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IQware! Applications for Health Care

The uncommon cure for common data-sharing problems

IQware is a Health Care Information System (HCIS) that is designed to work cooperatively with existing health care IT systems. IQware helps all these systems work together and eliminates the need for error-prone, costly manual re-entry of critical health care and patient information. IQware can handle all common activities including admissions, EMR, pharmacy operations, tracking auditing and compliance verification.

IQware lets you KEEP your existing IT systems. Working with your system, rather than being at odds with it, IQware prevents the
culture shock that often accompanies the typical “IT improvement”
in the health care industry.

IQware is your paramount HCIS solution.

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Healthcare Providers

Information Technology (IT) systems in Health Care are a patchwork quilt of legacy platforms, organically-grown software and specialized applications. Managing these incompatible IT systems is error-prone, labor-intensive and very expensive. Scarce hospital and private practice resources are increasingly allocated toward “putting out fires” merely to keep systems running at the current level of functionality. No time or dollars are available for increasing capability, maintaining regulatory compliance and—most importantly—improving patient care.    IQware directly addresses these issues.

IQware has key patented (US Patent #7,322,028, others pending) features:

• IQware is interoperable and works on a variety of platforms without expensive custom-coding
  
  
• IQware can be installed easily and efficiently, without expensive downtime and the potential of lost data and incompatibility issues (often the case with large ERP implementations)
  
  
• IQware lets you KEEP your existing IT systems. Working with your system, rather than being at odds with it, IQware prevents the culture shock that often accompanies the typical "IT improvement" in the health care industry
  • If you are a user of MUMPS, IQware can share data with MUMPS applications by directly accessing the on-disk records created and used by the MUMPS applications. Click here (link to MUMPS info below) for more information.
    
    
• IQware specializes in the "regulated industries" where audit trails & security are essential, so reporting to regulatory and governmental agencies is a breeze
  
  
• IQware specializes in the "regulated industries" where compliance verification is essential, so an organization will always be able to verify transactions quickly and efficiently, as needed
  
  
• IQware specializes in providing HIPAA-compliant IT systems that protect patient information
  
  
• IQware specializes in providing automatic electronic "checks and balances," features vital to the promotion of patient medication compliance, patient safety, and the reduction of medication errors
  
  
• IQware is rule-based and interoperable, making it a perfect candidate for application in the health care industry, where disparate and incompatible ERP systems are the norm
  
  

Here are some of the top IT priorities named by hospital and health care executives,
and IQware addresses all of them:

• Upgrading security protocols
• Reducing medical errors and promoting patient safety
• Replacing and upgrading inpatient clinical systems
• Implementing wireless systems
• Upgrading network infrastructure
• Designing process and workflow
• Improving the IT department

Here are some of the top clinical applications desired by hospital and health care executives,
and IQware addresses them all:

• Bar-coded medication management that is consistent across the medical industry
• Electronic medical records that are portable to other platforms
• Clinical information systems
• Computerized provider order entry (CPOE)
• Picture archiving and communication systems (PACS)
• Enterprise-wide clinical information sharing
• Point-of-care decision support

Here are some of the biggest barriers to investment in information technology,
and IQware addresses them all:

• Cost and complexity of IT implementation
• Significant changes in work process and cultural changes within the health care profession
• Payment policies that reward volume rather than quality
• Fragmented delivery systems
• Competition with other priorities, especially bricks and mortar projects
• Costs of training and support when new systems are delivered

The health care industry has attempted to build incentives, including financial rewards and expanded efforts to standardize record formats, nomenclature, and communication protocols to enhance interoperability, but most efforts have failed because the consequences of the actions taken were not thoroughly researched and considered. The unfortunate consequence: many health care professionals continue to view information technology as an administrative tool, used to handle rote business functions, rather than a powerful clinical assistant used to streamline workload, improve efficiency, and enhance patient care.

IQware Software Solutions Allow the Health Care Industry to View Technology as a Clinical Asset, not a Necessary Administrative Evil.

