficient?
2. In the absence of healthcare reform what should the industry be doing to revolutionize the healthcare financial network?
Do consumers play an important role in this (consumer demand)?
3. How can banks partner with healthcare groups to advance the “health-wealth” paradigm for the consumer?
Casillas takes the topic further at the International Journal of Medical Banking.
Why is the XBRL community so disinterested in the Medical Banking space?
Posted by ED
From "Designing the Healthcare Financial Network of the Future" By John Casillas
The U.S. healthcare system represents some $2.5 trillion annually and growing. Hidden within the cost of the infrastructure are the diversity of methods used to manage money and associated remittance data. Incremental advances in this area could result in systemic savings across the healthcare stakeholders. While existing regulations under the Health Insurance Portability and Accountability Act (HIPAA or “the Act”) recognize the value of this critical area (as specified in the Administrative Simplification provisions of the Act), the advancement of industry-wide and systemic programs, best practices and standards to capture this value have proven remarkably tedious and slow to implement.
A good example of unrealized value in this area is the comparative cost to transfer funds and remittance data in other industry segments (an area called ‘financial electronic data interchange’ or ‘FEDI’), at $5 more or less, versus a cost of $11 per payment or more in healthcare (Banker’s EDI Council, 1994). Extrapolation of this data suggests that the healthcare industry could save $35 billion annually by implementing electronic payments, inclusive of the ability to trigger workflow automation across the complex healthcare revenue cycle, like automating contractual allowances, denial management, contract management and more (Casillas, 2001). More recently, a new “Healthcare Efficiency Index” estimates a $30 billion savings could be attained by making improvements that include this vital area (see http://www.save30billion.com )
[ED: XBRL as a technology could hasten John's predictions but nobody seems interested in the slightest. If I'm wrong please see http://www.mbproject.org/8MBI2010.php ]
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Paul Wilkinson, CEO at paulwilkinson.com responds:
Perhaps the same challenge we had implementing XBRL in the financial reporting sector is part of the answer: those $30 billion or $35 billion or whatever "savings" aren't really savings if you're the one billing companies for those monies today -- whether you're an outsourced firm or someone in the internal department responsible for your large and important existing business process. One person's "savings" are another person's "losings." Therefore, there's not just plain old fear, uncertainty and doubt to address -- there are strong incentives for many current market participants to paint change as "high risk," tell their customers and their employers there are more important priorities, and that they should "let other people go first" with all of this scary technology stuff.
With such a large health information ecosystem, and so many long-term information technology contracts and projects already in place, and many of the unnecessary costs being paid and managed by non-profits or by people who believe their main purpose in life is helping patients, not promoting efficiency, it probably shouldn't be a surprise that innovative energies devoted to the ultimate mission of improving medicine are directed more at improving treatments and less at improving how the back office works.
Also, HHS apparently has yet to fully realize that it could do exactly what the FDIC and SEC did and simply mandate the use of an open technology standard like XBRL. In fact, XBRL would be a good standard for lots of health related data. Automated data validation and low- or no-cost software upgrades via taxonomy updates and access to the existing XBRL technology infrastructure would all be wonderful in the health sector. Heck, the FDIC and the SEC have already laid the foundation for the necessary cost/benefit analysis, and despite all the FUD, found the benefits to exceed the costs. But those $30 billion or $35 billion losers are sure to explain to HHS and everyone else who will listen to them in painful detail every reason they can conceive why an open technology standard would be a bad idea and why they should move s l o w l y.
The good news is that on my last trip to DC, I met some new HHS people who understand this and who are quietly leading to do the right thing -- and this is from someone who spent 16 years in DC working for leaders of what today is the minority party. And more good news is that market pressures always prevail, even if they don't do so as quickly as we like. Someone will find a value proposition for an open technology standard. I've been working with http://www.cloudinc.org -- looking at ways to avoid reinventing perfectly good technologies that XBRL has already developed and offering a new value proposition: A domain that's based not on a particular industry, but on the end user -- people.
Advancing Health Information Exchange
February 12, 2010 A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology
Today we announce the first cooperative agreement awards authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act. It marks a major milestone in our journey towards nationwide adoption and meaningful use of health information technology (health IT). One set of awards provides $386 million to 40 States and qualified State-Designated Entities to rapidly build capacity for exchanging health information across the health care system both within and between states through the State Health Information Exchange Cooperative Agreement Program. The other awards provide $375 million to create 32 Regional Extension Centers (RECs) that will support the efforts of health professionals, starting with priority primary care providers, to become meaningful users of electronic health records (EHRs). Additional awards will be made in both programs over the coming weeks. Together, these programs will help modernize the use of health information, improving the quality and efficiency of care for all Americans.
As part of the State Health Information Exchange Cooperative Agreement Program, states will play a leadership role in achieving HIE to meet health reform goals. The funds awarded will be used to establish and implement plans for statewide HIE by creating the appropriate governance, policies, and technical services required to support HIE. Developing this state-level capability will help us break down the current barriers to HIE and help providers to qualify for Medicare and Medicaid incentives under the HITECH Act. The awards will also strongly encourage states to consider participating in the Nationwide Health Information Network as an approach to HIE. This would create a pathway toward seamless, nationwide health information exchange.
While the State HIE awards will strengthen capacity for health information exchange, the Health Information Technology Extension Program awards will establish RECs to deliver direct outreach, education, and technical assistance services to health care providers in their regions. Each REC will focus most intensively on the physicians, physician assistants, and nurse practitioners who work as part of individual and small group primary care practices, as well as those who dedicate themselves to providing health care to the underserved. Primary care providers in small practices provide the great majority of such services in the U.S. but have limited resources to implement, meaningfully use, and maintain EHR systems. On-site technical assistance for these priority primary care providers will be a key service offered by the RECs. RECs will assist providers who have not adopted EHRs, as well as those who have but need help progressing to meaningful use. Regional extension centers will also help providers keep health information private and secure.
The Health Information Technology Extension Program and the State Health Information Exchange Cooperative Agreement Program are critical components to the end of a nation-wide interoperable, private and secure electronic health information system. I look forward to working in collaboration with each state and REC as they establish their programs, begin work within their communities, and promote the transformation of our health care system. I applaud each awarded entity for its dedication to the mission of improving the quality of health care and for the leadership and guidance it will provide.
David Blumenthal, M.D., M.P.P.
National Coordinator for Health Information Technology
U.S. Department of Health & Human Services
The Office of the National Coordinator for Health Information Technology (ONC) encourages you to share this information as we work together to enhance the quality, safety and value of care and the health of all Americans through the use of electronic health records and health information technology.
For more information and to receive regular updates from the Office of the National Coordinator for Health Information Technology, please subscribe to our Health IT News list.
EIGHTH NATIONAL MEDICAL BANKING INSTITUTE @ HIMSS10
Designing the Healthcare Financial Network of the Future - The Medical Banking Institute@HIMSS10
Designing the Healthcare Financial Network of the Future, a centerpiece program that seeks to support overall health improvements by leveraging banking systems, is being offered on March 1-2 at the Omni Hotel in Atlanta, in conjunction with HIMSS10. The program's theme focuses on a new, multi-year global strategy tied to HIMSS' acquisition of the Medical Banking Project earlier this year. The Medical Banking Institute@HIMSS10 is open to all HIMSS attendees interested in the medical banking area.
