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The realm of Health Information Technology (HIT)...


Gold Member, Moderator: Marketplace
12 August 2003
Austin, Republic of Texas
I've been meaning to do this for awhile, I believe this to be the perfect spot!

The field of Health Information Technology (namely, HIT or Health IT) has been at the forefront, attributable partly to forthcoming healthcare initiatives & the rest due to advances in healthcare delivery & technology. It's growing at a breakneck speed, domestically & internationally. The fields of informatics, analytics, information exchange, etc are the future.

I've somewhat recently transitioned myself towards Health IT, coming from a background in medicine & related experiences. After gaining some more insight into the domain & subject-matter through certifications & internships, I've been exploring opportunities on the EHR-EMR vendor side in terms of clinical content development and/or physician executive/consultant well as other roles, while getting involved in various local/regional/national groups.

I was curious to see if there were others here on 'Prime who are in Health IT and/or the relevant sectors of industry. Any contacts, connections, comments?

Here are some interesting links for those who want to read further:

Some of the notable players that come to mind:

- McKesson
- Epic
- Cerner
- Allscripts-Misys|Eclipsys
- eClinicalWorks
- NextGen
- Greenway
- GE Healthcare - Centricity
- Dell Healthcare
- Vitera Healthcare
- Siemens Healthcare
- Athena
- Oracle Healthcare
- Lumeris
- eCareSoft
- The Advisory Board Company
- MaxIT Healthcare - SAIC

* NOTA BENE: please keep this discussion apolitical, meaning on-topic for Health IT opportunities, networking, and industry-relevant discussion! Thanks, in-advance...
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I use many of those systems you linked every day.Hrant is an expert as well in the hospital/ health care delivery space.....
transition to "cloud" & SaaS offerings on the up, slowly...

Shameless VMware plug, but here's a lot more resources, case studies, etc in the Health Care vertical

Nothing shameless about that, very nice share - thanks! VMWare operations in Austin have been doing quite well. I've noted that (w/ regards to non-tech roles) as they've been hiring robustly for their healthcare sales needs.

Are you w/ them and/or in the industry? Any other insights?
I use many of those systems you linked every day. Hrant is an expert as well in the hospital/ health care delivery space.....
I was actually waiting for the good doctor to chime'in! I'm part of a state HIE task force charter for provider & consumer involvement, so I'd for sure look forward to getting your experiences sometime.

I've noted Hrant's posts on healthcare topics on 'Prime, especially his input on insurance/reimbursement & provider-group administration/management subject matter. He's obviously very knowledgeable & experienced, I welcome his thoughts & shares in this thread.
if you have specific questions about how the emr/ris/pacs functions from an end user like myself,just ask.
Re: transition to "cloud" & SaaS offerings on the up, slowly...

Nothing shameless about that, very nice share - thanks! VMWare operations in Austin have been doing quite well. I've noted that (w/ regards to non-tech roles) as they've been hiring robustly for their healthcare sales needs.

Are you w/ them and/or in the industry? Any other insights?

I'm with VMware but not working in the Health Care field so I have nothing credible to contribute. Of course many problems and solutions cross pollinate across verticals so if you have questions on VMware-specific technologies I can provide input or steer you in the right direction.
Health related IT issues are quite interesting and frustrating at the same time since there is no consensus on platform, nor on what constitutes user friendly interface - not to mention consumer centric metrics, and of course every vendor wants to pitch their own purported turn key panacea.

Just to give you a reference point, some 20 years ago I was surprised to find out that a health care delivery system with multiple institutions could not pool all its contract driven financial data so that one could do a systemwide negotiations. I asked my staff to develop such an Excel program (rudimentary by current standards) and I believe we were the first in the country to do so. The key was to convince all the CFOs that I didn't care about being 100% accurate as far as accounting protocols went, all I needed was a point in time that gave a picture of the financial performance of the contracts and then I could plug in different rates to see the outcome. The key for negotiations was having a reference benchmark and not constantly chasing new bills in the pipeline, plus to see the impact of a payer across the spectrum of the system's multi-institutions for a big picture of the financial negotiations. Some systems still still have not figured this!

