CIO Briefings Report - Nuance Communications · OCTOBER 2016 | HealthLeaders Media CIO Briefings...

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CIO BRIEFINGSWhat CIOs Need to Know and Do

OCTOBER 2016

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AN INDEPENDENT HEALTHLEADERS MEDIA REPORT SUPPORTED BY

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http://nuance.com/healthcare

OCTOBER 2016 | HealthLeaders Media CIO Briefings

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Access. Insight. Analysis.

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Facing significant pressure to shift from

volume to value, providers continue to

search for ways to improve their clinical

documentation. The challenge, of course, is

that no single strategy works for everyone.

There are simply too many variables:

• EHR technology differs, particularly

within consolidating health systems.

• Hospitals and ambulatory clinics have very

different organizational workflows.

• Some clinicians have embraced speech

technologies willingly, while others are

more comfortable with transcription.

• Analytic requirements differ depending

on a provider’s data needs for accountable

care and population health strategies.

In addition to these complex dynamics,

the onerous requirements of clinical

documentation are contributing to an

unprecedented degree of physician burnout.

As a response, organizations are striving to

integrate the EHR with solutions that enhance

the clinical documentation experience for

physicians. There are two key areas in which

healthcare leaders need to invest:

Giving Clinicians a Choice in Documentation Methods

Even as the industry rapidly embraces direct

dictation into the EHR through real-time

speech, many organizations continue to offer

transcription services. In doing so, they’re

allowing clinicians to decide which option

is the best use of their time. Moreover, these

Sponsor Perspective: Building a Documentation Strategy on a Bedrock of Flexibility and Choice

Satish MaripuriExecutive Vice President and General Manager, HealthcareNuance CommunicationsBurlington, Massachusetts


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documentation solutions are increasingly available on

mobile devices, whenever and wherever they’re needed:

in the office, on the road, or at home. By offering

clinicians choice and flexibility in how they document,

organizations are improving the speed and quality of

documentation, while freeing clinicians to focus on

patient care.

Capturing Quality Documentation at the Point of Care

To support care coordination, accurate documentation

should happen in the moment, not days or weeks later.

Organizations are investing in computer-aided physician

documentation technology to prompt physicians

with information that supports diagnosis specificity

at the point of care. They’re also rethinking clinical

documentation improvement programs, using trained

nurses to work alongside and coach doctors toward

more accurate documentation. These strategies make

documentation less distracting for physicians while

allowing them to capture necessary details to expedite

financial reimbursement and improve compliance, care

coordination, and outcomes.

As every organization charts its own course toward value-

based care, there’s no denying the need for integrated

solutions that improve the physician’s experience through

greater choice and flexibility. With the right solutions,

clinicians can meet documentation requirements in a way

that doesn’t disrupt their workflow and allows them to

get back to the patient.

For more information, visit nuance.com/healthcare.

Sponsor Perspective (continued)

http://nuance.com/healthcare


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Healthcare IT Strategy

In many aspects of healthcare, we see indications of

change, with movement toward new payment models

and investments in infrastructure to support the

delivery of value-based care. While the direction is

clear, it is also clear that many of today’s providers

lean more toward positioning for change than toward

implementing change.

While nearly every provider is engaged in this

transformation to a degree, not all providers are

evolving at the same pace, and there is variability

between organizations in terms of the level of

commitment to value-based care activities. But no

one wants to be behind the competency curve when it

arrives, and it can be expensive to build competency

for a new model before it is financially viable, which is

why providers remain cautious.

Healthcare Analytics Activity

Healthcare is witnessing the evolution of analytics

from mainly a finance and administration tool to

an expanded role that includes integrating financial

and clinical data—an evolution that continues to

gain momentum. Its use and sophistication, driven

by the steady advance of value-based care and the

assumption of greater downside risk by providers, will

likely accelerate in the coming years.

As the industry moves from fee-for-service to value-

based care, providers will likely find themselves

consumed with analyzing payer- and patient-related

data from diverse internal and external sources.

The need for analytics tools to make sense of these

disparate sources will only grow.

Some of the challenges may relate directly to financial

resources, while others are more closely tied to levels

of expertise. The need to deliver timely analysis is a

challenge for all industries, but it is perhaps even more

acute in healthcare.

Executive Summary:What CIOs Need to Know and Do

What Leaders Are Saying“Key factors are the credentialing of the specialists used to view the patient via telemedicine and the ability of the specialists to be compensated for their time and liability.”—Chief financial officer for a medium hospital

“You need to ensure that the support areas such as imaging and IT are on board from the very beginning and that they are available to troubleshoot when the need arises.”—Chief nursing officer for a small hospital

“We are moving our independent data analytics teams to imbed them within finance and clinical quality to improve the contextual analysis of the information.”—Chief financial officer at a medium health system


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Telemedicine and ED Efforts

Emergency departments are optimized to provide emergency care,

of course. The timing of medical emergencies cannot be predicted,

so EDs must maintain continuous readiness. Their open-door

policy brings patients who need emergency care, patients who worry

that they might need emergency care, and patients who don’t need

emergency care at all.