Industry leaders representing payers, providers and other stakeholders will convene in a neutral setting to identify and discuss critical path issues that currently impede cross-industry efficiency. Topics include emerging functions in the new 'healthwealth' paradigm to standards and best practices that simplify and automate workflows. The Institute will feature sessions on health data privacy and security in banking channels as well as discussion that contextualizes general healthcare trends against medical banking metrics; a senior level banking panel that will help healthcare providers and payers to understand how banks are investing in revenue management technologies; and case studies that show the emergence of bankdriven community care platforms and more.
Preceding the Institute, HIMSS Medical Banking Boot Camp will offer attendees an overview on the emerging role of banks and financial institutions in healthcare. The Boot Camp will meet from 1-5 pm on Feb. 28, at the Georgia World Congress Center. Registration for the Institute and Boot Camp is now open. Visit http://www.mbproject.org/8MBI2010.php for more information. In addition to the Medical Banking Institute and Boot Camp, one of the Views from the Top sessions will explore why banks are interested in healthcare and examine the synergies between healthcare and treasury management. During Medical Banking: An Emerging Strategy to Improve Global Healthcare on March 3, attendees will hear how the world's largest custodial bank (with over $23 trillion in assets under custody) is gearing up for investment in the healthcare industry and how banks can help bring efficiencies to healthcare processing. For more information on this and other Views from the Top sessions, visit http://www.himssconference.org/viewsfromthetop General brochure here.
HIMSS Strives to Help Build Healthcare Financial Network of the Future
Interested in Medical Banking are Welcome at the 8th National Medical Banking
Institute @ HIMSS10 in Atlanta
CHICAGO – (December 8, 2009) – Designing the Healthcare Financial Network of the Future, a centerpiece program that seeks to support overall health improvements by leveraging banking systems, will be offered on March 1-2, 2010 at the Omni Hotel in Atlanta, Ga. The program is held in conjunction with the Healthcare Information and Management Systems Society (HIMSS) Annual Conference & Exhibition at the Georgia World Congress Center from March 1-4, 2010.
The program’s theme focuses on a new, multi-year global strategy tied to HIMSS’ acquisition of the Medical Banking Project earlier this year. The Medical Banking Institute@HIMSS10 is open to all HIMSS attendees interested in the medical banking area.
“Demands on financial systems, both domestic and global, have created new roles for banks, said John Casillas, senior vice president, HIMSS MBProject, Business and Financial Systems. “There is a growing need for banking systems to improve fiscal processes for payers and providers.”
Industry leaders representing payers, providers and other stakeholders will convene in a neutral setting to identify and discuss critical path issues that currently impede cross-industry efficiency. Topics include emerging functions in the new ‘health-wealth’ paradigm to standards and best practices that simplify and automate workflows.
The Institute will feature sessions on health data privacy and security in banking channels as well as:
- Discussion that contextualizes general healthcare trends against medical banking metrics;
- A senior level banking panel that will help healthcare providers and payers to understand how banks are investing in revenue management technologies;
- Case studies that show the emergence of bank-driven community care platforms and more.
Preceding the Institute, the HIMSS Medical Banking Boot Camp will offer attendees an overview on the emerging role of banks and financial institutions in healthcare. The Boot Camp will meet from 1-5 p.m. on Feb. 28, 2010 at the Georgia World Congress Center.
Registration for the Institute and Boot Camp is now open. Hotel reservations can be made through Ambassadors.
The Healthcare Information and Management Systems Society (HIMSS) is a comprehensive healthcare-stakeholder membership organization exclusively focused on providing global leadership for the optimal use of information technology (IT) and management systems for the betterment of healthcare. Founded in 1961 with offices in Chicago, Washington D.C., Brussels, Singapore, and other locations across the United States, HIMSS represents more than 23,000 individual members, of which 73% work in patient care delivery settings. HIMSS also includes over 380 corporate members and nearly 30 not-for-profit organizations that share our mission of transforming healthcare through the effective use of information technology and management systems. HIMSS frames and leads healthcare public policy and industry practices through its educational, professional development, and advocacy initiatives designed to promote information and management systems’ contributions to ensuring quality patient care. Visit www.himss.org for more information.
For more information, contact:
312-915-9237 – firstname.lastname@example.org
Just Got My Obama Administration "Pay to Play" Invitation
Posted by ED
Disclosure: my personal political leanings tend to be toward libertarian. I joined the Medical Banking Project hoping to encourage solutions different from those offered by the status quo. This a.m. I tweeted that the DC Republicans just released details on their healthcare reform plan entitled "Soylent Green" and moments ago I got an invite from "statusquo.gov" asking me to submit a question possibly to be asked of President Obama in the Forum slated for the 20th. Natch, I asked about open source healthcare software solutions' role in the DC Democrats plans and I received this nifty little "Pay to Play" response form when I hit 'submit." Now, I realize it doesn't SAY I have to contribute to be heard -- but the message I hear is loud and clear.
Let's keep supporting cutting edge reform -- The Point and Click Expedition - One Man’s Journey to Transcend the Gridlock -- http://www.mbproject.org/tour.expedition.php and http://www.mbproject.org/blog/
The Social Credit Card [presented at IdeaBlob]
Posted by ED
IdeaBlob started out as an internal collaboration/innovation engine. It has since been turned outward to benefit from remunerated crowdsourcing (you get $10,000 if you win the contest). Since I'm always whining about the fact that fed taxes don't account for hours donated to NGOs/NPOs I thought this was a cool approach to track "social capital". This would be an excellent way to do a "census" of how much healthcare related volunteerism goes unnoiticed/uncompensated. Why, yes, open source/standard healthcare programming would count. Think also about the impact it could have on HSAs -- or a whole new class thereof. Oh, and if you wonder how to implement it just determine at what rate a federal employee would be compensated to complete the same or similar task. Also, accountants could volunteer their time to NGOs/NPOs to help track these things (and of course the shift to international accounting standards and adoption of extensible business reporting language and standard universal charts of accounts could be utilized as well).
Credit card companies and banking institutions develop a social credit system whereby activities like volunteer hours are tracked and compensated. Every time we make a social contribution (helping a neighbor, volunteering at a homeless shelter, donating to charity, etc.) we accumulate points that appear on our monthly statements. These points are then redeemable, similar to frequent flyer miles, for the purchasing of goods or services. The points can also be used to pay down debt or donated to other individuals or charities as a financial contribution. By combining social with financial capital we create incentives for good works and a more comprehensive picture of our net worth.
