Between tight healthcare finances and the swirl of government initiatives, the healthcare IT consulting business has never been better. It seems as if there are more challenges to overcome and higher stakes than ever in today's healthcare climate, causing both providers and payers to line up for help from professional problem solvers.
Tori Sullivan, manager for Capgemini Government Solutions in Washington, acknowledges that business is strong, especially in her area of expertise – the transition from ICD-9 to ICD-10 coding, due to take effect in October of 2013. The scope of this change is so pervasive, it's intimidating to many providers, she said.
"This isn't just a coding update, it is truly an organizational change," said Sullivan, who published the book "ICD-10 for Hospitals" in 2009 and leads the HIMSS ICD-10 Task Force. "There is a lot of misunderstanding about the complexity of it and how it interacts with other regulations."
The coding transition issue is of such importance that it has created a cottage industry, Sullivan said.
"It has opened up opportunities for many vendors – not just consultants, but for technology related to assessments, computer-assisted coding and exam certification," she said. "From a consumer perspective, this is a confusing time because there are so many vendors. But let the buyer beware when it comes to the credibility of some of these companies."
Denver-based Health Language has been working on vocabulary and coding standards for more than 10 years and has established a reputation for helping to standardize the healthcare industry's diverse terminology. President and CEO George Schwend said the ICD-9 to ICD-10 transition is one of the biggest projects his firm has worked on to date.
"It has put us in touch with the integrators bidding for that work," he said. "They do the heavy lifting, but they definitely need help."
Schwend calls ICD-10 "an intense, ticking time bomb and everyone needs to get ready for it. If they aren't, when the clock strikes 12 on Oct. 1, 2013, they won't get paid."
The biggest challenge is the shift from 15,000 codes in ICD-9 to 110,000 codes in ICD-10, he said. Amazingly, there are coders who "know the 15,000 practically by heart because they use the same 5,000 every day," Schwend said, adding "it will be very different when it expands to 110,000."
Integration still vital
Managing the massive amount of data being produced by healthcare organizations continues to be a hot-button issue for consultants as well. Because nearly everything a hospital does relates to its financial health, gaining control of the mounting data proliferation is critical, said Matt Seefeld, CEO of Atlanta-based Interpoint Partners.
"In this rapidly growing digital space of healthcare, the IT staff has to look at the relevancy of data, understand all sides of the business, identify what is important with digital information and work with third parties to drive performance," he said. "Healthcare organizations are not required to pull everything, and they shouldn't. There are many pressures from government, consumers and internally and all of this should be considered in decision-making."
Interpoint focuses on data integration and analytics, offering a solution that sits on top of what Seefeld calls the "digital chaos of the various technologies that capture information." The software creates a user-friendly interface to integrate disparate systems in various hospital domains, including clinical, financial and operations.
"There is all this digital information and no one knows what to do with it," he said. "The first problem is that there are 20 different vendors in hospitals with 20 different platforms. There needs to be interoperability, but it will be a long time before someone creates a completely seamless connection."
From a consulting standpoint, any firm that goes in to educate hospital staff and direct IT strategy will have to first deal with the disparity that exists between systems, Seefeld said.
"Even if the perfect enterprise solution came out tomorrow, it would be three years before implementation – so that's the first thing," he said. "The way we approach it is to start with relevancy and what data points drive the most value for the operation. Then we walk backwards to where that data resides. While some companies will take every piece of data and put it in their warehouse, we identify the relevant data points and pull from those systems."
Interpoint is a "non-traditional" consulting firm, Seefeld said, because the company is also a vendor.
"People hire us for our subject matter expertise – we say 'here are the things that will make an impact for your organization,'" he said. "We want to deliver more than reports. We leave an application behind for clients to achieve sustainability on their own. Our motto is 'true sustainability.'"
