UMass Memorial Health Care contracts Informatica and MedCPU to lower preventable hospital readmissions

The Centers for Medicare & Medicaid Services (CMS) have initiated the Hospital Readmissions Reduction (HRR) Program that reduces reimbursements to hospitals that have an increased readmission rate. Aligning with this initiative of lowering avoidable readmissions, UMass Memorial Health Care (UMMHC) has roped-in Informatica Corporation, a data integration software provider, and MedCPU Inc., a provider of clinical decision support technologies, to deploy at its facility, a data integration technology.

As a Central and Western Massachusetts non-profit healthcare system, Worcester, MA-based UMMHC provides specialty services in cancer, cardiology, newborn intensive care, children and women’s services, orthopedics, diabetes, emergency medicine, and trauma. The American College of Surgeons has accredited UMMHC as the only designated Central Massachusetts’ Level One Trauma Center. The organization, a clinical partner of the University of Massachusetts Medical School, includes five hospitals accredited by Det Norske Veritas (DNV) or the Joint Commission, 1,700 physicians, and 12,350 staff.

In context with the requirement to reduce readmissions, the senior vice president and CIO of UMMHC, George Brenckle, states that precise monitoring of patient’s status, and recognition of flaws in clinical or administrative processes may help lower the risk for readmission. With the vast amount of patient data, he opinions that only advanced technology can consolidate and present all the data into a brief outlook of a patient’s condition.

Under the terms of the current deal, UMMHC has selected the two technology vendors to support the readmission reduction initiative through their technologies, across the inpatient and outpatient departments, outpatient clinics, affiliated physicians, and patients. Providing clinical and administrative support on a single platform, the new technology, will aid providers, care managers and patients to lower preventable readmissions and enhance care delivery. The new initiative will gather complete clinical and administrative patient information, including admission, discharge, administrative and scheduling data, for all inpatient and outpatient activities. This will help provide a clinical overview of the patient by capturing information from the clinician’s dictations, free-text notes and structured documentation fed into outpatient and inpatient EMRs, and from secondary information sources.

In an attempt to avoid readmissions, the initiative will process and evaluate clinical and administrative data to detect inadequacies in care delivery during outpatient consultations, stay at the hospital, and before discharge. These deficiencies will be sent as prompts and messages leveraging the tools: MedCPU’s Advisor Button, SMS/email, and Alert Manager to outpatient PCP/Providers, as well as UMMHC inpatient EMR, patients, and care managers, respectively, to aid in addressing data loss associated with narrative documentation by clinicians. Informatica and MedCPU will provide UMMHC a solution that can not only identify high-risk patients, but also concentrate on intervention and proactive medicine.

Apart from the present contract, the UMMHC has previously roped in MedCPU for its Meaningful Use Advisor™ in 2011. The organization has also contracted with Informatica for its integration platform, Informatica Platform, Informatica PowerCenter Advanced Edition to manage change during data integration, Informatica Data Quality, a unified platform for maintaining data quality, and Informatica EMR Data Migration Foundation for migrating patient data from disparate sources.

Formed by physicians, MedCPU Inc., apart from its flagship decision support platform, MedCPU Advisor™, also offers the following technologies: medical text processor, decision support system engine, clinical database, and best practice and protocol plug-Ins.

Established in 1993, Redwood City, CA-based Informatica Corporation employs more than 2,690 staff across North and South America, Asia, Europe, Middle East, Africa, and Australia, and caters to the needs of financial services, manufacturing, energy and utilities, retail, transportation, public sector, telecommunication, and healthcare industries. For the healthcare industry, the company offers providers and payors solutions for managing healthcare data, reusing healthcare interfaces, complying with HIPAA 5010, and data migration. The company been named into the leaders quadrant by Gartner, Inc. in the 2012 Magic Quadrant for Data Integration Tools.

Informatica’s chief healthcare strategist, Richards Cramer, finds it crucial for UMMHC to have access to reliable and accurate health data for providing optimal care, with the introduction of HRR legislation.

In an attempt to negate avoidable readmissions the HRR Program was introduced as a provision of the Patient Protection and Affordable Care Act (PPACA), to penalize hospitals by up to 1% from federal fiscal year 2013, on preventable readmission. According to Infectious Diseases Society of America (IDSA), close to one out of five Medicare patients is re-hospitalized within 30 days of discharge, leading to more than $26 billion in healthcare costs, annually. According to a Medicare Payment Advisory Commission (MedPAC) report, around 75% of 30-day Medicare readmissions are preventable, enabling saving in healthcare costs of up to $12 billion.

The HRR law holds good for three conditions: heart failure, pneumonia, and acute myocardial infarction, from October 1, 2012. Readmission rates will be calculated based on three years of data (discharges from federal fiscal year July 1, 2008 to June 30, 2011). Hospitals with a risk-adjusted readmission rate to the unadjusted raw US average rate ratio of more than 1.0 will incur payment penalty.

As the pressure mounts on providers to reduce readmissions and prevent payment reductions, IT plays a major role in achieving these goals. In view of this, HIMSS, suggests providers the following methods to address this challenge:
• Application of IT in case management, patient communication, and post-acute follow up
• Participation in a health information exchange (HIE)
• Utilization of business intelligence, dashboards, social media/networking, cloud computing, mobile technologies, and robotics

With tightened budgets, providers need to develop a new technology, novel updates on already existing technology, to drive innovation that aids in mitigating avoidable readmissions and improving their operating margins.

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