July 17, 2009 in A Bank-Driven eHealth Ecosystem, Community Care Platform, Cooperative Open-source Medical Banking Architecture and Technology, Medical Consumerism | Permalink
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James Nennemann on Harkin Healthcare Reform Town Hall Today [Update]
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Dr. Larry Ozeran response:
I received your email too late to send anything before your meeting, but thought I would send you some comments from one California community's perspective in case you have another opportunity. I am personally a trauma / general surgeon involved in Health IT for 20+ years and healthcare reform for 10+years (http://www.DrOzeran.com/policy.php). Our YSHC consortium includes both health providers (all types) and economic / education / workforce organizations. This is our message:
Washington is again considering temporary healthcare reform, and at great cost. Negotiating to the center of the proverbial table which is tilted heavily in favor of health insurers to the detriment of patients, providers and employers, has not worked in the past to lower cost, improve care, or insure more Americans. "Cost containment" for its own sake, whether Medicare's SGR, "managed" care, capitation, or "Pay for Performance", has not worked to contain costs. By ignoring our fundamental health system problems, past "reform" efforts have caused the American healthcare system to be the most expensive system in the world even as it leaves 15% of our population without good care.
To get true health system reform we must:
1) Get everyone in our nation's capitol to agree with Albert Einstein on two key points:
* "We can't solve problems by using the same kind of thinking we used when we created them."
* "Everything should be made as simple as possible, but not simpler."
2) Define the healthcare system that we want by identifying the principles necessary to make it effective and sustainable one actionable example: http://www.YubaSutterHealthcareCouncil.org
Please forward this message in the hopes that more Americans will seek to promote fundamental change to Congress and the White House.
Dr. Larry Ozeran
Chair, Yuba-Sutter Healthcare Council
Banks say IT key to mortgage market (Update)
Posted by ED
Thought: what banks do re: mortgages will probably model how they approach healthcare
Research carried out for Capgemini, Unicredit and Efma for the 2009 World Retail banking report shows that banks see IT optimisation as the third most important (45%) opportunity in addressing the mortgage market over the next five years, with 36% saying that using remote channels is.
Thought #2: What banks are doing is trying to figure out what they've done
Dr. Johannes C. Scholtes, President and CEO, ZyLAB North America LLC wrote recently (Investigate or Investigated? The Credit Crisis is Turbo-Charging Enterprise Search):
At this moment, only two specialized applications in the enterprise search market exist that show growth potential: those that are used to investigate the fall-out of the credit crisis and those used by organizations as part of their defense against investigations that result from heir activities in the banking and financial industry. Although most of the economy is reeling and IT budgets are being slashed, enterprise search applications are one of the few areas where organizations are allocating investment resources.
Thought #3: A more pertinent question for banks may be what will they be doing in the future
This makes Alan Reiter's observations (Revolutionizing Money: Virtual Currency Gets Real) especially sobering:
We are witnessing a revolutionary financial trend: Virtual money. "Fake" online currency of gold, points, etc. -- is becoming real. Differences between real and virtual currency are diminishing. Currency "exchanges" have been established. Multiplayer virtual worlds will soon host government-licensed banks.
And the sins of real money, such as bank robberies and currency laundering, are infecting virtual money as well. Government taxing agencies, including the U.S. Internal Revenue Service, are exploring laws for virtual income. At least one government is concerned that virtual money could actually devalue "legitimate" money. I predict we will eventually consider some online currency at least as useful as traditional currency.
See also BusinessWeek's take at Virtual Currencies Gain in Popularity.
Thought #4 this will add a "virtual" blue ocean opportunity for peer to peer micro loan industry
Collateralized debt obligations (yes, of subprime fame) on virtual cash revenue streams are a possibility
Snippets from the Google Groups Cloud Computing Listserv As They Awaken to Medical Banking in the Cloud
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# # # #
The Medical Banking Project agrees on the "cloudy" future of healthcare but argues banks (or their 3rd party suppliers) are the vendors with the greater exposure to security concerns, have the greatest history with online data delivery, etc.
Hopefully on this one occasion these resource pointers will not be considered "too spammy" for this listserv:
MBlog - Medical Banking Blogging - http://mblog.mbproject.org
International Journal of Medical Banking - http://www.mbproject.org/journal
Medical banking Project site - http://www.mbproject.org
LinkedIn Group - http://www.linkedin.com/e/gis/74285/183D9F20CD6D
7th National Medical Banking Institute ADVANCING HEALTH CARE REFORM BY CREATING A FEDERAL HEALTH BOARD - http://www.mbproject.org/stream.php
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With the due date for Electronic Medical Records provision of HIPAA coming in 2014 - The Healthcare Industry needs more innovative solutions around the implementation that is easier for those less technical to use. It will be very tempting for all of us technologist to jump on the opportunity - but we need to proceed with caution.
One of the biggest burdens faced by medical care professionals are the very systems we put in place to help make their jobs easier. The number one complaint I have heard when talking to the users in the medical industry is the amount of time needed for the electronic charting, syncing, loss of data etc taking away from continuity of care for their patients.
Centralizing this data is a HUGE savings for physicians. Universal Client computing came from understanding the impact of not applying the right technology for the right use case but also understanding the need that there has to offline capabilities as well as online to avoid negative outcomes. Tying together offline and online with solutions like application virtualization that can leverage local compute power by do bidirectional updates of data to the cloud over HTTP/HTTPs - or other hybrid based uses cases will go much farther then just espousing one technology over another.
We need to think both In and Out of the Cloud to have solutions that will work in the real world.....
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There are many uses in the healthcare industry where the Cloud can help but when implementing for those systems a bit of care needs to be taken. From the major hospitals I have worked with in the US and discussions in EMEA the following uses cases fair very well in the cloud:
1) Medical Billing - particularly when billing is done either in a foreign country or by a third party. Privacy laws in Europe around health information require the data to be kept in the country of origin. I have seen medical billing done successfully with VDI implementations for larger institutions but believe a CLoud implementation with EC2 (following proper SAS70 guidelines) would also be a viable solution.
2) Transcription services make sense as well - similar to medical billing.
Edge Cases Not Recommended 3) I am a large proponent of the Cloud and Virtual Desktops but there are edge cases that should wait until the technology is more mature like Critical applications required for 3D or 4D imaging used in diagnosis, in Emergency Medical areas like ER, Nurses Stations, ICU, etc that require access to vitals and charts, Pill dispensing stations that are locked. As someone that has provided technology for infrastructure for over a decade - I know too well how lives can be lost due to accidental patch or reboot on an individual basis now multiply that by 40 or a 100. The technology is not ready yet.
For the Optic Digital imaging diagnosis below - can you tell us where the graphics processing was done? Also did anyone chart the malpractice or misdiagnosis ratio of those films over traditional methods? At first blush the costs savings look great - but we are talking about eyesight and lives when we are talking about medical.
I have heard of issues with hospitals trying to implement Cloud based solutions in Emergency rooms. In one case the wireless network connection failed while a physician was trying to review films to remove a bullet from a patient. Although IT tried they could not fix it in enough time to save the patient.
