When a Health IT Rollout Runs Off the Rails

If ever a large-scale health IT project needed a reboot, it was the rollout of Healthcare.gov. Fortunately, it got one — in the form of an emergency, behind-the-scenes “tech surge” assembled to salvage the government’s new health insurance portal after a halting launch.

To recap, only six people completed the online enrollment process on Oct. 1, 2013, the day Healthcare.gov officially opened for business, according to notes from war room meetings at the Center for Medicare and Medicaid Services (CMS), the agency charged with implementing the site. Things didn’t improve much the next two days, with a cumulative total of 248 enrollments successfully submitted and at times up to 40,000 consumers stuck in a waiting stage.

Malfunctions crashed Healthcare.gov twice more the last week of October, the second time while Kathleen Sebelius, Secretary of Health and Human Services (HHS), the parent department of CMS, was testifying before Congress about the website’s problems.

Administration officials advised consumers who experienced trouble with the online process to apply by phone — or even mail in a hard copy form.

President Obama called it a “well-documented disaster” and pundits had a field day.

“Only the government could come up with a website that’s slower than sending something by mail.” — Jay Leno

“If you are in need of healthcare, you have two choices: You can wait for them to get the site fixed, or you can enroll in medical school, graduate, and then just take care of yourself.” — Jimmy Kimmel

“People are getting a busy signal when they try to apply over the phone. You can’t use the Internet and you can’t use the phone. So now fax machines are like, ‘Look who’s come crawling back!’” — Jimmy Fallon

To its credit, the administration retooled and relaunched the site by December 2013 and hit its stated goal of signing up 7 million people by the end of the first quarter of 2014. Nonetheless, substantial damage had already been done. Hundreds of millions of dollars had been spent, and by April 2014 Sebelius had resigned after taking ultimate responsibility for the launch debacle.

What went wrong

In retrospect, the management and technical problems that plagued Healthcare.gov throughout its development seem fairly apparent.

A February 2016 report issued by HHS’ Office of the Inspector General stated that the most critical misstep made by the project team leading up to launch was “absence of clear leadership, which caused delays in decision-making, lack of clarity in project tasks and the inability of CMS to recognize the magnitude of problems as the project deteriorated.” Other contributing factors included devoting too much time to policy issues rather than to actual site development, poor technical decisions and improper management of the key development contract. The report also criticized CMS’ organizational structure and culture, which hampered coordination, pushed back against warnings of “bad news” and failed to alter plans in the face of problems.

The Government Accountability Office (GAO), in a separate analysis, pointed out CMS shortcomings in the areas of capacity planning for the site, as well as failure to correct software coding errors and implement full functionality prior to launch. Additionally, GAO said, “Healthcare.gov and its supporting systems were not fully tested prior to launch, and test documentation was missing key elements such as criteria for determining whether a system passed a test.”

A CIO retrospective summarized the project’s faults and how the fiasco could have been prevented: “Healthcare.gov was a single, Big Bang rollout that couldn’t be stopped.” The huge undertaking should have been tracked forward in incremental stages, with early and complete testing, and a more flexible scope to find areas of risk before they unexpectedly appeared.

Not a singular instance

Despite all the negative fallout, perhaps we shouldn’t be surprised with Healthcare.gov’s early-phase stumbles. Standish Group, an advisory firm focusing on software project performance, studied 3,555 projects from 2003 through 2012 that had labor costs of at least $10 million.

The takeaway: Only about 6 percent were deemed successful. A majority, 52 percent were “challenged” — meaning over budget, behind schedule or failed to meet user expectations. The rest, about 42 percent, were either scrapped or started anew from scratch.

Further research, from Forrester Consulting, shows that less than 40 percent of IT executives believe their internal IT organizations can regularly deliver projects on time and within budget, due in large part to continually changing user requirements and overburdened departmental resources.

In general commercial environments, such a low success rate may be accepted as a “cost of doing business,” and the worst outcome could be scope creep or project delays. In healthcare, the stakes are higher, with patient lives potentially on the line when IT systems don’t work or aren’t available when needed. That’s why many healthcare entities are looking for trusted third-party help in gaining control over their interconnected systems and expanding ecosystems.

NetDirector has been around for almost 15 years, offering cloud-based services that are now considered a staple solution for data integration in healthcare and other industries. Learn more about the HealthData Exchange platform here or request a free demo.

NetDirector Enables Next-Generation Integration in Radiology with American Health Imaging

Tampa, FL – May 24, 2017 – NetDirector, a cloud-based data exchange and integration platform, has engaged in a rapid expansion strategy in the healthcare industry over the last few years. Recently, the Integration-Platform-as-a-Service (iPaaS) has completed implementation with American Health Imaging, a regional network of radiology providers across multiple states, to provide increased accessibility and data utility in their company.