Fast forward to new emphasis on EHR and the huge dollar investments and outlays from the federal government under the ACA, etc., ...... just recently University of California at Davis received $17.5 million from the feds and the state to have an IT system to electronically link California hospitals, emergency departments and physicians by 2014. This a lot of money, but then again I am not an IT geek to know what a screw driver or 20 gauge wire costs when charged to governmental programs:wink:

The biggest concern has been and still remains the lack of sufficient and "strict" safeguards in securing and maintaining privacy of personal records/info. Almost every organization has had a breach. But having said this, the value and efficiency of EHR is yet to be determined after all the hype is gone. If providers do not use them to "coordinate" care (another term to managed care) and hence develop best clinical pathways or best practices then having an EHR is great for eco-environmental causes but does little to enhance care/outcomes.

To give you another example, I am currently focusing/seeking funding to develop a platform - on how far health care IT needs to still go compared say to financial institutions like credit cards, or search engines like Google for a nearby Starbucks, even department stores/warehouses with options to compare product specifications ......... try to shop for a health insurance product with some specifications (ie benefits) that you want to have through a platform that allows you to compare different insurance products with their deductibles, copays, whether a particular physician (your current one or a new one) belongs to more than one network, or whether he/she accepts different insurance payments, whether he/she is paid on capitation vs. fee for service (the incentives are different), how far they are from your residence or work, if they are taking new patients (like if the advertised product is in stock) and how long the wait is for an appointment .....

There is great opportunity in this still nascent field. But there is also a lot of marketing hype and as always political networking as who gets a slice of the your tax dollars funding the next wave of government sponsored winners and losers.
...we see the same lack of integration and recognition when the metric is patient imaging studies,and xray dose.There is curently no way of tracking the individual who gets thier cat scans ect form different hospitals and imaging centers even in the same region.The amount of wasted $ and increased needless xray dose due to redundant /duplicated procedures is troubling.

Just curious... what happens when the exchanges kick in?
We do some work in the health IT industry (from the security side of things), mostly through the HITRUST organization (http://en.wikipedia.org/wiki/HITRUST). This is definitely an emerging field which is still probably years away from giving security issues the kind of attention they deserve.
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Harry, you ask a very simple question yet the answer to which is quite complex and convoluted depending on many variables. For starters, California's exchange has an official name now Covered California. The ACA addresses two separate pools: individuals and small employers (aka SHOP: small business health options programs).

Here is a link for a quick overview of the ACA and below is my take.

Some of the provisions of the ACA have already been implemented - such as you can a dependent on your policy up to age 26. But here is the gist of what I believe you are asking.

1) Those individuals and/or families who couldn't afford to purchase health insurance before because of premium pricing (not pre-existing conditions which is no longer an excuse to deny) are "expected to be able" to purchase comprehensive coverage based on federal subsidies which is scaled to a family/one's income. This relates to individual markets.

What is not clear at this time is (a) whether the federally mandated benefit coverage (aka essential health benefits) and (b) what state like California through either the exchange's policy or new legislative mandates that add more benefits will be able to lure health insurers (aka QHP: qualified health plans after accepting solicitations) to provide products that will be affordable. This even after the federal subsidies to families and the requirement that insurers charge no more than 20% of a premium to administrative costs (aka medical loss ratio - some exceed this most often because of the high marketing costs associated with individual and small group products).

2) It is well established economic fact that some small employers will opt to not expand/hire new employees to remain below the 50 full time employees thus avoiding the ACA mandate to offer health insurance because they won't be able to afford it given the margins.

A few employers will opt out of providing mandated health insurance by deliberately choosing to pay the "$2000 penalty tax" which would be cheaper than purchasing/offering health insurance benefits to their employees - this even after the tax deductions of such benefits. Such employees will be then able to purchase their health insurance through the private sector which includes the exchange. In other words they will be subject to (1) above.