Just look at what IQware, currently instrumental in providing state-of-the-art systemic solutions for the pharmacy industry, is already doing for the health care industry:

• IQware has partnered with IQware Marketing, LLC to deliver health care providers a secure reporting system for tracking, billing and reimbursement of Medication Therapy Management (MTM) services

As it has with the pharmacy industry, IQware has plans to provide state-of-the-art systemic solutions to address the needs of the broader health care industry as well, including:

• Improvements in electronic health records (EHRs), providing more real-time access to patient records and making them more effective longitudinal records.
• Improvements in computerized provider order entry systems (CPOE), extending the CPOE to include lab orders, radiology studies, procedures, discharges, transfers and referrals.
• Expansion of clinical decision support systems (CDSS), making them more portable to more devices and improving the real-time responsiveness of data retrieval.
• Improvements in picture archiving and communications systems (PACS), making dissemination among disparate systems seamless and more responsive.
• For those interested in interfacing with MUMPS, IQware/IQware Marketing, LLC can share data with MUMPS applications by directly accessing the on-disk records created and used by the MUMPS applications. Click here (link to MUMPS info below) for more information about MUMPS.

Medication Therapy Management

Pursuant to the Medicare Modernization Act (MMA), sponsors of Medicare Part D are required to include Medication Therapy Management (MTM) systems designed to optimize therapeutic outcomes for targeted beneficiaries.

What is the Opportunity for Pharmacists and Pharmacies?

• Pharmacists can bill PDPs for professional MTM services provided to patients
• Reimbursement levels are expected to be $1 - $3 per minute for professional MTM services

The intended use of these plans is to improve medication use and reduce adverse drug events, including adverse drug interactions. The MTM encounters are fee-for-service encounters, a cost that prescription drug providers are required by law to reimburse. To be provided primarily by pharmacists, an already over-burdened professional population, the services must be adequately tracked, regulated and reported. In an effort to ease the administrative burden on pharmacists while concomitantly increasing their ability to provide—and charge for—MTM patient services, the team at IQware has developed the first comprehensive, HIPAA-compliant health information delivery system for Medication Therapy Management (MTM) Plans.

What are the Operational Requirements of MTM?

• Pharmacists are statutorily recognized, compensated and regulated for MTM.
• Medicare “Part D” drugs are targeted for verification of optimal usage.
• Prescription Drug Plan (PDP) sponsors must cooperate with licensed pharmacists & physicians through compliance assistance and compensation for services.
• Patients with chronic disease(s), certain levels of monthly drug expenditures, and those with other risk factors are targeted for MTM services.
• Eligibility cost threshold is $4,000 per patient per year.
• Flexibility in plan development and execution is encouraged by CMS (Center for Medicare and Medicaid Services).
• Innovation is encouraged by CMS.
• Identification of patients who might benefit from MTM services is encouraged by the CMS.
• Plan evolution and “best practice” development are encouraged by CMS.
• Time and resource tracking required.
• Reporting is required
• Audit trail is required due to the overlap of HIPAA and definition of electronic medical records.

IQware MTM System Benefits:

• Eases administrative and reporting burdens to provide pharmacists more time with patients and increased revenue opportunities (more MTM patients = more MTM revenue for the pharmacist)
• Each MTM transaction is tracked and "taxed," creating revenue for the pharmacist each time an MTM encounter is logged into the system
• Tracks adverse drug effect(s) and interaction(s) to specifically target and maximize positive patient outcomes, thereby reducing negative consequences of drug interactions
• Integrates seamlessly with all existing pharmacy systems
• Installs without cooperation with or intervention from current vendors
• HIPAA compliant
• Desktop-virus-immune and hacker-resistant and 100% secure
• Identifies and alerts the pharmacist to "dual eligibles," keeping the pharmacist abreast to lapsed or late payments by PDPs
• Installs simply and is easy to use
• Interacts and complies with all Prescription Drug Plan (PDP) and governmental filing requirements
• Offers complete audit trail of all transactions for governmental and PDP reporting and compliance

The Barrier without the IQware MTM System:

• Implementation is very costly and error-prone.
• Administrative burden outweighs any increase in revenue.
• Manual billing is prone to errors, including oversight and missed opportunities for re-billing rejected claims.
• Training is costly and time-consuming.
• Pharmacy is unable to easily and effectively identify patients who may benefit from MTM services, currently or in the future. This creates a losing situation for both patients and pharmacists!