The next example is a personal one - My family was impacted by a significant misdiagnosis of EchoCardiogram films for my husband's heart. The EchoCardiograms were misread by a Physician in India collaborating with the Physician in Phoenix. We were told that my husband's condition was graver then it was, asked if we wanted to participate in an experimental study for the greater good of man kind because his condition was not reparable (Supra Cristal VSD, Pulmonary Stenosis and a Patent Ductus Arterosis). At the time our childre were 6 and 11. We spent two days of hell planning for the worse. The second physician we spoke to the following week had a different opinion and referred us to Stanford. Stanford concurred with the second physician. He did have the VSD but did not have the other issues. Apparently the resolution on the remote display protocol was not clear enough for the Physician in India that read the Physician in Phoenix's file to get an accurate discern that what she was seeing was not a PDA but additional movement on the echo from the higher pressure shunting of the blood when the valves opened and closed. We never sued the doctors because it was a technology issue.
Had we have listened to the first doctor mentioned - chances are my husband would be dead given the morbidity rates of the experimental surgery or at best would have another 2 or so years left. Instead - he has a good prognosis.
Now I ask you - if that is your spouse, parent, child or YOU would you want the films processed at the server and streamed? I for one am glad we sought a second and third opinion from someone that used a local PC with high end video graphics cards.
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Khazret Sapenov :
I also know, that doctors use Amazon Mechanical Turk to process transcripts, thus reducing their HR burden.
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Yes - in fact you can use the cloud for making the supply and demand equalise. We did this for a diabetic retinopathy project where we connect doctors within certain regions to do diagnosis of eye images of patients who have been to clinics in different city or country. Thereby reducing the waiting time and giving dr's additional revenue streams.
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Medical expenses are increasing everyday although the same medical processes have been around for a while with cloud computing do your think there is an opportunity to overhaul and simplfy high cost medical processes leverging infrastruture-as-a-service?
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In healthcare its important to learn first and foremost the HIPAA regulations. Some of the clauses from what I understand require in simplified terms that the patient sensitive data be separated and/or encrypted from others and the machines be in a “cage”.
Having said that once you have the patient identifiable data separated from the actual data, you could use the cloud. I can see specially in claim processing, image processing or data mining that the cloud could be very useful.
Also since the “cloud” sits on the internet and a down internet can bring in a lot of liability to the end provider – I feel EMR would be a long shot.
John Casillas on A Vision for eHealth Using Banks
Intro: Thank you Maureen and the entire team at the President’s Council, they deserve so much credit; Members and Sponsors.
Once a person visiting a restaurant in France was so taken by the entrée that she asked the Chef for the recipe. The following year she visited the same restaurant, ordered the same dish and asked for the Chef again. “I’ve tried it over and over again and its not coming out. What’s the missing ingredient?” The Chef replied, “madamme, after you follow the directions you must throw yourself into it”.
Today, during an unprecedented global crisis in banking and as our domestic healthcare systems strain under the weight of a growing underserved population, it may seem counter intuitive to link two ailing systems. But for those in banking and healthcare who have thrown themselves into the prospect of improving healthcare, a new vision of the future is emerging that is powerful, energizing and compelling! They have stumbled upon a missing ingredient in our national dialogue to improve healthcare – medical banking. And they realize there is simply too much at stake for banks not to be sitting at the table as we fix our healthcare system.
The recipe for economic disaster is a broken healthcare system. This was the central message of the President at last week’s healthcare summit. Thus all the things that drive the banking and financial services engine rely on healthy individuals and communities and a productive labor force. Dr. David Mirvis, who will be on our Federal Health Board panel today, researched this linkage and found that economies rise and fall based on the health of people in an article published in JAMA. Dr. Stephen Parente, who will also be on our panel today, wrote in our Dr. HSA Column that an economic stimulus pathway could be distributing using cards credited with $500 to be used for prescription drugs, adding that while he’s not very excited to see so much money being spent, if its going to happen anyway, let’s spend it smartly. Many see a clear link between healthcare and economic vitality so the real question is why wouldn’t banks be fully engaged, why wouldn’t banks use their resources in the national quest to fix healthcare.
We’ve all heard a common ingredient for success: “necessity is the mother of invention.” Perhaps it will be of necessity that we find healthcare using the rails of our banking complex to finally realize the national dream of real time data exchange between all the industry actors. When the dish is ready, we believe that banks can ramp healthcare onto a digital platform. Banking processes were at one time mired in paper too, and there is no question that the lessons they bring to the table, and in some cases their very systems and processes, in which they are highly invested, can fast forward our national eHealth strategy. Yet we don’t hear very much about this paradigm shift in the national process. We hear about spending billions of dollars to create a new digital system, but what about the digital system lying right under our nose?
Ultimately, our challenge is to forge a health-wealth view of the future, where banks join with fellow healthcare stakeholders to develop common solutions to help the uninsured and unbanked, to socialize better tools and information that families can use for their medical treatments, to help individuals get real time access to their healthcare records through online banking used by 55 million households in America and growing, and to enable community centers that President Obama is investing in with eligibility, funds and data transfer platforms that support far greater coordination of the finite healthcare assets in the community. Oh yes, we have a vital ingredient and a critical role in the national dialogue and don’t let anyone tell you otherwise.
Banks and financial services firms are teaming with health technology companies and others to create a new paradigm, starting with vastly improved administrative processes and moving up the value paradigm in phase 1, to automating workflows that remove the paper chase, leveraging the unique market position of the bank to process and capture payment data that improves revenue cycle decisioning through denial management or contract management routines that take up so much time in the business office, and finally moving to the top of the pyramid of value, to address the enterprise needs of the healthcare community. Different banks are evolving at different rates along this pyramid. As you do, know that the top contenders have found compelling prospects for profitability. As success stories come in, medical banking groups are following this strategic pathway, creating one of the nation’s most compelling “Green Tech” engines – another tie into the goals of the Obama Administration. Yes, we have a critical ingredient for the national dialogue to improve healthcare.
Moving to phase 2, we should align the immense annual investments in privacy and security in online banking with the unique data needs of each stakeholder. This calls for electronic integration of assets to liberate data so it can travel securely in real time. We’re all stirring this pot together – our own build-out of specialized banking platforms, NGA’s recent summit where former HHS Sec Leavitt called on leaders to “remember Argentina” and to invest in healthcare to stimulate the economy, John Halamka’s HISPC 11-state collaborative to normalize state laws that impede the flow of health data across state boundaries, WEDI’s leadership to move us toward the 5010, EHNACs program for clearinghouses, ABA’s HSA Council, TAWPIs new HPAS, HIMSS’ annual summit and much more – all of these efforts, in my view, are moving us towards greater data liquidity that at the end of the day will, and must, empower the consumer.
In phase 2, banks are embracing the power of their market position, reving up eHealth strategy, creating real time gateways with health IT partners, specializing card platforms to automate payment processing across stakeholders, leveraging online banking to support single-sign on for the consumer, giving families private access to health-wealth tools, and although Track 1 is a primary focus for many today, the recipes of the future belong to Track 2: innovations in medical consumerism.
