Healthcare application requirements emphasize security, which makes software vendors in that market—and even some outside of it—big fans of the i platform.

Healthcare and medical insurance is one of those things we all hope never to use, but when we do need them, they become paramount. With 2012 being a U.S. Presidential election year, and with the U.S. Supreme Court set to rule on the constitutionality of parts of the Patient Protection and Affordable Care Act (PPACA) by summer, healthcare is on nearly everyone's radar to a larger extent than usual.

Of course, PPACA, probably better known by its political moniker of "Obamacare," is far from the only federal law that healthcare providers must heed. When it comes to hospitals, clinics, physician's practices, and other healthcare-related businesses, U.S. federal legal requirements abound. However, some of those mandates make the IBM i the platform of choice for a number of healthcare application providers.

It's Bad Luck to Break Your HIPAA

The list of laws and regulations healthcare providers must heed is long, but the most important of the recent ones are the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health Act (HITECH) (which is actually part of the American Recovery and Reinvestment Act), and the PPACA. HIPAA's most significant requirement is protection of any patient's personal and medical information. HITECH's significance is that it requires healthcare providers to prove how much quality their services provide and puts even more emphasis on patient privacy. The PPACA's importance has the negative aspect of creating uncertainty for software vendors about what aspects of it the Supreme Court is likely to uphold or reject.

The healthcare apps vendors are ahead of the curve on implementing all three. When asked if any of these federal requirements will change their software in the future, all the healthcare apps vendors interviewed for this article say that ship has already sailed.

"Most changes are already done in our systems," affirms Don Martin, general manager of AIM Software Systems, which builds apps for scheduling patient appointments, tracking medical information, and handling medical transcriptions. His response in this area was typical of all. "We follow all the HIPAA rules. We'll find something every now and then, or we'll change something in response to customer requests."

"While HITECH has added challenges to all persons in the medical community, as a software vendor, the major impact is that we have had to put additional tools in place to identity any access to protected health information," responds Randy Brittingham, MED/FM consultant for CPU Medical Management Systems, whose company produces practice-management and revenue-cycle management software for healthcare providers.

"As with all healthcare regulations, we have never had any problem or delay in adhering to new regulations," notes Thomas Fahey, president of Health Care Software, Inc. His company specializes in development, installation, and support of healthcare information systems.

However, meeting those requirements is apparently easier when you run on the IBM i.

"Given the inherent security capabilities of the IBM i platform, our applications required very little in the way of modifications to adhere to the new security requirements imposed by [the PPACA]," Fahey admits.

"We utilize the proven, built-in security features of [the i] along with program-defined security features to restrict access to protected patient health information," agrees CPU's Brittingham.

The Emerging Problem of EMRs

One area where the vendors' opinions diverge is on the issue of electronic medical records (EMRs). The HITECH Act provides incentives for medical institutions to adopt EMR systems, extends privacy and security protections for EMRs first established under HIPAA, requires providers with EMR systems to provide patients with their own data in an electronic format on demand, and requires providers to report EMR security breaches. Insurance-claim documents were largely made electronic by a decade ago, but extending that practice to the patient medical records that physicians and other providers keep to record treatments lagged.

"Electronic health records never took off," AIM's Martin recalls. "Commitment was lukewarm from the providers. They resisted the expense of document-capture systems. The hospital at Harvard University's medical school did a study that found that electronic medical records was more expensive" than sticking with paper systems.

Many other hospitals followed the same path for documents that aren't claims-related. So now the big culture change forced by PPACA and HITECH is going to be for the healthcare providers themselves, not the healthcare app vendors, nearly all of whom have document-imaging tools within their products.

"Generally, healthcare reimbursement is a measurable outcome. Software success is determined by how efficiently you can generate a healthcare claim for services," Fahey explains. "With EMRs, it's much different. It's all about the user and giving them tools to document care delivery. For EMRs, the user experience is how your software gets measured against the competition generally."

Partly driving a change will be the International Statistical Classification of Diseases and Related Health Problems (ICD-10), a classification list of more than 16,000 codes for diseases, symptoms, and diagnoses. Originated and maintained by the World Health Organization, the U.S. adopted an EDI data-transmission prerequisite this past January (5010) for all electronically transmitted health records.

The Future for Medical Apps on the i

One piece of good news for fans of the IBM i is that all three medical app vendors still see it as their platform of choice going forward.

"Our clients rely on the stability and reliability of the IBM i platform, which is why it continues to be a major component of our application and our future plans," Fahey notes.

"We came up with interfaces [for our products] to MS Word and Excel and expanded use of Windows-like screens to stay competitive," Martin observes. "We did the integration because the i system is the most dependable system around. Dependability is one thing people are looking for because some of our customers have to be up 24 hours a day. About the only reason our customers consider getting off the i is a lack of talent to support their systems." Martin admits AIM does offer Intel-based versions of their products, "but customers using it see more outages."