While the effective handling of patients with emergent conditions

remains a principal focus, to deliver that care, EDs also need

techniques to be effective with nonemergent patients. One new

technique they are considering is telemedicine.

Nearly half of respondents to a recent HealthLeaders Media survey

use telemedicine in EDs now, and another 11% expect to begin

using it within three years. Among those using telemedicine in their

EDs now, the top applications are for neuro/stroke consults and for

behavioral health consults.

IT Systems and Value-Based Care

IT is expected to play a critical role in the effective delivery of value-

based care, and developing competency in this area is a strategic

priority for most providers.

Within IT, EHR elements lead the list of areas organizations are

committed to developing or have developed as a competency for

value-based care. The top three responses are enhancing provider

efficiency through EHR usability, EHR interoperability, and EHR

standardization among care partners.

Because not moving forward may mean being left behind,

healthcare organizations face serious strategic decisions. Once

a path is identified, the executive team must implement systems

to monitor progress, as well as make strategy adjustments when

needed.

Executive Summary (continued)


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More than one-quarter (28%) of healthcare leaders say clinical IT is the No. 1 strategically important IT area in supporting their pursuit of financial targets over the next three years. A similar share, 25%, say EHR interoperability is No. 1. Although only 11% say data-driven knowledge of patient health factors is the No. 1 IT area of strategic importance, 52% include data-driven patient knowledge among their top three.

Survey Question: Of the following areas of healthcare IT, please rank the top three according to their strategic importance in supporting

your organization’s efforts to reach its financial targets over the next three years. Base = 471. Source: HealthLeaders Media Intelligence

Report, January 2016, Ready, Set, When? The Drawn-Out Shift to Value.

HEALTHCARE IT STRATEGY

Clinical IT

EHR interoperability

Predictive analytics

Data-driven knowledge of patient health factors

Telehealth

Security

Mobile health, mobile technology

Actuarial skills for risk assessment

25%

10%

3%

3%

2%

11%

28%

18%


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Survey Question: Please select the top three data-related challenges your organization expects to face in performing analytics over the next

three years. Base = 350. Source: HealthLeaders Media Intelligence Report, February 2016, The Analytics Challenge: Gaining Critical Insight Into

Risk-Based Models.

The top three data-related challenges respondents expect their organizations to face are integrating internal clinical and financial data (54%), establishing/improving EHR interoperability (47%), and integrating external clinical and financial data (41%).

TOP DATA-RELATED ANALYTICS CHALLENGES OVER NEXT THREE YEARS

Integrating internal clinical and financial data

Establishing/improving EHR interoperability

Integrating external clinical and financial data

Improving data accuracy

Creating full internal/external patient histories

Accommodating unstructured data

Obtaining payer claims data

Obtaining per-unit or per-case cost data

47%

26%

24%

23%

22%

32%

54%

41%

Don’t know 4%


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Responses for claims data—Medicare/Medicaid patient claims data (78%) and commercial payer patient claims data (67%)—take the top two spots for finance-related data drawn on now. The prevalence of payer claims data suggests the importance of analyzing the relationship between patient care and revenue. Internal provider productivity data, which is the third most frequently mentioned data source, provides insight into the cost part of the value formula; it also offers the benefit of provider-specific performance tracking.

Survey Question: Please select the top three data-related challenges your organization expects to face in performing analytics over the next

three years. Base = 350. Source: HealthLeaders Media Intelligence Report, February 2016,

The Analytics Challenge: Gaining Critical Insight Into Risk-Based Models.

HEALTHCARE ANALYTICS ACTIVITY

Medicare/Medicaid patient claims data

Commercial payer patient claims data

Internal provider productivity data

Patient financial data

Chargemaster data

Payer cost data

Care partners’ provider productivity data

Care partners’ cost data

67%

52%

38%

19%

17%

54%

78%

59%

Don’t know 4%

None 1%


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Medicare/Medicaid patient claims data (83%), commercial payer patient claims data (76%), and internal provider productivity data (66%) are the top finance-related data types respondents expect to draw on within three years. All data types are expected to increase compared with finance-related data drawn on now, with the greatest increases found in care partners’ cost data (up 24 points), payer cost data (up 18 points), and care partners’ provider productivity data (up 17 points).

Survey Question: Which of the following types of finance-related data do you expect your organization to draw on for analytics activity

within three years? Base = 350. Source: HealthLeaders Media Intelligence Report, February 2016,


TYPES OF FINANCE DATA DRAWN ON FOR ANALYTICS WITHIN THREE YEARS

Medicare/Medicaid patient claims data

Commercial payer patient claims data

Internal provider productivity data

Patient financial data

Payer cost data

Chargemaster data

Care partners’ cost data

Care partners’ provider productivity data

76%

56%

55%

41%

36%

60%

83%

66%

Don’t know 7%

None 1%


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Providers lean toward using a vendor’s proprietary software, or a combination of proprietary software and open-source software, because developing in-house analytics software can be time- and resource-intensive. Their analytics teams may also lack the necessary skill set to conduct software development.