So we ask you to apply yourselves diligently to the task of exploring how financial systems can align with the national process to improve healthcare; and this moves us to phase 3, examining how governance models, like the Federal Reserve, can spearhead common standards banks can use to empower business and consumers with mission-critical and family-critical tools…tools that hospitals can use to automate the routines in Phase 1, tools that health plans can use to reduce disbursement costs, tools that community care centers can use to access healthcare assets in real time, tools that will allow you and I to use a “healthcare ATM” just like we use the regular ATM, so if we travel abroad as a medical tourist or just across the country and we get ill, we have secure and private on demand access to our healthcare records and our financing resources at the swipe of a card. We can get this done!
Building an electronic medical banking community, the theme of our event, moves the President’s “Green Tech” agenda forward. Rationalizing the extreme paper chase in healthcare is core to modernizing our healthcare system. We’ve done good work digitizing the front door, sending the claim from the provider to the payor but the back door was left wide open and today, whenever you visit a care giver, a steady stream of paper follows you – almost all payment related. This mountain of paper invades our healthcare system, creating enormous barriers to efficiency, siloing data that needs to be securely liberated to improve healthcare at every point along the process and especially at point of service, where adverse drug events cause avoidable pain and loss.
Who will liberate this data? How will it happen? If you follow the trail, it leads through the banking world – a service is rendered, payments are processed. In this country, payments only move through banking systems. Thus banks can use their tremendous investments in information technology to ramp healthcare onto the on-demand paradigm that leads to better health programs for all the stakeholders. That is in large part what our educational program here is about. And what we need to do is understand how to add value to that data so it can address the unprecedented cash flow pressures our health care system is experiencing, not just from the economic downturn but because of the very complexity of our healthcare payment system. Today, I’m very proud to report success stories coming in from our members – one provider saving $4 million in 12 months after implementing a medical banking platform, another saving $660,000 and other stories that are catapulting medical banking into best practices. Yes, we have a Green Tech Message that is delivering compelling ROI and we need to spice up the national debate by making our voices heard. And I’m proud to say that that is what we can do at this Institute.
Sometimes when agonizing over problems you wake up to find solutions right under your nose. I want to suggest to you today that the medical banking build-out is inevitable. As banks linked with airline systems removed layers of inefficiency, enabling consumers with online tools, so medical banking is following a similar pathway, pushing paper out of the system, liberating data, fueling revenue cycles and decisioning; helping banks and their healthcare clients to gain a better view of the intrinsic value of the fundamental financial unit in healthcare, so taxed with myriad codes, and potentially unleashing $200 billion in credit from receivables that are wasting away on the books and records of our nation’s healthcare systems. Other industries have liquidated this asset. This is a mainstream practice except for healthcare, where the value of receivables is too often locked in a deep freeze. This will change in the new medical banking paradigm.
Now, do you remember how when growing up, Mom made you eat the peas? Some of you still don’t like peas because of that. Value should drive progress not legislative fiat. It may make sense to engage a legislative agenda at some point, but for now we’ve chosen to take our ideas to the marketplace and let the market decide. And they have. The 1100 employer strong Automotive Industry Action Group embraced medical banking as a strategy, helping us to create a new Tool Kit for Employers to diffuse medical banking practices in the marketplace, and we’re excited that LeapFrog and others are taking notice of our efforts. MBProject just aligned with NCPDP, the only group that is doing real time processing on a general basis, to cross-pollinate ideas with our banking members. The HFMA is here, a powerful healthcare group, and this is testimony to the power of our ideas. I look forward to hearing Bob Broadway tell us how we can help hospitals navigate one of the toughest times in the history of healthcare. As Obama said, we’re at that Thelma and Louise flashpoint in healthcare, where the car could go over the cliff. The medical banking community will not stand by idly and watch banking and healthcare crash burn. We’re in the game. Its Game On for Medical Banking!
We reached out to consumer groups too. Greg Scandlen, founder of Consumers for Health Care Choices, will share his ideas and I’m going to listen to him carefully. We need to listen to consumers, because our quest to build platforms that serve business will ultimately find critical mass in service to families. Banks know the power of scaling services for the masses, which they do everyday. As we collectively fine tune the vision in medical banking, new concepts will emerge of how to marry online banking, credit terminals, ATMs, branch systems, to personalized healthcare platforms that promote better lifestyles and better healthcare. Not only will this improve customer retention but banks may add three times more to the bottom line by creating a health-wealth portal, linked to online banking, based on an extrapolation of research done by Dr. Paul Whitman, here from California Lutheran University in Simi Valley.
We need to gather other chefs into the kitchen who don’t mind the heat. So we reached out to national leadership like the Mayo Clinic Health Policy Center. Bob Schmoldt, a leading national figure from Mayo, recently concluded a high level meeting in DC to fine tune the concept of a US Health Board. We’ll explore this area today and gain your valuable input. So you better plan on throwing yourself into this discussion, which we will document and provide to the White House Office for Health Reform.
Healthcare and banking groups are sharing ingredients, they are finding common ground to improve healthcare in increasingly powerful ways. When I first started talking about this in 1996, I was met with a field of bank stares. Yet convergence is vital to the national dialogue to improve healthcare. The Medical Banking Project has pioneered new ground; we’ve thrown ourselves into the healthcare dialogue with a critical ingredient and with our members, we are making great strides. All of you, top executives in your domains, must know that you are an integral part of the process, not a bystander. You should not accept the fact that everyone in healthcare is sitting around a table and leaving you out. You must be in the process, you must, if necessary, throw yourself into the process to fuel an electronic medical banking community that provides powerful and relevant services for our ailing healthcare system.
This is not a time sit back. I know there are groups that are struggling. I know that you are coming here trying to find your footing in this dynamic and complex area. I know its not easy. But I exhort you to move forward. Hold on and invest. Your ideas are far too compelling and you have a very good chance of being rewarded well for your efforts. You must not give up! Your participation is vital to the healthcare interests of our nation.
To help you, MBProject has created new tools:
Our Gold Seal program, is the essential underpinning of our movement. Its not just a technology platform that we need; we must build a platform of trust for business and consumers and bankers know that all too well. One slip up, and 58% of your customers will change banks. Your margin for error is almost non-existent. I encourage you, because even though today’s climate of low confidence is tough, consumers are still depositing funds into your accounts, using ATMs, credit cards and more. Let’s not throw the baby out with the bath water. Banks will continue to provide a central driving force in the evolution of healthcare solutions.
Our Dispute Resolution Initiative is a key tool that Sheila Schweitzer will discuss at our National Roundtable during lunchtime.
Our Medical Banking Tool Kit for Employers will be unveiled tomorrow where we’ll hear from Scott Sharland, Executive Director of the Automotive Industry Action Group; about their initiatives to manage fiscal stress, and how medical banking offers a key ingredient for their long term viability.
Our International Journal of Medical Banking, as Maureen discussed, provides a peer reviewed tool that helps to get the mental juices flowing to spur creative strategies linking banking and healthcare systems.
Our Executive Training Program, as announced by John English, a professor at Vanderbilt University, will address a growing need to train new medical banking talent and to foster critical leadership standards in this emerging area.
