Dr. HSA

News & Views on the Rise of Medical Consumerism

What Do HSAs and Electronic Health Records Have in Common?

August 2005 - Vol. 3

Even though the healthcare industry has been talking for years about national EHRs it seems we are no closer today than during the last Bush administration.  We're still locked into a cold war of sorts between policy, standards, commercial interests and more.  The "Berlin Wall" is still standing in healthcare.

David Harris, National Healthcare Revenue Cycle Partner, PricewaterhouseCoopers LLP, NY, NY © 2005 All rights reserved.

In fact, think of hospitals as different countries speaking their own language and the equivalent of the Berlin Wall protecting every border.  How do you break down the walls within the healthcare industry, and across industries, so that patient information can be "liberated" in a secure fashion and delivered at the precise moment when and where it is needed; sort of like our personal financial information in the banking community?

This very complex and difficult task was given to President Bush's Healthcare Information Technology leader, David Brailer, PhD. Recently his office (ONCHIT) and the U.S. Department of Health and Human Services issued Requests for Proposals to streamline and automate clinical information in the form of electronic health records (EHRs).  Fortunately for Dr. Brailer and the US healthcare system, there appear to be some signs that the Berlin Wall is cracking. Consider some of the main barriers that exist to EHR adoption: physician receptiveness and standards.

Physician Receptiveness. The first form of medical records automation was introduced during the 1970s - the dictaphone. It didn't take long for physicians to learn about the benefits. In the 90s cell phones replaced dictaphones and allowed physicians to carry one device for both telephone calls and dictation. As EHRs become more widespread, dictation is in jeopardy of becoming the buggy whip of the 21 st century.

Today clinicians use Computerized Physician Order Entry (CPOE) and mobile computing devices to create and edit medical documents such as patient histories, physical examinations, operating notes, nurse's notes and orders for ancillary procedures. While some clinicians find this leading-edge technology somewhat challenging, other physicians having grown up with high tech gadgets like PlayStationT, iMacT, PDAs and iPODT and they require automation in the workplace as a condition of employment. After all, if we can use technology to play games and manage our time better why can't we deploy EHRs to improve the delivery of healthcare?

Standards. Although the adoption of POE and mobile computing is increasing among medical providers, the industry has yet to overcome its biggest obstacle - standards. Like the early days of PCs, there are several technology companies using proprietary platforms. Few of these systems talk to one another. Without an upgrade many are unable to support the confidential exchange of patient information over the internet.

To help the process along, MBProject launched "C.O.M.B.A.T." (a.k.a. Cooperative Open-source Medical Banking Architecture and Technology), designed to combat rising healthcare costs using medical banking principles and technology. The effort will result in a prototype that utilizes existing standards, translated into a common XML-layer or open source framework, to support interoperability between different systems. In fact, MBProject responded to ONCHIT with this idea of creating a prototype of a National Healthcare Information Infrastructure with the caveat that an additional and necessary stakeholder in the process is the bank.

As Washington moves the healthcare industry closer to a digital community with the help of organizations such as MBProject and its membership, there's another movement in the works that MBProject is involved with advancing - Health Savings Accounts (HSAs). HSAs have experienced a higher adoption rate than EHR in a fraction of the time with over one million accounts and over a half billion dollars in assets. Banks are moving beyond traditional lockbox operations and expanding their service offering in healthcare to support HSA processing.

Linking EHR and HSA infrastructure. Today, our medical records are kept with providers. Each provider maintains their own unique set of records; some on paper and some electronic. For example, the internist has their set of records, the OB/GYN has their own set, the cardiologist and other specialists have their records and hospitals often have their own version. How do you string all these together so they make sense?

As financial service companies develop their infrastructure to exchange insurance eligibility information between payers and providers to support real time processing around HSAs, they are also considering the possibility of exchanging medical records information. Consider networks of banking customers sharing data based on unique identifiers that link all the different "snippets" of information together.

Yet, while most consumers have a long history of trust with banks managing their financial information, is it possible they will trust the bank with their medical information? A key point of the C.O.M.B.A.T. architecture is that banks don't store information; they move it. By doing so, banks can act as conduits (like the US Postal System) and this can spur critical mass adoption of EHR messaging technologies considering their extensive customer base.

Healthcare is where banking was before Automated Teller Machines (ATMs). The healthcare industry lacks its version of the automated clearing house (ACH) to share and process information. So the question is how do we build this and who has the most experience in building it right?

Case in Point. What seems like the easiest place to start is likely the most difficult, and it revolves around the patient identifier (i.e., key field in database structure). Washington has gone on record saying that the Social Security Number is off limits. So where do we gain a common identifier? Well, banks have substantial systems in place to correctly identify their customers. When was the last time you pulled money from someone else's account using an ATM or card terminal? When was the last time you paid for someone else's gas using a credit card at the pump?

There is also an important relationship between healthcare financial transactions and clinical information; specifically, shortening the payment cycle. In order to eliminate the paper in our healthcare system, we need to automate the healthcare revenue cycle; especially as we move towards a consumer-directed payment model.

For example, patients with chronic diseases such as diabetes and high blood pressure require more care than those who don't. In the current payment model, their claims are often suspended for medical review with the payer. Medical reviews are a key element of containing healthcare cost, but they are manual and require a significant amount of rework by providers in order to substantiate claims-often delaying payment. If EHRs were structured in a standard data repository similar to banking, algorithms could be developed around business requirements to review claims with minimal manual intervention-accelerating much needed cash flow to fund operations.

Automating Myriad Transactions. We've all seen the commercials touting expedited mortgage processing. They stress consumer convenience and satisfaction. Today there is relatively little time spent by banks to review mortgage applications, allowing consumers to get approval online within minutes. We need to think of healthcare in the same ways as we begin to automate documentation of care through EHRs.

Streamlining the medical review process and exchange of clinical information between payers and providers will not only reduce administrate costs, it will free up much needed resources to focus on patient care. Most medical review functions are staffed by nurses. Moving nurses out from behind the desk and allowing them to treat patients on the hospital floor will help address our national nursing shortage. Just think of it as an added benefit to automation.

A broader perspective on EHR is the premise behind positioning MBProject's workgroups around the C.O.M.B.A.T. Initiative. The workgroups bring diverse views related to a "medical banking platform" that touch on policy, training, automation, etc. The effort also relies on an Advisory Board of standards groups and other experts. With a lot of team work, a new "healthcare ACH" could emerge that uses existing standards and infrastructure to support better healthcare practices.

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Related:

Learn more about the C.O.M.B.A.T. Initiative - click here