Survey Question: Which of the following best describes your current applications for working with large and/or complex data sets to

reveal trends or specific insights? Base = 326. Source: HealthLeaders Media Intelligence Report, February 2016,


CURRENT APPLICATIONS FOR WORKING WITH LARGE/COMPLEX DATA SETS

Vendor’s proprietary analytics software

A variety of open-source and proprietary software

Our own in-house analytics software

Open-source analytics software and utilities

Other

Don’t know

No analytics-specific software or utilities

24%

2%

7%

10%

6%

33%

18%


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Nearly half of respondents (49%) use telemedicine in EDs now, with 33% planning additional deployment. Another 11% expect to use telemedicine within three years, and one-quarter are still investigating. The benefits of the technology are apparent, and it is just a matter of time until it becomes a standard ED resource.

Survey Question: What is your organization’s status regarding deployment of telemedicine in the ED? Base = 212. Source: HealthLeaders

Media Intelligence Report, May 2016, ED Success: Coordinating Emergent and Nonemergent Care.

TELEMEDICINE AND ED EFFORTS

16%

33%

11%8%

Use already, fully deployed

Use already, additional

deployment planned

Usage planned within three

years

Investigating Do not plan to use

25%

Don’t know

8%


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By far, the telemedicine application mentioned most frequently is specialty neuro/stroke consultations (79%). The second most common use is for behavioral health consults (40%). However, telemedicine has broad applications. Other cited uses are pediatric consults (mentioned by 6%) and burn consults (mentioned by 4%).

Survey Question: What are the principal applications for telemedicine in your ED? Base = 125. Source: HealthLeaders Media Intelligence

Report, May 2016, ED Success: Coordinating Emergent and Nonemergent Care.

PRINCIPAL TELEMEDICINE APPLICATIONS IN ED

Specialty neuro/stroke consults

Behavioral health consults

Remote diagnosis via diagnostics interface

Patient monitoring in lieu of bedside observers

Specialty surgery consults

Pediatric consults

Burn consults

Don’t know

40%

10%

6%

4%

1%

14%

79%

17%


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Slightly more than half of respondents (52%) say they are in the beginning stages of evolving their processes and systems to support their care teams and practices in coordination, communication, and patient outreach efforts. Only 3% say their care processes and systems are fully mature, though a fairly large percentage (33%) say these are evolving to a mature state. Only 11% say they are still evaluating required changes.

Survey Question: How well do your existing processes and systems support your care teams and practices in their coordination,

communication, and patient outreach efforts? Base = 212. Source: HealthLeaders Media Intelligence Report, July 2016,

Value-Based Readiness: Building Momentum for Tomorrow’s Healthcare.

STATUS OF CARE PROCESSES AND SYSTEMS

3%

33%

11%

Our care processes and

systems are fully mature

Our care processess and

systems are evolving to a mature state

We are in the beginning stages of evolving our processes and

systems

We are still evaluating

required changes

52%


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EHR elements dominate the top three IT areas. Respondents say their organization is committed to developing or has already developed a competency for value-based care, led by a tie between enhancing provider efficiency through EHR usability (73%) and EHR interoperability (73%), and standardizing EHRs among care partners (65%). While predictive analytics (42%) receives the lowest response, this will likely change over time as providers continue to develop analytics skills and invest in IT staff to leverage this important tool.

Survey Question: For which of the following IT items is your organization committed to developing (or has already developed)

competencies to prepare for value-based care? Base = 200. Source: HealthLeaders Media Intelligence Report, July 2016,


IT AREAS COMMITTED TO DEVELOPING COMPETENCIES

Enhancing provider efficiency through EHR usability


EHR standardization among care partners

IT-based clinical decision support

More rigorous data accuracy standards

Prescriptive analytics (predictive plus suggested solutions)

73%

47%

42%

59%

73%

65%


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In the previous figure, respondents indicate that they are especially committed to developing EHR competencies to prepare for value-based care, and this figure reveals that this commitment is paying off—55% of respondents say their EHR standardization among care partners is very strong or somewhat strong, and 55% say this for EHR interoperability. Rounding out the top three for very strong and somewhat strong responses is more rigorous data accuracy standards than required by fee-for-service (51%).

Survey Question: What is your organization’s level of strength in each of the following areas of IT, specifically as it relates to the change

from fee-for-service to value-based care? Base = 212. Source: HealthLeaders Media Intelligence Report, July 2016,


IT AREAS LEVEL OF STRENGTH

EHR standardization among care partners


More rigorous data accuracy standards than required by fee-for-service

Staff analytics skills to identify patient cohorts

Integrating data sets from various sources, including payers

Staff actuarial skills for financial risk assessment

Prescriptive analytics (predictive plus suggested solutions)

Very Somewhat Somewhat Very strong strong weak weak

15% 40% 31% 14%

14% 41% 33% 12%

7% 44% 40% 9%

6% 41% 37% 17%

6% 33% 41% 20%

6% 30% 39% 25%

3% 30% 44% 23%


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CIO Briefings Report - Nuance Communications · OCTOBER 2016 | HealthLeaders Media CIO Briefings...

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