"We are severely dedicated to the i," Brittingham declares. "Its security features are paramount for dealing with health information."

When asked what changes they see for medical applications in the future, each of the three interviewed vendors pointed to different aspects of the market.

"Payment reduction and making the delivery of healthcare more efficient and cost-effective will be the major driving force for healthcare over the next several years," Fahey predicts. "There are significant changes from a regulatory standpoint, such as ICD-10, that will have an effect on the industry as a whole. As adoption of EMRs continues to grow, the healthcare industry will also have the availability of a tremendous amount of reportable information, and the vendors that can harness that information and make it useful will be in a strong position," he adds.

"Clinical systems will be important," Martin speculates, but he wonders if a cloud model for medical apps will work well enough. "We'd need hot backup systems to support our customer base. Those are too expensive and would make us less competitive pricewise. I also worry about hacker protection and Internet reliability problems." An outage of their systems for three or four days, regardless of cause, would be a potential disaster for healthcare providers, he notes. Martin also wonders how long the i will stay with IBM. "IBM is getting smarter about how to keep the i alive, but I wouldn't be surprised if they eventually spun off the i to another company like they did with PCs. IBM seems to require 30 to 50 percent margins and if they can't maintain that [there could be a change]."

"The government is constantly thrusting changes down our throats," Brittingham points out. "All vendors must comply or leave the field. I think we'll be forced to capture more information to broaden data beyond insurance claims. For example, we may have to store such things as ethnicity data to prove what percentage of patients are using Medicaid for HITECH."

"Something's always coming down the pike. For one thing, if the Supreme Court decides against the PPACA, we might see a lot of money we spent on complying with it go out the window," Martin concludes wryly.

A View from Outside the Software Arena

With healthcare being a topic that is increasingly moving into the mainstream of discussion, it might be illuminating to also seek an opinion outside the IBM i software vendor community.

Maria DeGiglio is a principal at Maria A. DeGiglio and Associates, a health-advocacy and healthcare industry analysis organization, and a person with extensive background in the IBM i earlier in her career. She sees problems facing healthcare applications as having a different emphasis.

"There's still a lot of proprietary, legacy software in use [particularly at physicians' offices] that's not interoperable," she explains. "Those applications need re-engineering to talk with software [in use at other healthcare provider offices]. [Software vendors] need to provide a scaffolding that lets their software access other platforms. How can you get a 360-degree view of a patient if you have to rely on the patient's memory [instead of being able to access other providers' records for the same patient]?" Of course, she admits, "this brings in privacy and confidentiality issues even if the patient signs off on cooperation between physicians' offices."

"HIPAA was enacted in 1996, but it's only taken effect more recently," she notes, and the law hasn't kept pace with technology. For example, when HIPAA was written, wireless devices weren't factored in. "The right checks and balances need to be in place to protect patient information," she suggests. "Large organizations are handling it better, but small groups, such as physicians' practices, are relying on their vendors for this. Yet there is no checklist of standards in place for evaluating areas of exposure," she warns.

And paradoxically, sometimes computer technology actually gets in the way. Scenarios that "make physicians spend their time with patients looking at tablets or laptops detracts from physicians making eye contact and further developing their personal relationships with their patients."

Another issue is computer training for healthcare providers' staffs. "Healthcare has only entered the electronic arena in the past 10 years. Making the leap from paper health records to electronic ones is a huge learning curve for physicians and their support staffs," she warns. Even those providers who have somewhat computerized their operations can face a problem. For example, even a hospital that uses an enterprise resource planning application may find that staff using it generally know only what they need to know to get their particular job done and have no idea what the total application can do.

When asked if she thought the IBM i was a strong platform for healthcare apps, DeGiglio responded with an unqualified yes. "The technology behind it is perfectly suited for healthcare and EMR. The software, hardware, and middleware are separate, so multiple operating systems can run on it," which helps solve interoperability problems for software. "The security and protection are great. It's not hackerproof, but it's pretty ironclad," she adds.

Looking to the future, DeGiglio thinks the i will shine in healthcare even more than it already does. "The next big step in electronic healthcare is analytics: slicing and dicing of medical data. The i has always been a platform that makes that easier to do."

Overall, DeGiglio's advice to healthcare vendors and buyers is to focus on the need for more open-source and interoperable systems, to advocate enaction and measurement of even better security and privacy standards for patient information, and to ask for and increase the user-friendliness of healthcare applications.

Medical Applications and Services for the IBM i

Below is a summary of major medical-related applications and services available on the i. All products are compliant with all current government requirements.

Please note that the brief summaries here don't cover all the features each software product provides. You should consult the links provided for each product and contact the associated vendors for a more complete idea of what each product's capabilities include.

And as always when looking for products or services, be sure to check the MC Press Online Buyer's Guide.

