Can Technology ‘Cure’ Health Care’s Future?

Aneesh Chopra, senior adviser of health-care technology strategy at the Advisory Board Co., envisions a scenario where once a doctor has all necessary patient data, she could begin to look at how to best engage the patient in newer ways to improve his overall health outcomes. Photo courtesy of

One day soon, patients will routinely interact with doctors via remote telepresence. It’ll be common for people to take digital photographs of medical conditions and send them to health-care professionals for evaluation. And improvements in data capture and analysis will lead the way toward better, more cost-effective medical care.

These are just a few predictions for how health care will evolve over the next 25 years. But the future of health care is cloudy at best, given the broad array of changes that will take place in the health-care system over the next several years. What’s clear is that technology will play a vital role in improving health care for Americans and making the system more sustainable. Whether it’s used to help ease the Medicaid burden on states or to enable patients to be diagnosed more quickly and easily, technology has huge implications for the future of health care … whatever that future may bring. 

In 2009, Medicaid costs accounted for an average of 15.7 percent of states’ general fund spending, according to Medicaid and State Budgets: Looking at the Facts, a publication of the Center for Children and Families. By 2011, that amount had risen to 16.8 percent, with no sign of slowing in sight. Medicaid as it exists today is simply not sustainable. A new model that meets the needs of an aging population is necessary. The Affordable Care Act (ACA) requires states to take a number of steps over the next several years to reform the system. And while the ACA’s future also is in question (Gov. Mitt Romney has promised to repeal all or part of it if he’s elected president), the need for significant reform still is evident, and technology will likely play a role in a number of areas, including enrollment and eligibility, pay-for-performance and electronic medical records.

Cheryl Camillo is a senior researcher with Mathematica Policy Research, a Princeton, N.J.-based research organization. Camillo focuses on ACA and Medicaid and is also the former executive director of the Maryland Office of Eligibility Services. Camillo said the ACA is motivating states to use technology to change the future of Medicaid application and enrollment processes.

“From 2014 through 2019 there will be a substantial transformation of Medicaid due to ACA,” said Camillo. “If it all works out, the Medicaid program in 2020 will be very different than it is today, especially in the eligibility and enrollment areas. The use of IT systems will be a significant part of that.”

Rather than apply to numerous programs to determine eligibility, future applicants would fill out one electronic application and be automatically routed to the most appropriate program with minimal interaction and paperwork — a scenario dramatically different than today’s complex, paper-driven process.

“Information technology is essential to making that happen,” Camillo said. “It will allow people to apply electronically, and the systems will interface behind the scenes. The data needed to determine eligibility would be pulled from sources where it already exists electronically.”

Technology could also play a significant role in changing how providers interact with and manage chronic care patients. According to Alain Enthoven, professor of public and private management at Stanford University and a founder of the Jackson Hole Group, a national think-tank on health-care policy, Medicaid’s open-ended, fee-for-service payment system is a major contributor to the high level and rapid growth of spending. In 2009, the Massachusetts Special Commission on the Health Care Payment System said that fee for service “rewards overuse of services, does not encourage consideration of resource use, and thus cannot build in limitations on cost growth.”

Moving to a fee-for-performance scenario would change how doctors are rewarded while also promoting better outcomes. “Medicaid as we know it is a 1950s-era concept based on acute, episodic care and built around a doctor making a living,” Enthoven said. “In the future it will be more about doctor performance, actually helping improve health, and reducing patient dependence on the doctor. Coaching and electronic exchange of information would replace many in-person visits, and patients would be encouraged to manage their own health.”

Aneesh Chopra, senior adviser of health-care technology strategy at the Advisory Board Co., envisions a similar scenario. “Once a doctor has all the data they need, they could begin to look at how to best engage the patient in newer ways to improve their overall health outcomes. Technology tools could be used to collect patient monitoring data, and doctors could text or call patients instead of having them travel to the office,” Chopra said. “I envision an iPhone App Store scenario where patients download and use tech tools that support behavior change and help them make better health decisions.”