American Health Imaging (AHI) began providing diagnostic imaging services in Decatur, Georgia, in 1998, and has since expanded to 21 locations. In each area, they distinguished themselves by providing excellent customer service and high quality diagnostic imaging for their patients and referring physicians. By partnering with NetDirector to provide cloud-based integration services, it is the goal of AHI to create an automation platform that will increase overall customer satisfaction through streamlined processes and to create internal manpower savings through enhancing their ability to scale the business without having to add staff.

“We want to provide the best possible patient care, to the maximum number of patients, while minimizing the need for human intervention in the process,” said Dan Balentine, Chief Operating Officer at AHI. “By utilizing the NetDirector integration, it has allowed us to take our staff’s focus off of the day to day busywork, and shift focus to providing unmatched patient care.”

With traditional integrations, a company like AHI could be paying upwards of $20,000 plus an 18% annual maintenance fee for each vendor that would be integrated with AHI’s EMR and other in-house systems. For AHI, this was clearly not the optimum solution. Several vendors might not have the volume of transactions to justify the integration cost, creating a system built around the exception and not the constant. NetDirector’s one-to-many integration approach allowed AHI to integrate once with NetDirector, and use that single integration to connect to the entire hub of HealthData Exchange participants.

Three main technologies formed the backbone of the AHI-NetDirector integration – HealthLogix, Exchange EDI, and IntScripts.

HealthLogix Integration – Patient Check-In, Appointment Confirmation, Patient Billing

AHI utilizes a patient engagement platform called HealthLogix to help follow up with patients after exams or appointments, confirm scheduling, prompt for surveys, create a seamless check-in process, and more. The cloud-based integration model helped AHI bring this information directly into their Fuji Radiology Information System (RIS) and patient billing databases, to keep patient records current and to leverage the data they were collecting most efficiently, and allowed the utilization of HealthLogix’s full functionality such as automating check-in procedures at a digital kiosk, and more.

Exchange EDI Integration – Insurance Coverage Confirmation & Verification

Additionally, in a time where high-deductible insurance policies are increasingly commonplace, insurance confirmation simply isn’t enough information. AHI utilized NetDirector to connect with Exchange EDI, which not only confirms the participation in an insurance policy or group but analyzes policy levels and remaining deductibles. This allows patients and providers alike to understand the patient’s responsibility up front – the transparency provided by this data allows for accurate collection of copays during visits, reduced collection costs down the line, and overall reduced revenue leakage for providers.

IntScripts Integration – Physician Referrals and Radiology Communication Integration

Finally, it was critical to make the ordering process for their referring physician population as simple as possible, so an integration was performed with IntScripts, which provided the ability to directly receive orders from the referrer’s EHR and have the results automatically dropped right into the patient’s chart.  This automation eliminates the traditional manual processes that were previously encountered by both AHI and referring physicians.

For patients, the NetDirector integration platform provides not only an elevated level of understanding of their coverage and responsibility through stronger integration between provider and vendor, but also makes life easier for their primary care doctor or other referring physician to communicate and refer patients. This increases the likelihood of single-service care, as primary care physicians are more likely to refer patients as needed, and patients can trust they are receiving the right treatment for them.

“The integration that we have created for American Health Imaging is a model case for the value of cloud-based integration in healthcare,” said Harry Beisswenger, NetDirector CEO. “When we set out to enter the healthcare industry, our primary goals were to reduce costs for providers, increase potential care level provided to patients, and create an environment of data transparency and communication. AHI’s integration has accomplished all of this and more.”

Company Bio:

NetDirector provides a secure cloud-based data and document exchange solution for the healthcare and mortgage banking industries to deliver seamless data integration between parties. NetDirector bridges gaps created by disparate systems & technologies by allowing companies at any location to share data & documents securely over a single internet connection with any other member of the ecosystem. Our approach allows trading partners to collaborate and exchange data in a seamless, bi-directional, real-time manner. With security and longevity as a focus, NetDirector is a certified HIPAA Compliant company, a 6-year member of the prominent Inc. 5000, and currently processes more than 8 million transactions per month.

Healthcare Innovation: New Threats, New Technology

On the heels of the May 12 WannaCry malware attack that infected more than 300,000 computers in at least 150 countries — the largest hack in nearly a decade — investigators continue to evaluate what happened while victims assess the resulting damage.

The exploit emerged as ransomware, which encrypted files stored in unprotected computers and effectively held them hostage to demands for money in exchange for decryption.

“The suspected syndicated attack is … using a particularly nasty form of malware that can move through a corporate network from a single entry point,” noted Simon Crosby, chief technology officer of cybersecurity firm Bromium. He added that healthcare organizations, governments, police and fire departments and military organizations are “massively vulnerable.

The outbreak started in Europe and in one of the most significant impact zones affected about 20 percent of the United Kingdom’s publicly funded National Health Service. Routine surgeries and outpatient appointments were canceled, while seven hospitals had to divert emergency patients due to disruptions, BBC reported, although media accounts said patient data had not been accessed.

