Affordable Care Act (Obamacare) upheld—so what does it mean to me in IT? (… its BI)

In a momentous ruling touching virtually every American, the Supreme Court narrowly upheld President Barack Obama’s historic health care overhaul (Affordable Care Act – ACA) on Thursday, June 28, 2012 with the unlikely help of conservative Chief Justice John Roberts.

So how does this impact us in Healthcare IT today, those of us who are running from meeting to meeting, applying patches and working on our punch-lists of “to-dos”? Well, HIMSS officials noted that while there are many potential implications for health IT in the ACA, the Medicare and Medicaid Electronic Health Records Incentive Program was never in jeopardy regardless of the outcome of this case; that program was authorized by the HITECH Act, which was part of the American Recovery and Reinvestment Act (ARRA) of 2009. The ACA was separate legislation passed in 2010.

So now, the focus will shift to implementing these programs as soon as possible. Bart Stupak, former Michigan congressman, said now that the ruling has been made, “the focus within the executive branch, in the states, and throughout the healthcare industry will be on developing and implementing the programs as quickly as possible.” The demand for healthcare is about to explode as baby boomers continue to age. “It will be critical for all parties involved in the healthcare system—providers, hospitals, insurers, and the government—to innovate and develop methods for reducing the costs of delivering quality healthcare, “Stupak added, “so the country will be able to afford expansion.”

Now back to our challenge: our systems in our hospitals are not integrated and:

  • they don’t support shared identities
  • they’re too focused on “structured data integration”
  • they’re more “push” data-focused versus “pull” data-focused
  • they’re more focused on “heavyweight, industry-specific formats” instead of “lightweight, or micro formats”
  • data emitted are not tagged using semantic markup, so they’re not shareable by default
  • they don’t produce common output in a security- and integration-friendly way

What can we do? Focus on:

  • data Warehouses to provide the ability to integrate data from multiple systems
  • developing Business Intelligence (BI) solutions to allow the organizations to offer easily accessible data and automated reports that can improve efficiency and provide information for quality and safety initiatives, and tracking of Meaningful Use (MU) metrics
  • building “Dashboards” that provide leadership with a personalized view of aggregated data

It is important, however, to assess which tools are best for displaying your end product. Consider the current state of BI deployments and issues impacting Healthcare BI adoption:

  • Project focused where BI technology was deployed either as a part of “solution initiatives” or on a “project-by-project basis for data warehousing”
  • Entities have “standardized on several core BI vendors” and many are “decentralized and deployed at the department level” (i.e., Quality, Finance, etc.)
  • Economic pressures and healthcare reform are cited by providers as the issues having the greatest impact/influence on their adoption of BI/analytics technology
  • Regulatory pressures are just the beginning – tremendous opportunities to compete and thrive using analytics
  • Care providers are seeking to integrate various data sources and deliver key information at the point of service
  • Analytics vendors will be challenged to keep up with the pace of change – data interoperability and openness, flexible systems, cost and ease of Implementation
  • Your data might be better than you think(!) – vendors can significantly improve how they utilize available data, rather than expecting a “nirvana state”
  • People are still the point – the future of analytics is to enhance distributed decision‐making, not replace it

Why the focus on BI and Integration? Well, a day after the Supreme Court’s ruling, Health and Human Services Secretary, Kathleen Sebelius, announced new funding to help states continue their work to build health insurance exchanges (HIEs) as specified under the Affordable Care Act. “The federal government and our state partners are moving forward to implement the healthcare law,” Sebelius said. “This new funding opportunity will give states the resources they need to establish affordable insurance exchanges and ensure Americans are no longer on their own when shopping for insurance.”

Heads up: read HIE as standards-based interoperability and Information Exchange. Standards-based solutions that enable simple, secure, and scalable methods for sending authenticated and encrypted information directly to trusted recipients are out there and now come Off-the-Shelf. Oracle, for example, helps organizations satisfy Stage One Meaningful Use requirements through the use of the Oracle SOA Suite and the Healthcare Adaptor. The adaptor allows senders and receivers to securely trade information using standard document protocols such as HL7 v2 & v3, HIPAA X12 (4010/5010), CCR/CCD, and several more. Oracle’s SOA Suite supports National Information Exchange Model (NIEM) processes to facilitate reuse, interoperability, security, and reliability with regard to implementing information exchanges. These SOA solutions allow for real-time exchange of information and are scalable across multiple organizations, allowing for health information to be quickly sent during emergency situations such as pandemics, natural disasters, or terror attacks.

So, how do we begin this process?  Well, let’s start with aligning our budgets to support these initiatives. Like the discussion at this year’s HFMA national conference in Las Vegas in the “How to Create a Strategic IT Budget through CFO/CIO Partnership” session, where CIOs and CFOs noted they need to partner to create a strategic budget to maximize resources and support the goals and missions of organizations to support ACA initiatives. A strategic IT budget that supports BI (and data integration), they said, emerges from the integration of effective IT governance, defined organizational and IT strategy, and rigorous planning and budget support. A strategic IT budget should:

  • align with the organizational strategic plan
  • be accessible, communicable, and dynamic
  • provide guiding principles
  • inform and support technology decisions
  • serve as a formal reference and baseline for performance measurement and progress reporting
  • be “owned” by the organization
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