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Medical Transcription and Coding demand will increase with ICD-10

Medical Coder and TranscriptionistThe world of medical transcription and medical coding is extensive and always changing. The change that has the medical field buzzing right now is the change from ICD-9 to ICD-10 (International Classification of Diseases – Version 10). Currently, health care facilities use ICD-9 for documentation and coding, but by October of 2014 every facility must abide by the new system. These new changes will increase the need for skilled medical transcription and medical coding. It will also bring these two jobs expertise closer and merge at some time in the future.

Why will demand for transcription and coding increase?

For healthcare employees already working as a medical transcriptionist or medical coder, they don’t need to worry about these changes affecting their chances of employment. The truth is that the need for these highly skilled workers will actually increase with the implementation of ICD-10.

One of the main reasons for the increase of work is that the new book of codes is a lot more specific than ICD-9. For instance, in ICD-9, the code for a burn on the left arm is the same code as a burn on the right arm. While this may not matter to the insurance company, it does matter to the treating physician, the patient and the transcription. There are not numerous new diseases in the new manual, but it will have over 70,000 codes listed. These are also going to be seven digits, instead of the five seen in the past. The increase in codes and length of codes will help the medical coder be more specific.

There is no substitute for an intelligent human mind, so the fear that medical transcription will be obsolete after the new implementation is unfounded. Both transcriptionist and coders will actually have to work harder and attend more training to become compliant. The new system may be confusing and overwhelming to those who have worked on ICD-9 for years. As these older employees leave the workforce, fresh new recruits will be needed.

Importance of Implementing Electronic Health Records (EHRs) from ICD-10 prospective

In order to be compliant with the new rules, healthcare facilities will find that having an efficient EHR (electronic health record) system in place first will be a huge benefit. There are still thousands of private practices that have not made the switch to electronic medical records, but this will hurt them when they must face compliance with the new coding regulations.

By implementing an easy to use and efficient EHR, the transition to ICD-10 will be a lot smoother. If a facility does not yet use computers for their records, they should consider doing this as soon as possible to be ready for the upcoming coding and documentation changes.

The reason an EHR is so important is because it helps streamline the coding process. It is much easier to use a search function on a computer than trying to pore through hundreds of pages in a patient’s chart to find information. To determine whether an injury was on the left or right side of the body, for example, the coder can simply search for this terminology within the patient’s electronic record. To find this information in a paper chart wastes hours of valuable time.

How will the New System Help Medical Transcription?

It may be true that the new system will mean less hours of transcribing work but it doesn’t appear transcription will be absolute. In fact, those that choose to stay in the field and learn ICD-10 coding will be rewarded with more hours than ever of transcribing work.

Because ICD-10 demands greater detail, physicians will have to begin giving greater detail in their records. This translates into more words for the transcription, which equals greater pay. Also, the increased need for transcription with coding expertise will mean better rewarding opportunities.


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Community Web Projects Gain $1.3 Million Boost

A new $1.3 million grant from the John S. and James L. Knight Foundation will fund four projects that connect communities with their local governments, the foundation announced Oct. 2., the legislation tracking platform, will gain a sister site in the form of, which will focus on state, city and local government, allowing citizens to track issues in their area. The project, led by the Participatory Politics Foundation, received $225,000 and will begin as a pilot in Philadelphia, Washington, D.C., and San Jose, Calif.

Another website, Change By Us, received $590,000 to expand its platform to include more features. Managed by CEOs for Cities, Change By Us lets people propose grass-roots projects, find supporters and seek grants. The planned upgrade will add Facebook integration and make the website less expensive to adopt in new communities. The platform is available in New York City, Phoenix and Philadelphia. also received funding to expand from a website that encourages people to make small achievements and track them, to a website that also promotes community involvement. A typical feat is something like “take the stairs instead of the elevator” or “spend 30 minutes talking to your family instead of watching television.” The website plans to encourage its users to be better citizens. New feats will include actions like helping a local food bank, supporting the arts or encouraging voting. The website also announced plans to perform detailed analysis of user behavior in order to determine relationships. For instance, is a person who works out in the morning more likely to vote?

The final recipient of grant funding is, a website that connects corporate donors with nonprofits. Funding will create new features that allow nonprofit users to create wish lists, seek financial support via social networks like Facebook and Twitter, and share stories with donors.