And there are more exciting programs being developed our Tool Shed. Tools that are being honed by an awesome cast of executives – our members – who are building common standards for creating a Green Economy, A Digital Economy, A Lean Economy; (a lean, green, stimulus machine)…they are building an electronic medical banking community. We urge you to become part of the process! Don’t sit aside when we need you to come to the table. We can’t educate you in medical banking in three days! This is much like drinking water from a fire hydrant. To get the recipe right, you need to be involved 12 months out of the year, you need to join MBProject and help us to make a difference!
In closing, I want to emphasize again that necessity is the mother of invention. What if one of the most important and critical ingredients for fixing our banking and healthcare crisis was to find common ways to help each other? What if two broken, elephantine systems, prodded by a dancing mouse, discovered new ways to heal themselves? Cleary, a healthy community supports a productive workforce that ultimately results in healthy deposits. Healthcare and banking leaders truly have much in common. There is good reason to invest in healthcare to energize the bottom line, and get the economy moving forward again. I believe we have an historic opportunity to influence the progress of our nation by throw ourselves into the creation of an electronic medical banking community. Towards this end, we offer this Institute to inform the national process, so that we can collectively build a healthy-wealthy future for our families and communities. Thank-you.
Presentation of awards
Medical Banking Project is driven by a mission: to convert digital savings into charitable resources. We do this by optimizing banking resources for healthcare. What gives life to our mission are the executives that have come into our process as members and leaders of our workgroups and councils. We want to acknowledge each of these leaders for their hard work. Each year, one or two people rise to the surface.
John Halamka on IT Spending: When Less Is More
Financial-services providers outspend the health-care industry on information technology, but they haven't made good use of all that data
When it comes to information technology spending, I've often been told companies in the health-care industry should behave more like banks.
During the decade I've been a chief information officer, IT operating budgets have been 2% of my organization's total budget. That proportion is typical for health care. During the same period, IT budgets for the financial-services industry have averaged 10% or higher.
Given the recent troubles of AIG (AIG), Lehman Brothers, Merrill Lynch, Washington Mutual, and others, you have to wonder whether those IT budgets represent money well spent.
Of course, financial-services firms have had great systems for handling such tasks as share trading, disaster recovery, and data storage. But did they have the business-intelligence tools and dashboards that could have alerted decision makers about the looming collapse of the industry?
Too Much Data
Did the financial-services industry have controls, risk analysis, or a memory of previous crises ranging from the Depression to the Japanese banking debacle to the collapse of Enron and WorldCom? Was it greed, irrational expectations, or too much data and not enough wisdom that brought down these institutions?
We in the health-care profession naturally take no delight in the financial industry's descent. At the same time, we're trying to make the most of our IT spending and make wise choices with the data we've amassed.
One of the challenges of being a doctor in the 21st century is information overload. More medical literature is published every year than a doctor can read in a lifetime. As electronic health records become more common, doctors can be overwhelmed with data gathered about each patient. They do not want to review hundreds of normal findings; they want to know the information that can be acted on to keep patients healthy. More
John Halamka to John Casillas: The purpose of my article was unrelated to banking or medical banking - it was to point out that we all need less data and more wisdom. I was asked the question yesterday - what is the advantage of medical banking as compared to a fully functional PHR like Google Health?
John Casillas to John Halamka: John,Touche. Yet people arent stuffing their money under the matress, they're depositing it. They are still using ATMs, credit cards and according to the last ABA report, online banking continues to grow. For all the hazards that we've encountered in investment banking, the commercial banking side of the house is operating as its always been, 24x7. Today, people still trust their banks to access the money instantaneously all over the world. We should not throw the baby out with the bath water. Most people, even and especially the uninsured, seek the ER when they are sick. Is the health care system broken? Yes. Do people still rely on it when they get sick. Yes. In medical banking, we find ourselves linking two broken systems - systems that represent the health and wealth of peoples and nations. Both have the potential to fundamentally transform our lives for the better. Linking tremendous investments in IT in banking to optimize healthcare isnt only good thinking, its actively being persued by mutiple muti-nationals and other companies - even governments. Needless to say, I wouldnt be too quick to erase the high levels of automation acheived in banking from my website or resume. Those levels of automation have produced outstanding improvements in how we manage our money today. And they will continue to do so as medical banking, mobile banking and even micro-banking evolve in the marketplace. Bottom line: our message is still the same. Banking systems have enormous potential to improve healthcare. And we have an historic opportunity to make this happen for our world, for our families. -from vacation in sunny California
Ed Dodds to John Casillas and John Halamka: Diebold ATMs infected with credit card skimming malware at ZDNet
Tools For Building An Electronic Medical Banking Community
The theme of our 2009 Medical Banking Institute, "Building An Electronic Medical Banking Community", wasn't an empty promise! Our Members have been very busy!
We are pleased to announce the creation of a new series of digital and educational tools for the growing medical banking community! These tools will do things like help assure the marketplace that medical banking organizations are meeting the highest standards of privacy, confidentiality and security, rationalizing costs in the healthcare revenue cycle, implementing medical banking programs that save time and money for groups that purchase healthcare and much more!
Make sure to check back often! More MBTools are being developed to increase the efficacy and efficiency of your operations! Send comments and suggestions to: email@example.com. We wish you every continued success engaging and developing medical banking programs!