WannaCry manipulated flaws in Microsoft’s Windows operating system that had not been updated by many of the targets. While analysts believe elements of the malicious software had been leaked by a hacking group from a trove of cyber-attack tools held by the U.S. National Security Agency (NSA), Microsoft reportedly was aware of the Windows weakness and had issued a free fix on March 14.

“Say what you want to say about the NSA or disclosure process, but this is one in which what’s broken is the system by which we fix,” commented Zeynep Tufeki, a professor at the University of North Carolina.

Hackers target healthcare

The 2017 Healthcare Breach Report, compiled by data protection firm Bitglass from U.S. Department of Health and Human Services records, reveals that 328 U.S. healthcare organizations disclosed data breaches in 2016, up from 268 the prior year. All five of the largest breaches were the result of hacking and IT incidents in 2016, according to the report. What’s more, network servers were almost always the targets for hacking-related breaches.

Robert Herjavec, CEO of a global information security company (but perhaps more widely known as one of the venture capitalist investors on the television show Shark Tank), recently told Healthcare IT News that the industry needs to prioritize a proactive approach to security.

Herjavec emphasized that providers are vulnerable to hacks in part because they are highly dependent on information systems, but it is difficult to keep them up-to-date and refreshed with current security patches. He added that large projects “can take years, and security considerations and proactive protection often fall by the wayside during these transitions.”

In general terms, he recommends increased use of account access management tools while restricting access to HIM systems to the greatest extent possible. Additionally, as shown in the WannaCry incident, operating systems must be updated regularly and endpoints patched aggressively — all while staff and clinicians receive training on cybersecurity risks and challenges.

NetDirector recognizes that unknowns in cybersecurity will always create gaps between emerging exploits and preventive measures. That’s all the more reason for the company to stay ahead of the curve in its technology development. With its HealthData Exchange platform, for example, clinical and financial data move electronically among disparate systems via a cloud-based solution that fully complies with HIPAA and SOC2 standards. NetDirector securely processes over 10 million data and document transactions per month for its healthcare clients.

For more information, please contact us or request a free demo.

Integration Can Power the Tools for Patient Engagement

Roughly 70 percent of health systems, hospitals and physician practices proactively work toward getting patients more involved in their own care, according to a 2016 NEJM Catalyst survey. However, considering the drive to implement and deliver value-based care, industry observers are wondering why that number isn’t closer to 100 percent.

“[We] need to engage patients outside the exam room with frequent, creative interactions that do not have to always include their physicians,” according to Kevin Volpp, MD, PhD, and Namita Mohta, MD, who analyzed the survey results.

Patient portals, secure email, online/mobile scheduling, patient-generated data and social networks lead the way among engagement initiatives currently being used at scale, according to respondents.

Nonetheless, portals in particular tend to be “systems of record, not systems of engagement,” observes analyst Brian Eastwood of Chilmark Research, a health IT advisory firm. Today’s portals aren’t optimized for value-based care or population health management because they’re geared toward the individual and don’t encourage behavior change, he adds.

Forward-looking solutions must be built on a broader engagement model that loops in coordinated community care teams and enables bi-directional information flow, Eastwood explains. “The point solutions that consumers use to access the healthcare system will get bigger,” he continues. “We need to try to connect to these solutions in some way — and integration is the best we can hope for.”

A pathway to future success

Design and usability will be the main drivers of behavior changes in patient engagement, predicts Sean Duffy, CEO of Omada Health, a tech-based company targeting diabetes care through analytically identified trends.

“It’s about fine-tuning and personalization, [which will spawn] an incredible wave of potential in the way we work to improve the health of the country,” Duffy tells FierceHealthcare. Optimizing the way patients interact with engagement technology is a core part of the process so that a wide range of individuals can be effectively served.

And there’s good reason to expect positive patient response to emerging engagement technology. CDW’s 2017 Patient Engagement Perspective Study finds 70 percent of patient respondents saying they’ve become more knowledgeable about their personal medical information because of online access. Half of the same sample said they’ve noticed increased engagement with their own healthcare.

At the same time, it’s essential to view patient engagement as a two-way street. To wit, 67 percent of providers surveyed by CDW consider patient engagement to be an important part of improving overall care and the top motivating factor in spurring their respective organizations into action.

Indeed, leading healthcare institutions such as Johns Hopkins Medicine are making sure employees understand patient data and know how to communicate it. That behavior is “becoming very ingrained in the way we do our work,” says chief patient experience officer Lisa Allen.

NetDirector’s HealthData Exchange platform supports such initiatives by electronically moving clinical and financial data among disparate systems — transparently mapping it to the correct format of the recipient. In this way, HealthData Exchange serves as an engine for integrating engagement technologies, increasing the likelihood of not only utilization, but also the accuracy of data circulating in multiple environments without human intervention.

For more information, please contact us or request a free demo.