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Can States Get Out of Telehealth’s Way?

This exists: a pair of house shoes, equipped with pressure sensors and a special pedometer, that can sense when the wearer is about to stumble and send out an instant message to that person’s doctor. Developed by AT&T in 2009, the slippers monitor the gait of the person wearing them and can alert a physician if there’s anything unusual. That early notification might prevent a dangerous fall and a costly trip to the emergency room.

Seem crazy? How about a doctor’s visit that takes place entirely through video conferencing? Or an in-home blood-pressure monitor that instantly relays a patient’s stats to her doctor’s office? Or glucose meters that constantly upload information to a password-protected website, allowing a diabetic patient’s daughter to track her mom’s health online?

It still sounds a little like science fiction for senior health care: Jetsons Age technology for a generation that grew up on The Jetsons. But it’s part of the very real, very rapidly growing telehealth industry, which is expected to triple in size to $27.3 billion by 2016, according to projections by BCC Research, a market research firm.

It could be a cost-saver too. Some industry analysts have said remote monitoring could lead to savings of 20 to 40 percent by reducing unnecessary hospitalizations and catching chronic problems early. Others have cited pending doctor shortages — a national gap expected to reach 130,000 by 2025, as the baby boomer retirement wave crests — as reason to embrace remote health-care technology.

But state policies must first catch up.

Regulations set by state medical boards can make it difficult for doctors to practice telemedicine, Gary Capistrant, senior director of public policy at the American Telemedicine Association, told Kaiser Health News in May. State boards often require an existing doctor-patient relationship or a prior in-person exam — severely limiting for an industry that frequently crosses state lines. Just two years ago, in a ruling that was decried by telehealth advocates, the Texas Medical Board expressly prohibited physicians from treating new patients virtually without an initial face-to-face exam (or a referral from another doctor who had met with the patient in person).

The national Federation of State Medical Boards convened in March 2011 to examine the relationship between regulation and telemedicine. Members voiced concerns over maintaining quality of care and providing adequate tech training for physicians. But there was an acknowledgment that telemedicine offers an important opportunity. “We have scarce resources, and there is recognition that life has changed when it comes to how best to ensure access to medical care for those in need,” Dena Puskin, a senior adviser at the federal Human Resources and Services Administration, told the group.

Some states are embracing telehealth. The New Mexico Medical Board, for example, will issue a telemedicine license to any health-care provider outside the state who is licensed in any other state or territory in the United States. At least nine other state boards have modified their licensing requirements to allow some kind of telehealth practices across state lines. But with the other 40 states maintaining in-state licensing requirements, telehealth advocates say more action is needed.

“The best thing we could do is get rid of the term ‘telemedicine,’” said Jay Sanders, president and CEO of the Global Telemedicine Group, at the 2011 conference. “When we started using CAT scans we didn’t call it ‘CAT-scan medicine,’ and when ultrasounds came in we didn’t call it ‘ultrasound medicine.’ It’s medicine, period.”

This story was originally published in the October issue of Governing magazine.

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Promoting EHR Standards and Interoperability

One of the oldest electronic health record (EHR) vendors in the United States is promoting what it calls “standards-based interoperability,” joining the leading edge of “a movement to break down barriers between disparate systems and reduce the need for expensive interfaces,” according to

The vendor, Greenway Medical Technologies, already has its users exchanging Continuity of Care Documents (CCDs), which are standardized clinical summaries, with other providers that are using two primary inpatient systems — Cerner and Epic.

Providers with disparate EHRs can still exchange CCDs via health information exchanges, said Greenway’s Justin Barnes, VP of marketing, industry and governmental affairs, but that requires costly interfaces.

In contrast, Greenway’s approach — using “cross-platform exchange between different systems,” Barnes told InformationWeek, “could reduce interoperability costs in America by 80 percent to 90 percent. That’s what we’re trying to do.”

Ultimately, establishing a standards-based approach would reduce costs drastically, and employing standards created by the Integrating the Healthcare Enterprise industry workgroup would make the sharing of some documents between organizations an easy task.

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