Panel: Driving Medical Banking Into Everyday Practice - A New Tool Kit for Employers
John Casillas, Chair, Medical Banking Institute
J. Scot Sharland, Executive Director, Automotive Industry Action Group (AIAG), Southfield, MI
June St. John, Chair, Education and Programming, Medical Banking Institute; Wells Fargo
Eric Booth, COO, The Leapfrog Group, Washington, DC
The role of an educational video
Capitalizing A Whole New Industry
Kevin Lavender, Senior Vice President, Healthcare Finance, Firth Third Bank, Nashville, TN
Keynote Panel - Banking on Better Healthcare
John Casillas, Chair, Medical Banking Institute
Al Briand, Division Head, BNY Mellon Treasury Services Product Management and Strategic Development, New York, NY
Making the case for standards allowing for economies of scale and will determine the success of medical banking
Mentioned SWIFT and messages moving capabilities; they should be studied to see how they produced their standards
Paula Fryland, Senior Vice President and managing Director- Corporate Banking, PNC Bank, Louisville, KY
Community involvement, community development
Boards members at community hospitals
Charitable giving - building facilities, fundraising
Health NPOs liquidity markets have collapsed, banks have stepped up
Extending and/or customizing current products or services
Point of Sale technologies
Whole new solutions
Pete Wheeler, Wells Fargo
Leading by example to create knowledge dissemination
WF 281,000 employees; HSAs, wellness program
Huge deposit base, huge lending base, huge brokerage presence, huge mutual fund presence, huge geographic reach
As employees go to other companies they bring their knowledge of the medical banking options to others firms
Global angst re: banks
PNC: Virtual wallet, healthcare 10s of millions of dollars in business investment, incredible opportunities in administrative transactions of hc, including noncredit products to build relationships
BNY Mellon: Can't count on certain aspects of traditional business so discovery of new opportunities must be explored; there must be a business case for them; friction (not seemlessness in transactions) means opportunity; consumer-centered healthcare; health custodians
WF: Opportunities coming from the synergies of combining 2 banks
Question from floor: quality rating on bonds
How will existing clearinghouse and transaction engines be tied together; current "RAILS" in place
How will XBRL and international standards impact -- bring as many players to the table to create and apply the standards
Economy of scale is THE DRIVER
Super-regional and community banks: Smaller banks have many healthcare related account; train a couple of SMEs first, build portfolios over time; attend conferences and be involved in groups active in the space
Will banks repeat their earlier investment in automation to accounts receivables
Health Wealth Portals? Convenience for either business or retail banks is important; cell phone convergence metaphor
How does hc impact your strategy? PHRs??? Wealthy individuals request new services; back office accounting of wealth management tools
How does the money saved by more efficient transaction being targeted to indigent care by hc orgs impact your banks? Banks have not recognized indirect benefits of their efficiencies investment in the communities they serve
TAKE AWAY: Economy of scale is THE DRIVER, standards are THE ENABLERS
March 13, 2009 in A Bank-Driven eHealth Ecosystem, Community Care Platform, Medical Banking Institute, Medical Consumerism | Permalink
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Next Steps for Moving the Industry Forward
Maureen Turo, President, National Medical Banking Institute, VP, Healthcare Strategy, The Bank of New York Mellon Treasury Services Division, Pittsburgh, PA
Comments from many on how many different constituencies are represented at the Institute and in MBProject
There needs to be a voice for Washington, DC
1) Task Force, Richard Mobley, Lead - 18 volunteers to climb the Hill
2) Ideas collected by the Mayo Clinic at the Institute will be compiled and emailed to attendees
Medical Banking Report provided on a quarterly basis at the MBP Portal
Deven McGraw on the Great Privacy Debate: Impact of ARRA 2009
Health Privacy Project at Center for Democracy and Technology
- Health IT and electronic health information exchange have tremendous potential to improve health care quality, reduce costs, and empower consumers
- The public wants health IT – but also has significant privacy concerns
- Failure to build foundation of trust is an obstacle to achieving greater health information exchange
Health Privacy Project at CDT
- For years there was no progress on resolving the privacy and security issues raised by e-health
- Project’s aim: Develop and promote workable privacy and security policy solutions for personal health information
Evolution of Federal Privacy Protections
1996 – Enactment of Health Insurance Portability and Accountability Act (HIPAA)
- Congress gives itself 3 years to enact privacy legislation
- 1999 – Proposed rules
- 2000 – Final rule
- 2002 – Regulatory changes
- 2003 – Effective for most
Era of Health Information Technology
Health IT bills stalled in 108th &109th
- Privacy was framed as the obstacle – but it wasn’t the only issue
Legislation moved furthest in 110th – but economic woes stalled progress
ARRA (Title XIII- HITECH)
- Broke the privacy "logjam"
- Most significant change to the healthcare privacy and security environment since the original HIPAA privacy rule
- Not a change to everything about HIPAA – but some significant changes that will need to be addressed by many entities handling health care information
- Most provisions require further regulatory clarification
Privacy and Security Provisions – Overview
- Substantive changes to HIPAA statutory provisions and privacy and security regulations
- Enhanced enforcement of HIPAA
- Provisions to address health information held by some entities not covered by HIPAA
- Misc: Administration/Studies/Reports/Educational Initiatives
Substantive HIPAA Changes
Breach notification requirement
- Definition of breach
- Safe harbor for “protected” data
- Detailed requirements re: timing and content of notice; how provided to individual and HHS
- Business Associates must notify covered entities Strengthened individual right to restrict disclosures to health plans for payment and operations
- Secretary guidance on minimum necessary
- Use of limited data set where possible in interim
- Discloser determines minimum necessary Minimum necessary still does not apply to treatment
- Requirement applies after standard and regulations are developed
- Phased in over time
- Covers only 3 years Change with respect to how business associates comply
- Can direct record to another entity or individual (PHR) Changes to definition of marketing
- Limited right to use information for marketing if the communication is paid for by an outside entity
- Exceptions for treatment communications and communications about current drugs and biologics Opt-out for fundraising communications
- Public health
- Treatment of an individual
- Sale of a facility/business
- Payments to business associates
- Copies to individuals
- Designated by Secretary in regulations
Accounting for disclosure requirements for entities using electronic health records
Patient right of electronic access
BA contracts required for RHIOs – and PHRs in some instances
Prohibition on “sale” of health records or protected health information
HIPAA EnforcementBusiness Associates accountable to authorities for compliance with some HIPAA privacy and security rules (+ new provisions)
Application of HIPAA criminal provisions to individuals
Ability to civilly enforce where violation qualifies as criminal but no criminal penalties pursued
Requirement to impose civil penalties in cases of willful neglect
- Corrective action may still be pursued for lesser offenses
Distribution of % of civil penalties to individuals (penalties also go to OCR)
State AG civil enforcement
Secretary required to do periodic audits
Provisions for Entities not Covered by HIPAATemporary breach notification provisions for PHR vendors and internet applications
- Breach definition
- Same safe harbor for protected information
- Enforced by FTC
- Which agency should regulate?
