healthcaretechoutlook

Methodical Approach for Convergence of Revenue Cycle Management into Healthcare Arena

By Cletis Earle, CIO, Kaleida Health

Cletis Earle, CIO, Kaleida Health

The healthcare arena has witnessed a rapid transformation over the last decade, bringing in an amalgamation of technologies such as the Cloud, Analytics, IoT, and the Revenue Cycle Management (RCM). The healthcare providers and organizations have attained a certain level of maturity that is on par with other significant industry verticals. This can be substantiated by the fact that the healthcare sector hold almost the same amount of resources, work on similar platforms, and face identical challenges as its counterparts. I believe the integration of RCM solutions has re-defined the healthcare landscape for better. The integration was much needed, as we move towards an era where we can have ‘Intelligent Clinics’. Healthcare firms today are more focused on merging their RCM systems together, as they move away from the smaller and disparate legacy EMR systems.But, the onboarding process is not as easy as you would imagine,as the challenges continue to cripple the foundations of the industry. This brings us to a standstill where we have to really sit and contemplate our moves for the future.

Security: A Primary Concern

Security remains to be one of the prime elements that deter the healthcare arena. The ever-changing security landscape is one of the things that keep us up at night. From a strictly RCM perspective, most of the existing systems within healthcare institutions are integrated with Electronic Medical Record(EMR) systems, which sit outside their Revenue Cycle System. Moreover, the lack of simplification for users makes it a tedious task to maintain a balance between the revenue or financial data, and the clinical data, turning the entire process into a ‘juggling act’, making it more challenging to realize any benefit. It’s a difficult task to completely predict security breaches, but when it happens, it leaves the organization in peril, costing us millions of dollars. We haven’t faced much of security hurdles when we talk about RCM systems, but you are never completely aware. Given the fact, today sumptuous amount of money is spent on bringing in RCM offerings; any security exposure might impact the organization significantly. It brings into light few crucial questions before us. “What are we doing,as CIOs, for these systems?” or “What are the steps we should take to stay ahead of the game?” This awareness allows us to proactively plan this convergence, reflecting upon the fact that it is impacting revenue in the long run.

“Once we step into the future and as technologies mature, we will perceive better results with different types of IPSbeing incorporated, to provide us with a more secure environment”

We are striving to mitigate these threats as much as possible by aligning ourselves and catching up to the practices employed within very similar markets. In doing so, we are limiting the exposure to our Protected Health Information(PHI) and Payment Card Industry (PCI) information, besides safeguarding Intellectual Property that an organization withholds. The lack of a full-proof plan continue to bother CIOs in the space, however, with time significant number of tools have spurred up to make your job easy. Once we step into the future and as technologies mature, we will perceive better results with different types of IPSbeing incorporated, to provide us with a more secure environment. Virtual Networking will play its role to assure us that the vulnerabilities stay siloed. To truly integrate RCM into the existing healthcare systems, and thus reap benefits, value addition shouldn’t be the only focus, but cost and value should walk hand in hand.

Today, we witness RCM systems being converged with the cloud, as it offers utmost level of convenience. The surging amount of actionable content in the healthcare domain has made it critical for companies to move to the Cloud. But, as organizations such as ours tend to merge financial and clinical data together for better outcome, we will have to ensure that the network topology is secure, so that we can move all that data safely to the Cloud. What you are witnessing now is dribs and drabs of this convergence, from standard server or data center environment to completely and comprehensively adopting the Cloud infrastructure. We are cautiously moving onto the Cloud, but the day is not far when the technology will instill paramount confidence in us in terms of security and we will have all our systems rooted to the Cloud.

Demystifying the Role of CIOs:

I feel the role of Healthcare CIOs is not only integral to the convergence process but has also evolved significantly over the years. It has moved from back-office tasks to sitting at the Executive level, and being critical part of the decision making process with the Board members. Today, CIOs are not limited to their know-how about EMRs, assembling computers, or managing servers, but they have transcended fields and their job roles, reflecting upon the need of a transition from service to value-based care. In the process of attaining more useful insights and surpassing the usual, I see us interacting with community members and politicians. This change has indeed ushered in a level of maturity into the CIO world. Our focus also lies on connecting various organizations around our regions. This industry expertise will only make it easier for us to effectively adopt RCM offerings and streamline our clinical and financial data, by blending it cautiously with key technology trends in the market.