The large health care system faces the challenges of RCM (Revenue Cycle Management) which the Affordable Care Act proposes to mandate. This change converts the fee for service model to one of reimbursement for quality of outcomes (Value based payment model) and Pay for Performance and is not based upon volume. This is an enormous change about to take place.
The HIT department at Mayo Clinic is quite large, supporting clinical, administrative and educational functions. Mayo Clinic is heavily invested in Cerner's EHR, and 'patching' software requiring multiple changes for RCM, measuring outcomes, attesting to meaningful use present a formidable exercise at considrable expense. Ostensibly the number crunchers, clnicians, and administrators believe a fresh start allows for a more efficient transition both financially and in training staff to meet the new regulatory standards.
Cris Ross, CIO for Mayo Clinic explains,
'The scope of Mayo's practice is very large, so we have a lot – a lot – of detailed decisions to make'
John Noseworthy MD, President and CEO of Mayo Clinic, states, “We’re confident in choosing Epic as our strategic partner as we continue to enhance Mayo Clinic’s excellence in health care and medical innovation,” said John Noseworthy, MD, Mayo Clinic's president and CEO, in a statement announcing the partnership.
The Mayo Clinic Health System is a large health care enterprise. They have many facilities dispersed throughout the United States, and interoperability is a key factor for them. Their old system from Cerner did not provide this functionality, nor did it meet the requisites for Meaningful use and/or conversion from fee for service reimbursement to a value based reimbursement system. Redesigning or patching a legacy system would be too expensive and may not have provided the changes, or future changes to comply with CMS requirements. User friendliness may have also contributed to changing to an entirely new software vendor.
The original concept for EHR was to make a record more legible and to store data that was easily retrievable. This has been expanded to include data fields which allow analytics
The technical aspects to achieve interoperability, a built in tree to compute outcome analytics and quality of care go beyond this blog. In fact health clinicians must now depend upon others to design systems which will integrate record keeping with all the other mandates of the Affordable Care Act, and Accountable Care Organizations.
Accountable Care Organizaitons may well go beyond one health care provider, both clinics and hospitals. In some cases depending upon whether it will be an IPA, hospital, or insurer, each responsible organization will need to use appropriate software to integrate the ACO.
Early experience has not been all that successful. A few 'Pioneer' ACOs are operational, but several Pioneer organizations have failed, including the Sharp Health System in San Diego.
Some insurers are forming their own ACOs as an alternative for fee for service reimbursement. It promises to be a learning experience for all users
The Mayo Clinic has always fashioned itself as a 'leader". It's partnership with Epic signals a change. Kaiser Permanente already uses Epic for their system, replacing it's original system from IBM. Called Kaiser Connect it bases it's overall operation on Epic with some additional software modules to build upon it's success.
Kaiser's CEO states it's operational infrastructure upon EPIC .
Philip Fasano: We have every piece of information about that patient available to us to draw upon. The primary care physician has all the information about the patient, the specialists have all the information about the patient, and anyone they encounter in any of our hospitals has it as well. He or she can see the patient's health history, diagnosis by other providers, lab results, and prescriptions are all there. X-rays are stored digitally and are there. That information is also available if a patient goes to the ER.
Cost is significant, About $4 billion, a substantial amount of money, but we have 9 million members [so it costs about $444 per member]. This is not a one time investment. You have to invest continuously in the infrastructure over its lifetime. People have to recognize that these systems are life-critical once implemented, so you have to invest in the infrastructure to be sure they are always on. InfoWorld: What would it cost nationally to do what Kaiser did?Fasano: The health care reform act states that "meaningful use of technology" by providers nationally would be $11 billion. At the time, I said, "That's a nice down payment." It will cost tens of billions of dollars to implement this.
Kaiser, says Fasano blazed a new path, with considerable challenges and failures, a price from which all future users will benefit.
The new system was built with Epic Systems, a specialist in electronic health records that is now one of the top two EHR vendors, along with Cerner.)
