The document discusses how healthcare organizations will adopt new technologies required by healthcare mandates, categorizing them as Pragmatists, Collaborators, or Innovators. It also explains the differences between dual database and single database solutions for integrating ambulatory workflows like financial, operational, and clinical systems. A single database solution allows real-time updates across workflows while dual databases require manual updates between separate systems.

1. Engineering the Healthcare
Technology Transition

2. According to a report issued by
Deloitte in the summer of 2009, the
market will find health care
organizations fall into one of three
camps when it comes to adopting
new technology required for health
care mandates: Pragmatists,
Collaborators & Innovators.

3. Pragmatists
• Sixty percent of the industry will fall into the
“Pragmatist” category, and will do their very
best to achieve the minimum required for
compliance.
• This includes basic coding, EDI
transactions, CMS or government reporting,
all to facilitate only the core administrative
and revenue cycle management processes.

4. Pragmatists
• The risk of aiming for average is potential
failure to integrate these changes with
other workflows required for new legislative
requirements such as Meaningful Use and a
resulting loss of revenue opportunity and
negative return on investment in technology.

5. Collaborators
• Between 20-25 percent of the industry is
predicted to fall into the “Collaborator”
category.
• They strive to achieve successful
compliance by using mandates as an
opportunity to review and improve internal
reporting and possibly adopting advanced
analytic and payment monitoring tools, such
as digital dashboards.

6. Collaborators
• These Collaborators will break even, at a
minimum, and will likely experience an
actual value in return for the costs of using
these mandates as an opportunity.

7. Innovators
• The remaining 15-20 percent will win the
day in these transformative times.
• These “Innovators” will use 5010/ICD-10
and other ongoing legislative mandates as a
change agent to renovate overall health care
management.

8. Innovators
• This includes contracting processes,
advanced training, outcomes management,
physician report cards and possible business
acquisitions, arriving on the other side with a
competitive advantage and strategic
positioning for success.

9. Ambulatory Workflows
• From an engineering perspective, the
workflows in an ambulatory setting consist of
three components: Financial, Operational &
Clinical.

10. Ambulatory Workflows
• Financial
• A/R, Billing, Statements, Eligibility
• Operational
• Scheduling, Calls, Record Release, Referrals
• Clinical
• Notes, Vitals, Orders, Results, CCD, PMH, Rx

11. Ambulatory Workflows
• All three must work seamlessly to ensure
success. In the ambulatory vendor
community, there are two methods to
automate these three components: dual or
single database.

12. Dual vs. Single Database
• Dual Database/Systems Solution – A
separate practice management
database/system for scheduling, billing, AR
management, etc. that “integrates” through
an interface to an electronic health record
(EHR) database/system.

13. Dual vs. Single Database
• While the dual database can work,
providers should be cautioned that their
workflows can be impacted by having
workflows in separate systems.

14. Dual vs. Single Database
• Single Database/Systems Solution – This
means all three components reside on a
single database. If using a relational
database, such as Oracle or SQL Server,
end-users will be accessing the same data
field from a different workflow.

15. Dual Solution
Example

16. Practice Mgmt Side
(Will handle HIPAA 5010)
Dual System Solution Example
Two sides of the practice
divided by an interface.
INTERFACE
EHR Side
(Will handle ICD-10)

17. Practice Mgmt Side
(Will handle HIPAA 5010)
Dual System Solution Example
Telemedicine call
received by
Operational staff
INTERFACE
EHR Side
(Will handle ICD-10)

18. Practice Mgmt Side
(Will handle HIPAA 5010)
Practice Mgmt
Database
Dual System Solution Example
Call documented in PM database. In
order for call to be seen by clinical
staff, the EHR Database must be
updated separately.
INTERFACE
EHR Side
(Will handle ICD-10)

19. Practice Mgmt Side
(Will handle HIPAA 5010)
Practice Mgmt
Database
Dual System Solution Example
INTERFACE
User logs into EHR
database to
document call with
same information EHR
used in the Practice Database
Mgmt Database.
EHR Side
(Will handle ICD-10)

20. Practice Mgmt Side
(Will handle HIPAA 5010)
Practice Mgmt
Database
Dual System Solution Example
INTERFACE
Clinical staff answers
telemedicine call and
updates EHR
Database with billing
information.
EHR
Database EHR Side
(Will handle ICD-10)

21. Practice Mgmt Side
(Will handle HIPAA 5010)
Practice Mgmt
Database
Dual System Solution Example
The user now logs into the
Practice Mgmt Database
to document the same
information so the
Financial staff can bill.
INTERFACE
EHR
Database EHR Side
(Will handle ICD-10)

22. Practice Mgmt Side
(Will handle HIPAA 5010)
Practice Mgmt
Database
Dual System Solution Example
After the Practice Mgmt
Database has been updated
with the EHR Database’s
info, the Financial staff can
now look at billing the patient.
INTERFACE
EHR
Database EHR Side
(Will handle ICD-10)

23. In order for all staff to see Practice Mgmt Side
the same information, both (Will handle HIPAA 5010)
systems must be manually Practice Mgmt
and separately updated. Database
Dual System Solution Example
OPERATIONAL FINANCIAL
Scheduling, Calls A/R, Billing, Statements,
Eligibility
INTERFACE
Notes, Vitals, Orders,
Record Release, Results, CCD, PMH, Rx
Referrals
OPERATIONAL CLINICAL
EHR
Database EHR Side
(Will handle ICD-10)

24. Single Solution
Example

25. Practice Mgmt Side
(Will handle HIPAA 5010)
Single System Solution Example
Practice shares a
single database that
updates in real time.
This is called a Shared, Single
Database
Point-of-Care Total
Solution.
EHR Side
(Will handle ICD-10)

26. Practice Mgmt Side
(Will handle HIPAA 5010)
Single System Solution Example
Point-of-Care Total Solution
Telemedicine call
received by
Operational staff
EHR Side
(Will handle ICD-10)

27. Practice Mgmt Side
(Will handle HIPAA 5010)
Single System Solution Example
Point-of-Care Total Solution
Call documented in database.
This information is now
accessible to operational,
financial and clinical staff.
Shared, Single
OPERATIONAL
Database
EHR Side
(Will handle ICD-10)

28. Practice Mgmt Side
(Will handle HIPAA 5010)
Single System Solution Example
Point-of-Care Total Solution
Clinical staff completes telemedicine
request and updates information on
database. An alert is sent to the
financial staff to bill patient. An alert is
sent to the operational staff to
correspond with patient.
Shared, Single
OPERATIONAL
Database
CLINICAL
EHR Side
(Will handle ICD-10)

29. Same data fields seen by Practice Mgmt Side
all staff, regardless of the (Will handle HIPAA 5010)
end user’s place in the
practice workflow.
Point-of-Care Total Solution
Single System Solution Example
FINANCIAL
A/R, Billing, Statements,
Eligibility
Shared, Single
OPERATIONAL
Database
Scheduling, Calls, Record
Release, Referrals
CLINICAL
Notes, Vitals, Orders,
Results, CCD, PMH, Rx
EHR Side
(Will handle ICD-10)

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