Whether employers in the process of dropping such health insurance benefits/coverage and opting to pay the federal tax for not offering coverage will also increase - perhaps commensurate to the value of such benefits to employees - the wages earned by such employees is very questionable.

3) According to best predictions from UCLA's Center for Health Policy Research and others, about 2.6 million Californians will be eligible to participate in ACA's subsidized health insurance starting with Jan. 1, 2014. Another 2.4 million will be now eligible through Medi-Cal (Medicaid).

Read more: http://www.californiahealthline.org...urge-in-patient-population.aspx#ixzz2E90DJfY1

I have noted in another forum, with the influx of such dormant and pent demand for health care services by those who were uninsured or underinsured, there will be shortages of medial and allied health service to meet this initial demand.

Some of the physician manpower slack can be picked up by more flexible allied health care professions' scope of practices (this will need legislation). But the infusion of about 3-4 million uninsured Californians with their pent-up demand will no doubt strain the current system/providers particularly in some undeserved areas. There seems to be consensus on this.

If so, then in the short term, when the pressures to implement the ACA successfully is at its height in terms of consumer expectations, the law of supply and demand states that prices (not necessarily costs) will have go up to clear the excess pent-up demand. Many advocates of the ACA are now acknowledging this. If budgetary constraints continue to clamp provider reimbursements under such increased demand, then we may indeed see short-term rationing of care toward those contracts that pay more, and/or perhaps even triage/postponement of chronic and elective care for those that are more urgent or needing emergency care. This would de-facto institutionalize the two tier system that the a broader reading of the ACA's policy intent was supposed to overcome. Interestingly, the federal policy technocrats just released a policy that seeks some physicians seeing Medi-Cal (Medicaid) to be reimbursed at Medicare rates so more physicians see Medicaid patients. California's reimbursement for regular visit to a primary care is ridiculously low; doesn't even cover the costs of incidentals!

As long as the markets allow for the free entry/exit of innovation and entrepreneurship - yes this may read as blasphemy for few, the markets with robust governance can also offer an opportunity to introduce and test new payment and/or delivery models if the risk/reward meets or exceeds their opportunity cost.

---- and quoting myself from another forum:

Digressing a bit but since California's Exchange wants to also be a catalyst for change, what we fail to explicitly acknowledge in policy discussions of "community rating" of premiums is that self-inflicted risky or otherwise unhealthy behavioral habits/conduct (and the definitional criteria of what is and is not self-inflicted keeps changing) affect our collective overall premiums in standardized product designs/offerings [something that the Exchange is trying to implement]. Community rating by its design minimizes the advantages of experience rating - hence personal responsibility and accountability; two key economic factors in changing personal behavior. The ACA does not allow rating based on preconditions or gender; it allows based on age and geographic region.

This is the socio-economic welfare trade-off as part of addressing the affordability concerns of the uninsured while also avoiding moral hazard. From a strictly principled economic perspective, for such a social contract to work the personal mandate is essential. How one implements such a social contract gets us into the political arena.
Thanks for the thoughtful and complete reply.
My wife and I (she works for Kaiser, we both come from long standing medical families) have been following the ACA with interest, as has the rest of the populace. At least California didn't call their exchange "avocado."
We're all hopeful that those in control come to a smart solution and not only a political one.
Harry, if you already knew about the "avocado" inside baseball naming option, then you are leaps and bounds ahead of the general public/populace who still don't know much about the exchange! Let's see how the $30 million marketing campaign will do in the next 12 months.
Crap. Just scrolled over this thread; looks like I've got quite a bit to read. Another time (when I actually have time).

Was with Cardinal Health, now within a specialty sector of Siemens. Not on the IT side, but I give them plenty of headaches! :D
I'm a Sales Engineer for InterSystems. Have been in HIT since 1990 mostly in the US. Epic us one of our biggest clients. Others include Xerox, LabCorp, Quest, Sunquest, Quadramed, VA, DOD, IHS etc
I've worked in the HIT field on a few contracts. There's definitely money in the sector, but not all across it. If you have any specific questions, feel free to pm :)