The winds of unprecedented change have buffeted the healthcare industry for more than two decades. Amid the constant battle to keep up with the changes and manage through continual chaos and uncertainty, healthcare organizations are turning to technology as a prescription for long-term health.
Regulatory compliance remains a dominant challenge.
Regulatory requirements have dominated the healthcare industry’s focus, especially in the IT arena, as organizations are forced to upgrade systems to meet constantly evolving regulations. Here are some of the major changes that sent ripples through healthcare industry IT departments.
HIPAA (1996): The Health Insurance Portability and Accountability Act established security standards and general requirements to protect the privacy and security of electronic protected health information (PHI) as healthcare organizations moved from paper records to electronic records.
HITECH (2009): Enacted to strengthen enforcement of HIPAA rules, the Health Information Technology for Economic and Clinical Health Act addresses the transmission of electronic health records.
ACA (2010): The Affordable Care Act, aka “Obamacare,” had the goals of making affordable health insurance more widely available, expanding Medicaid to adults with income 138% below the federal poverty level, and lowering the cost of healthcare in general. The ACA caused a seismic shift in healthcare practices, both on the provider and the payer sides. It required healthcare providers to extend more services to more patients amid changing reimbursement models. All these changes had to be reflected in the electronic systems of healthcare organizations.
ICD-10 (2015): The International Statistical Classification of Diseases and Related Problems, 10th edition, created tens of thousands of new diagnosis codes used for medical billing in the United States. The US edition now contains about 70,000 codes, compared to 14,000 in ICD-9. For FY2019, the Centers for Disease Control and Prevention (CDC) announced another 473 ICD-10 code changes beginning October 1, 2018.
Regulatory compliance leads to associated systems changes, which is why so much time and energy has been spent in this area. But regulation isn’t the only challenge facing healthcare.
An aging population is putting increasing demands on the healthcare system
The baby boomer generation (born from 1946 to 1964), still about 75 million strong in the US, is now 54 to 72 years old. As this generation ages, its members consume more healthcare. Members of the cohort naturally have more chronic conditions than younger people. And, as they reach the eligible age, they are using Medicare/Medicaid entitlements rather than private insurance to pay for their care.
The focus is shifting to a more holistic approach to medicine
Another major upheaval is the industry shift to managing health along a continuum rather than treating people at the hospital when a medical event occurs. This perspective starts with preventive medicine to keep people healthier so that they need fewer healthcare services. When they do get sick, this new model incorporates remote patient monitoring after treatment to help them recover more quickly and minimize re-admissions.
This focus on wellness and care across a continuum is causing healthcare organizations to look at value-based care models that measure outcomes and move away from the traditional fee-for-service model. An offshoot of this is population health management, which looks at outcomes for groups rather than individuals and relies heavily on business intelligence and data analytics to be viable.
Uncertainty is the watchword
In addition to all these major trends, the industry faces doctor shortages, declining reimbursements, soaring drug prices, rising health insurance premiums and out-of-pocket costs for the insured, and uncertainty around how the ACA will evolve under the current administration.
Until recently, healthcare organizations have focused their technology adoption efforts on moving to electronic health records (EHRs) and complying with ongoing regulatory changes and requirements. Now, the focus has shifted to improving patient outcomes and providing a better patient experience, increasing clinician satisfaction, streamlining business processes, implementing innovative practices and programs, improving overall organizational productivity, maximizing revenue, and managing costs. This re-focusing of resources will help organizations adapt effectively to the new world of healthcare.
Some of the specific initiatives organizations are working on include exploring how to implement value-based care and population health models; implementing telemedicine and remote patient monitoring programs; reducing waste by optimizing supply levels with better materials management systems; and identifying the most and least profitable departments within the healthcare organization and outsourcing services when it’s economically beneficial and leads to better patient outcomes.
All of these initiatives require consolidation of data and systems to gain a 360-degree view of operations and apply business intelligence and predictive analytics effectively. And that requires a sound IT infrastructure built on integrated systems that are designed to seamlessly manage enormous amounts of data, consolidate that data for complete visibility, and run real-time analytics that lead to smarter decisions and better patient care.
Healthcare organizations need to implement innovative solutions while mitigating risks. Purpose-built for the database with identical infrastructure on-premises and in the cloud, Oracle engineered systems provide a single, integrated infrastructure that can help these organizations scale and adapt cost-effectively and securely. Many healthcare organizations are finding that implementing hybrid cloud solutions like Oracle Exadata and Oracle Cloud at Customer help facilitate a smooth, strategic journey to the cloud.
In this series, we speak with industry expert Michael Walker, Global Healthcare Lead, Healthcare and Life Sciences at Oracle, to look at how technology is helping build healthier organizations and how Oracle technology is the right prescription to achieve that health. Stay tuned for more.