- Timeframe for regulations (no specific authority to regulate)
Misc. (Administration/Studies/Reports/Educational Initiatives)
- Strengthened authority for ONC
- New advisory committees on policy and standards
- OCR public education initiative on uses of PHI and individual rights under HIPAA
- Privacy Officers in each HHS region
- Chief Privacy Officer within ONC - Not charged with HIPAA enforcement/oversight
Misc. (Studies/Reports/Educational Initiatives)
- Studies/Reports by HHS Secretary
- Annual report on enforcement
- Study on implementation of the de-identification requirements
- Study of HIPAA definition of psychotherapy notes with respect to inclusion of test data and materials used for evaluative purposes
- GAO Studies:
- Methodology for providing individuals with a % of civil monetary penalties
- Report on best practices for disclosure of PHI for treatment purposes
- Report on Impact of ARRA provisions on health care costs and adoption of EHRs
National Rountable: Medical Banking & The Health Data Ecosystem - Engineering A Revolution in Revenue Cycle Management
Sheila Schweitzer, Chairperson & CEO, CareMedic Systems, St. Petersburg, FL
Robert Nay, Director, BlueCross/Blue Shield of Florida, Health Options, Jacksonville, FL
Charlie Myers, Director of Operations, Special Programs and Support, Johns Hopkins Hospital and Health System, Baltimore, MD
Russell Taylor, Strategic Systems and Processes, Aetna, Inc. Middleton, CT
Laurie Holtsford, Director, Business Office Support, Community Health Systems, Brentwood, TN
Scott Hawig, Divisional CFO-Patient Revenue Management Organization, Duke University Health System, Durham, NC
Mayo Clinic Health Policy Center - Advancing Health Care Reform By Creating A Federal Health Board
Ceci Connolly, National Staff Writer, Washington Post, Washington, DC
Robert K. Smoldt, Chief Administrative Officer Emeritus, Mayo Clinic, Rochester, MN
David M. Mirvis, MD, University of Tennessee Health Science Center, Memphis, TN
Murray N. Ross, Ph.D., Vice President, Kaiser Foundation Health Plan, Inc., Oakland, CA
Roy Ranthun, HSA Consulting Services, Silver Spring, MD
Stephen Parente, Ph.D., Associate Professor Finance, Carlson School of Management, University of Minnesota, MN
Robert Broadway on Pushing the Envelope Out for Good - Moving Healthcare Onto An Electronic Platform Using Banks
The Electronic Platform
15% fewer errors in electronic records study
Get on the same page
2015 is deadline for pay for performance based on new unified quality standards
Bankers sit on the boards on nonprofit community hospitals
2011 certified electronic health record
The Electronic Platform
- Banking's e-commitment
- Investment in technology
- Transaction definition and standardization
The Banking System Electronic Platform
- Universal Acceptance
- Trust & confidence
The Healthcare System Electronic Platform
- Limited acceptance
- Lack of understanding
- Concerns for security
- Many Systems
Elements of Electronic Processing In Healthcare
- Clinical processing
- Technology processing
- Financial processing/(Accounting/Claims)
- Customer/patients relations
- E-health/web enabled
- EHR – Electronic health record
- Nursing care
- Physician care (Electronic order entry)
- Other providers
- Imaging (MRI, CT)
- Radiation therapy
- Monitoring – in-house and remote
Opportunity for Banks External Processing
- Billing transactions (claims)
- Payment transactions (remittances)
- Funds flow (cash)
- Medical credit
- Electronic data storage
- Health savings accounts
John Casillas Opening Remarks Highlights
A Vision for eHealth Using Banks - Orientation and Awards
Greater secure data liquidity
Receivables locked in the medical paper chase
Medical Banking paradigm produces a lean, green, electronic stimulus machine
Necessity is the mother of invention
All participants at the MBI must throw yourselves into the process
Health Wealth paradigm
MBP creating tools
Inform the national process
Stuart M. Hanson on How Medical Consumerism and Medical Banking Align to Create Value
Presentation of White Paper: The Impact of Consumer Directed Healthcare on Providers
Consumer Directed Healthcare (CDH) typically combines a high deductible health insurance plan (HDHP) with a personal saving/spending account, from which medical expenses can be paid directly. Most common spending account plans are Health Savings Accounts and Health Reimbursement Arrangements.
Consumer Directed Healthcare Research Study
- Gain thorough understanding of impact of Consumer Directed Healthcare (CDH) trends on healthcare providers, financially & operationally
- Ensure that feedback & findings were unbiased and broadly based
- Fifth Third engaged the Boundary Information Group
- The research was conducted over a two month period: July – August 2008
- The methodology consisted of a detailed one hour interview with CFOs, Patient
- Accounting Directors and selected thought leaders from hospitals and physician groups from across the nation
- Key findings of the research were compiled into a white paper “Impact of Consumer Directed Healthcare on Providers”
- Are providers seeing an impact on cash flow and operations from CDH?
- What Best Practices are providers pursuing to handle CDH?
Key areas of focus
CDH is a Growing Portion of $2 Trillion Market*
- CDH plans grew by 43% in 2008. CDH plans will reach 14.9M accounts by January 2009
- There is $5.3B value held in Health Savings Accounts which is expected to grow to $16B by 2010
- Consumers spent over $250B on out of pocket healthcare expenses in 2008. $242B paid for by cash, check, credit, debit. The remaining $8B was paid by some form of Healthcare card
- According to the US Census Bureau consumers will pay over $1000 annually in out-of-pocket healthcare related expenses by 2012 up from $800 today. The proportion of patient payments is projected to rise over the next few years from 15% to 21%
*Source: Consumer Driven Market Report, US Census, Celent, Forrester Research
- Consumers: Provides economic incentives to manage their own care. Ability to build a medical nest egg.
- Employers: Reduce benefit costs from lower premiums and FICA tax savings
- Government: Proponents hope to drive down healthcare costs by stimulating market competition
- Payers: Deliver high deductible health plans along with consumer tools such as quality and health information
- Banks: Deliver Health Savings Accounts linked to a debit card. Offer online payment tools.
- Providers: Must manage rising patient payment portion resulting from higher co-pays and deductibles. Less predictability in collections as responsible party becomes blurred further
What Does CDH Growth Mean for Providers?
As responsibility for payment shifts more to patients…
- Importance of financial arrangements at or before time of service increases Predictability of collections becomes less certain
- New set of tools and processes are required to minimize negative financial impact of CDHP growth
- POS Collection methods are stretched
According to a recent interview with a well respected industry expert: "In a nutshell, healthcare providers need to recognize that the tools they need today are not the tools they have from yesterday…they have to realize that they’re at a severe disadvantage unless they re-tool for this new patient responsibility paradigm … today many providers are basically bringing knives to a gunfight"
CDH Research Study: Key Findings
- CDH Impact
- Geographic Variability – but momentum building across all geographies
- Providers Lack Processes, Tools, Resources
- CDH Impact Far Greater Than Prior Experience with Self Pays
- Result Could Include Higher Costs and Lower Revenues
- Process Challenges
- Negative Public Relations Impact
- Lack of Price Transparency
- Financial Complexity Demands More Experienced Staff
- Technical Challenges
- Legacy Systems are Challenged with “Consumer Debt” Issues
- New Vendors are Emerging
- Providers Struggle with Limited IT Budgets
- Providers Seeking Single Vendor Solutions
Recommendations for Providers
- Assemble project team for examining current practices, evaluating options, making recommendations, and implementing new programs to adapt to CDHP growth trends and impact on your organization
- Evaluate existing processes and tools in place today, especially against best practice conclusions from this analysis
- Analyze method for managing commercial and governmental posting of EOB, ERA to speed posting process and potentially free up resources
- Work with strategic banking partner to streamline revenue cycle activities as much as possible and to understand financial tools and options that are available
- Determine suitability for new processes, tools, and/or possible upgrades to existing systems and capabilities
- Prepare to implement new tools, software, staffing model, training programs, financial tools as needed
HMBP on Twitter @mbproject (search #medbanking)
- Jim St. Clair, XBRL on the new Frontier: Integrated Reporting in Healthcare
- HIMSS Launches Blog
- HIMSS MBP Leadership Forum, Vanderbilt Center for Better Health, October 6 7, 2010
- XBRL, the New Language of Financial Reporting, Slated to be Included in the Financial Track of SemTech 2010
- Standardisation, regulation and recovery of the financial industry
- Epic fail: Hospitals arent publicizing charity programs
- HIMSS Virtual Conference Expo, Wed, Jun 09, to Thu, Jun 10, 2010
- Input on Tennessee's Strategic and Operational plans for Health Information Exchange
- Governor Bredesen, Mayor Dean, Commissioner Kisber Welcome Anchor Tenant To Nashville Medical Trade Center
- Georgia Automated Clearing House Association 2010 Solutions Request for Speaking Proposals