AIM Software Systems

AIMMedTran

AIMPath Integrated Pathology Lab Information System (APLIS)

AIM Scheduling

AIM System for Radiology – Radiology Information System (RIS)

AIMMedTran is an integrated radiology and medical-records transcription system for hospitals and radiology/oncology physicians' practices.

APLIS is an integrated information system for pathology laboratories.

AIM Scheduling is a patient/room scheduling solution for hospitals and multiple-physician practices.

AIM System for Radiology – Radiology Information System offers tracking for radiology patients and their records for hospitals, clinics, and imaging centers.

American Health Care Software

Harmony Health Care Management System

The Harmony system is a suite of applications designed to serve medical practices, clinics, and other healthcare providers. Applications in the suite handle financials, billing, patient-care records, and patient census.

BlueWare

BestBond

BestBond is a patient-records application aimed primarily at clinics. It offers electronic health records and exchange capabilities with other healthcare institutions, clinical document-management services, business-process management facilities with workflow features for analyzing patient activity, and HIPAA-compliant security.

Boston Technologies

Human Services Software (HSS)

HSS is an information-management system for behavioral healthcare services that is integrated with IBM/Lotus Notes. It includes features supporting client records, billing and financial reporting, appointment scheduling, claims processing, and human-resources functions.

Braid Software

Healthcare Software Interoperability Interfaces

Braid Software installs and configures interoperability interfaces for any type of software application running on IBM i to ensure those applications meet critical HIPAA and HITECH compliance requirements for software interoperability.

Champion Solutions Group

Healthcare Solutions

Champion provides cloud-based solutions for a wide range of industries, including healthcare.

CPU Medical Management Systems

MED/FM

MED/MC

MED/FM is a financial- and practice-management application for medical practices and medical billing services. MED/FM helps decrease the cost of billing and improves collections, includes patient-scheduling and trend-reporting tools, provides claims-management assistance, and includes HIPAA-compliant security. A version of the product for radiological specialists is also available.

MED/MC is an application for managed-care providers with integrated healthcare-delivery systems, including HMOs. It provides a managed care information system that tracks patients, histories, contracts, insurance claims and adjudications, service-call tracking, and other elements of managing healthcare businesses.

CRT International

Emergency Room and Specialty Physicians Billing System (SPBS)

SPBS helps hospital emergency rooms, urgent-care facilities, and physicians with specialty practices handle billing tasks. It supports electronic transmissions to Medicare, Medicaid, and insurance carriers.

Healthcare Management Systems

Ambulatory EHR

Health Information Management (HIM)

HMS Clinical

HMS Patient Access

HMS Patient Care

Ambulatory EHR is an electronic medical record and practice management system designed to help physicians qualify for ARRA HITECH incentives.

HIM handles redundant tasks in capturing and reporting patient data, including digitizing paper records, maintaining security of digital records, transcribing medical records, and reporting on hospital quality measures.

HMS Clinical handles information flows for community hospitals, including information systems for emergency departments, labs, radiology groups, pharmacies, and surgery teams.

HMS Patient Access is an applications suite that helps healthcare providers manage all patient access points, such as registering patients in person or online, estimating charges prior to procedures, and integrating patient data within moments of registration.

HMS Patient Care is an applications suite that helps ensure patient safety via modules for medication administration, physician order entry, patient-care documentation, clinical information tracking, and medical-device integration with software systems.

Health Care Software

INTERACTANT

INTERACTANT is a suite of Web-friendly applications for healthcare providers. It includes facilities for handling financials, electronic medical records, care planning, clinical documentation, and pharmacy records.

Lawson Software

Healthcare Solutions

Lawson offers an extensive suite of integrated healthcare solutions, including individual applications aimed at hospitals and health systems, non-acute and long-term care facilities, health information exchanges, healthcare IT vendors, physician practices, and managed-care payors.

MEDTRON Software Intelligence Corporation

MEDTRON Software Intelligence

MEDDATA Service Bureau

MEDTRON Medical Practice Management System

MEDTRON Software Intelligence is a software application for medical practices that includes insurance billing and related EDI capabilities, patient records, charge-slip tracking, complete accounting facilities, practice analysis, marketing, and collections. An extended version adds modules for case management, occupational and industrial medicine, anesthesia, and document imaging.

MEDDATA Service Bureau is a cloud-based medical-practice billing service.

NewGeneration Software

Decision Assist – Healthcare

Decision Assist – Healthcare is a reporting solution for community hospitals and clinics. It includes a Web portal, executive dashboards, multidimensional data models, and a scalable data warehouse module to support monitoring of revenues, patient care, and clinical-care performance monitoring.

Siemens AG

MedSeries4 Scheduling

MedSeries4 Scheduling streamlines appointment processes for community and rural hospitals. It helps with patient management and procedural scheduling, and it enables either centralized scheduling at the institutional level or decentralized scheduling at the departmental level. It also includes payroll and human-resources capabilities.