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.

Sincerely,

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.

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