The IQware MTM System solution automates MTM activities to:

• Easily document and verify all activities covered under Medicare Part D
• Easily prove HIPAA compliance
• Easily prove compliance to PDPs to ensure timely payment
• Easily provide an audit trail
• Easily integrate to existing pharmacy systems (without outside help or new tech work)
• Easily identify those patients within the current population who could benefit from MTM services.
• Easily identify those patients within the current population who could benefit from future MTM services.
• Easily manage the MTM workload. With automatic updates and patient alerts, the IQware MTM System administers the program, allowing the pharmacist to maximize time with patients and maximize revenue from MTM services.

MUMPS Overview

MUMPS (sometimes called "M") is a general purpose programming language that supports a native hierarchical data base facility. The language originated in the mid-60's at the Massachusetts General Hospital, and it became widely used in both clinical and commercial settings. ANSI, ISO (ISO/IEC 11756:1992) and DOD approved standards were developed for MUMPS, although several of these have lapsed.

MUMPS differed from other mini-computer based languages of the late 1960's by providing:

• an easily manipulated hierarchical data base that was well suited to representing medical records;
• flexible string handling support; and
• multiple concurrent tasks in limited memory on very small machines.

Syntactically, MUMPS is based on an earlier language named JOSS and has an appearance that is similar to early versions of Basic that were also based on JOSS.

MUMPS was originally written for the DEC family of mini-computers, including the very popular PDP-11 series. The operating systems supported included RT-11 (single-user), TSX-11 (multi-user), RSX11, RSX11-M, and RSTS/E. DEC-10 and DEC-20 systems also supported MUMPS applications for a number of hospitals.

Initially, the MUMPS’ structure was limited by the constraints imposed by the minicomputers and operating systems on which it was originally implemented. An early design goal for MUMPS was to provide multi-user, time-shared access despite the very limited memory and mainly single-user operating systems available at the time. Consequently, early implementations of MUMPS were mainly standalone, interpreter based, dedicated operating systems. In these implementations, each user was assigned a very small region of memory for both code and local data. Source code was loaded from external storage and stored in memory in source form. Since MUMPS programs were mainly interactive and dominantly data base access dependent, direct interpretation of source code did not introduce serious performance penalties. Typically, program partitions were less than 4,000 bytes, including all data, stacks, code and buffers thus allowing multiple time-shared partitions on even the smallest machines.

Because of early mini-computer memory and address space limitations, MUMPS applications usually consisted of many small, task-specific programs that were modular, compact, highly abbreviated, concise and focused on a limited objective. Program modules then, as now, were loaded frequently from a library. Applications typically consisted of a tree-like hierarchy of program modules that often corresponded to the structure of the underlying database in an early form of object-oriented programming style.

An excellent example of an early system structured this way can be found in the structure of the COSTAR System that employed well over a thousand tightly coupled and encapsulated separate code modules to service an ambulatory patient record data base. A more recent example is the widely used Veterans Administration Distribute Hospital Computer Program (DHCP) system, now known as Veterans Health Information Systems & Technology Architecture, which consists of several thousand MUMPS routines. Of course, DHCP now refers to the "Dynamic Host Configuration Protocol" which allows network devices to automatically "lease" a valid IP address from a server.

Initially, all MUMPS implementations were pure interpreters. As MUMPS evolved, various methods were developed to partly compile MUMPS code to intermediate representations, similar to Java byte codes or UCSD Pascal P code. However, due to indirection and the Xecute command, the interpretive nature of the language was always present. Indirection permits a MUMPS program to dynamically construct and execute MUMPS expressions and commands.

In 2000, development began on a compiler for MUMPS, written in C and C++ that translates MUMPS to C++. The compiler initially began as an interpreter implementation. It supports fast, flexible, multi-dimensional and hierarchical storage, retrieval and manipulation of data bases ranging in size up to 256 terabytes (TB).

IQware Interface to MUMPS Applications

IQware can share data with MUMPS applications by directly accessing the on-disk records created and used by the MUMPS applications. IQware can also interface with MUMPS applications by dynamically launching a MUMPS-coded “agent” to access the requested data records on an as-needed basis. A third way that IQware can connect to MUMPS applications is by dynamically copying MUMPS data records to its internal relational database. This lets modern structured applications and relational database tools be used on the data records. Note that this dynamic record transfer can be bi-directional, if desired. In this case, the MUMPS “agent” must be configured for record locking to prevent conflict issues. A sample deployment is shown below: