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Medical boards keep wary eye on doctors' social media posts - amednews.com

Medical boards keep wary eye on doctors' social media posts - amednews.com | EHR and Health IT Consulting | Scoop.it
A survey of board executives finds that inappropriate communication with patients is among online behavior by physicians that could lead to an investigation.

 

When doctors go to social media websites, they may want to think twice about posting patients’ photos without permission.

Using the images could be considered unprofessional conduct by a state medical board, according to a new study.

 

Other online physician behavior viewed as troublesome by boards: citing misleading information about clinical outcomes; misrepresenting credentials; and inappropriately contacting patients.

The survey of 48 state medical board executives, published in the Jan. 15 Annals of Internal Medicine, found that these social media activities likely would prompt a board investigation of a doctor. The study concluded that physicians should never engage in such behaviors.

“When you post something publicly online, it’s something that could be online in perpetuity,” said study co-author Humayun Chaudhry, DO, president and CEO of the Federation of State Medical Boards, which represents 70 boards that oversee MDs and DOs.

What triggers an investigation?

One of the survey’s 10 hypothetical vignettes of social media posed to medical board executives shows a photo of three doctors, drinks in hand, at a hospital holiday party. Forty percent of executives said a complaint to the board about the posting would trigger an investigation — a “low consensus” among survey respondents.

But 73% took issue with a vignette of a doctor who posted photos of himself intoxicated.

71% of state medical boards have investigated doctors for violating professionalism online.

Getting a “moderate consensus” among respondents of posts that would prompt an investigation were a scenario of a physician’s blog that used potential patient identifiers and a vignette about discriminatory language on a doctor’s Facebook page. The least troublesome of the 10 vignettes was a doctor’s blog describing a clinical encounter with no patient identifiers (only 16% of executives said it would lead to an investigation).

“People can really do a lot to stay out of trouble by applying common sense and avoiding the trap that you can do something online you wouldn’t do in real life,” said study lead author Ryan Greysen, MD, MHS. He is an assistant professor in the Division of Hospital Medicine at the University of California, San Francisco, School of Medicine.

Previous research has shown that doctors and medical students can get in trouble online. An article co-written by Dr. Greysen in the March 21, 2012, issue of The Journal of the American Medical Association found that 71% of state medical boards had investigated doctors for violating professionalism online. A study, also co-written by Dr. Greysen, in the Sept. 23, 2009, issue of JAMA said 60% of medical schools had incidents of students posting unprofessional content online.

Guidance for doctors

In 2012, the federation issued guidelines to help doctors maintain professionalism when using social media. That guidance discourages physicians from interacting with patients on social networking sites such as Facebook and says doctors should adhere to the same principles of professionalism online and offline.

Delegates to the American Medical Association Interim Meeting in November 2010 adopted policy on social media use that advises medical students and physicians to be professional online. They should keep appropriate boundaries when communicating with patients online and respect patient confidentiality, the policy says.

The Annals study notes that improper behavior online can do more than spark a board investigation; it can lead to loss of employment or lawsuits by patients over privacy violations. The study said greater awareness of potential pitfalls is needed among doctors to avoid unprofessional behavior online.

To avoid problems, Dr. Greysen said, physicians should apply the same ethical and professional conduct online that they do in their daily actions offline.

“This may be a wake-up call to some doctors, not only to the value of Internet communication, but also to the dangers,” Dr. Chaudhry said.

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Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Work IT! Optimize Health Technology with EHR Adoption – Breakaway Thinking | EMR and HIPAA

Work IT! Optimize Health Technology with EHR Adoption – Breakaway Thinking | EMR and HIPAA | EHR and Health IT Consulting | Scoop.it

Investing in an electronic health record (EHR) is largely based on the decision to improve patient safety, align with clinical guidelines, enhance revenue cycle times, and capture government-based incentives. But without a proper EHR adoption plan in place, healthcare providers risk never optimizing their investment and achieving their intended goals.

Once an EHR is implemented, healthcare organizations must continue striving toward their goals to optimize their systems. Improving workflows, establishing best practices and increasing overall proficiency of end-users in this application are all components of optimization. Healthcare organizations that are able to maintain this level of focus will see improved clinical and financial outcomes.

This process isn’t easy and requires a commitment to the initial performance metrics that drove the healthcare organization to purchase the new system. Today, nearly half of all healthcare organizations use an EHR, but many struggle to ensure it provides clinical value across the organization. They carefully select and implement systems but fail to make the tool work as originally envisioned. Just because they bought a new EHR doesn’t mean it is serving their patients, providers, or bottom line.

A parallel comparison can be made with buying a high-end, a mobile exercise device to track aerobic and anaerobic steps. Individuals seeking a healthier lifestyle invest in these devices, hoping it will help them achieve their personal health goals. After making the initial investment and adapting daily habits to wear the device, one can begin to adopt the technology to achieve improved health goals. But realizing these goals takes work and commitment. If performance is not monitored, results can plateau and, in some cases, regress. This could result in a growing waist line for the person trying to lose weight, an ironic and unfortunate twist. For healthcare organizations, their growing waistline is unhealthy organizational performance, visible through increases in adverse drug events, recurrent admissions, revenue cycle times and government penalties, all symptoms of goal misalignment. The more healthcare organizations look away from their initial performance goals and utilize EHRs for data storage only, the more noticeable the symptoms become. Both individuals and healthcare organizations can benefit from the process of system optimization to make the tool work for the betterment of the individual or organization.

Extensive research has been conducted by The Breakaway Group (TBG), A Xerox Company, to identify elements that lead to optimization. TBG reports the key adoption elements exhibited by healthcare organizations that optimize their EHRs:

Engaged and Clinically Focused Leadership
Healthcare organizations must demonstrate engaged and clinically focused leadership. Clinical leaders must align their EHR by refining workflows, templates, utilization, and reporting to meet their organizations’ clinical and financial goals. The Chief Medical Information Officer (CMIO) is well suited for this venture.

Targeted Education and Communication
Healthcare organizations must provide targeted education and communication.  When system upgrades are released, organizations must effectively and efficiently educate end users to alleviate reductions in proficiency and productivity.

Comprehensive Metrics
Healthcare organizations must be able to use EHR data.  Organizations must move past the superficial use of an EHR and begin to analyze what is entered. The EHR is of little value, if the data is neither clinically valuable nor used.

Sustained Planning and Focus
Healthcare organizations must sustain planning and focus. Change occurs frequently in healthcare, so system optimization requires preparation, adjustment and real-time communication.

With these adoption elements, healthcare organizations can make their technology work as originally intended—to improve patient and financial outcomes. To overcome the EHR implementation plateau, they must focus on their original performance goals to truly optimize health information technology systems. This process isn’t easy. It requires endurance, but the payoff is worth it. It’s time to “Breakaway” from the status quo and work IT– by optimizing use of HIT systems!



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AHA opposes proposed home health audit, payment procedures | EHRintelligence.com

The American Hospital Association (AHA) strongly opposes one provision in a proposed rule that would establish new audit procedures as part of the update to the payment system for home health providers, according to a letter submitted to the Centers for Medicare & Medicaid Services (CMS) on Monday.
Although the association supports many of the provisions comprising the Home Health Prospective Payment System (HH PPS) for 2015, it is contesting the proposed establishment of new auditing procedures concerning medical necessity. One of these procedures includes basing a provider’s audit on a medical record belonging to another provider.
“While we understand the intent of the audit provisions in this proposed rule,” writes AHA Executive Vice President Rick Pollack, “CMS’s mix-and-match audit approach is inappropriate and would place HH providers at risk of a denial based on the documentation of individuals outside of their oversight and control. Therefore, we strongly urge CMS to withdraw the following three audit-related proposals to avoid violating providers’ accountability boundaries.”
The letter provides further explanation of what the proposed audit procedures could mean to payments to a home health agency: “Under this proposal, if the certifying physician’s record lacks sufficient documentation of eligibility for Medicare HH services, payment would not be rendered to the HH agency.”
Additionally, the association is urging CMS to withdraw a related proposal to “base payment for physician claims for certifications (and re-certification) of HH eligibility on the status of a separate provider’s claim — the HH claim.”
A proposed new physician condition of payment has also drawn the ire of the AHA. Based on the association interpretation of the proposed, a physician claim tied to a denied home health claim would suffer the same fate and CMS remains unclear as to how the latter’s denial is triggered.
“The AHA urges CMS to withdraw this proposed condition of payment, due to both the noted policy and process concerns,” Pollack maintains. “If the agency elects to proceed with a regulatory proposal, it should do so through the physician fee schedule to ensure that all stakeholders, especially physicians, are aware of this proposed change and have the opportunity to submit public comments.”
The solution to the problems, the AHA letter claims, is education for providers and auditors irrespective of the proposed provisions going into effect
“Given CMS’s intent to use this section of the proposed rule to encourage timelier and better documented assessments of patients transitioning to HH services,” Pollack continues, “education is imperative for both providers and auditors — even if these proposals are withdrawn. Specifically, education is needed on Medicare coverage and documentation requirements for face-to-face encounters and HH certifications.”
The comment period for the proposed rule ends September 2. Nearly 70 comments have been received at the time of publishing.



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Interoperability, EHR data quality of top concern to industry | EHRintelligence.com

Senators Ron Wyden (D-OR) and Chuck Grassley (R-IA) may not have been expecting such an avalanche of input from the health IT industry when they requested comments on the struggle to turn disparate EHR systems into an interoperable network of high quality health data, but the responses just keep pouring in.  More than a dozen provider groups and leadership organizations have written to the lawmakers to express their support of the urgent need for interoperability, health information exchange, centralized registries to encourage clinical analytics, and industry-wide standards to underpin the data-driven healthcare ecosystem.
Here are highlights from some of the responses to the Senate Finance Committee provided by industry experts.
Why healthcare data must be accessible and interoperable
Healthcare reform efforts that include the shift to accountable care and the introduction of population health management techniques rely on clean and complete data sources that support the delivery of coordinated, cost-effective care, says the Bipartisan Policy Center. “Streamlined, meaningful quality metrics are critical to organized systems of care, and can facilitate public reporting of information that consumers can use to make decisions about their care and that providers can use to understand how their performance relates to their peers.”
The American Hospital Association adds, “Healthcare-related data is a growing but largely untapped resource for accelerating improvement in health care quality and value.  The ability to make that data available and useful in a meaningful way will impact health care delivery and consumers for years to come.”
“Patients and families need easy access to information that helps them evaluate the options open to them for their specific medical conditions, the relative risk and benefit of available options, and the quality and cost of such options (often hyper-variable and regionally-specific),” says the Gary and Mary West Health Institute. “Given that most personal bankruptcies in the country are related to healthcare debts, it is essential that whenever possible, the total cost of care to be borne by the patient be available prior to commitment to a specific treatment plan.”
Addressing data quality and fragmentation
Despite the growing need for robust data sources, healthcare information remains fragmented in disparate systems that cannot interact in a seamless way.  The American Medical Group Association (AMGA) calls this state of affairs “completely inadequate,” and urges more investment in clinical analytics that can harmonize data sources and generate meaningful insights for providers and patients.
The Pacific Business Group on Health (PBGH) encourages the development of multi- and all-payer claims databases that can inform employers’ decisions about provider networks and empower consumers with information about the cost of treatments and services among various hospitals and doctors. While these databases are statewide initiatives, federal support for harmonization of data collection standards among states would encourage their proliferation by minimizing the reporting burden for multi-state payers.”
Patient privacy must still be paramount
While making data accessible to more stakeholders is important, the patient must remain at the center of all decision making.  Ensuring patient privacy is vital if healthcare organizations want to maintain trust and make healthcare information truly useful to the consumer.
The National Committee for Quality Assurance (NCQA) notes that “privacy rules are not intended to impede good patient care. Current privacy rules under HIPAA explicitly authorize sharing of data for most medical treatment, payment and operations purposes, but are often misinterpreted as precluding this very type of essential data sharing.”
“Secure HIE that protects patients’ privacy rights and honors their wishes and directives is at the core of implementing broad data sharing among providers, payers, patients, and other stakeholders,” adds the HIMSS Electronic Health Record Association (EHRA). “It is widely recognized that the inconsistencies in various state and federal privacy laws as they pertain to sensitive health information, such as that protected under 42 CFR Part 2 (Confidentiality of Alcohol and Drug Abuse Patient Records), continue to be obstacles to widespread HIE. . . Harmonization of state privacy laws is essential, therefore, in order to deliver a mechanism that provides a nationwide, privacy-focused legal framework for access and disclosure of sensitive PHI based on patient-directed consent.”
“While many consumers are concerned about misuse of personal health information, most do want their data shared as long as they know with whom and why, and to meet care needs,” NCQA concludes. “They also understand that problems result when information is not shared as needed for care coordination purposes. Further study on the logistics, limitations, and implications for recording and adhering to patient-stated preferences for data sharing is warranted.”



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Hospital M&A Cost Boosted Significantly By Health IT Integration

Hospital M&A Cost Boosted Significantly By Health IT Integration | EHR and Health IT Consulting | Scoop.it

Most of the time, hospital M&A is sold as an exercise in saving money by reducing overhead and leveraging shared strengths. But new data from PricewaterhouseCoopers suggests that IT integration costs can undercut that goal substantially. (It also makes one wonder how ACOs can afford to merge their health IT infrastructure well enough to share risk, but that’s a story for another day.)

In any event, the cost of integrating the IT systems of hospitals that merge can add up to 2% to the annual operating costs of the facilities during the integration period, according to PricewaterhouseCoopers. That figure, which comes to $70,000 to $100,000 per bed over three to five years, is enough to reduce or even completely negate benefits of doing some deals. And it clearly forces merging hospitals to think through their respective IT strategies far more thoroughly than they might anticipated.

As if that stat isn’t bad enough, other experts feel that PwC is understating the case. According to Dwayne Gunter, president of Parallon Technology Solutions — who spoke to Hospitals & Health Networks magazine — IT integration costs can be much higher than those predicted by PwC’s estimate. “I think 2% being very generous,” Gunter told the magazine, “For example, if the purchased hospital’s IT infrastructure is in bad shape, the expense of replacing it will raise costs significantly.”

Of course, hospitals have always struggled to integrate systems when they merge, but as PwC research notes, there’s a lot more integrate these days, including not only core clinical and business operating systems but also EMRs, population health management tools and data analytics. (Given be extremely shaky state of cybersecurity in hospitals these days, merging partners had best feel out each others’ security systems very thoroughly as well, which obviously adds additional expenses.) And what if the merging hospitals use different enterprise EMR systems? Do you rip and replace, integrate and pray, or do some mix of the above?

On top of all that, working hospital systems have to make sure they have enough IT staffers available, or can contract with enough, to do a good job of the integration process. Given that in many hospitals, IT leaders barely have enough staff members to get the minimum done, the merger partners are likely costly consultants if they want to finish the process for the next millennium.

My best guess is that many mergers have failed to take this massive expense into account. The aftermath has got to be pretty ugly.


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Access Market Intelligence's curator insight, August 18, 7:18 PM

Of course this peculiar lack of interoperability has traditionally been considered a feature, rather than a bug, by most insular, indifferent hospital systems - a protective barrier, rather than an appalling hindrance to systematic delivery of health care. Let's see if the 'alignment incentive' of a sharp bite in the wallets of hospital leaderships results in anything like systemic change.....

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33% of patients don’t know if they have patient portal access | EHRintelligence.com

33% of patients don’t know if they have patient portal access | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
While it may be worrying for Stage 2 meaningful use hopefuls that just one in three patients confirmed they have access to a patient portal, an even more alarming statistic is that thirty-three percent of patients simply don’t know anything about the possibility of online engagement at all.  When asked by Software Advice about their online interactions with providers, those patients who have attempted to use portal systems generally expressed frustration, confusion, and annoyance with both the technology and the people behind it.
Patient portals have often been touted as a quick and easy way for patients to communicate with their providers between appointments while conducting routine administrative tasks that would otherwise keep staff members on the phone for most of the day.  But far from providing convenience and reassurance to patients, portals seem to be falling short of consumer expectations – and providers may be partly responsible.
Thirty-four percent of patients said their top frustration with portals was unresponsive staff who didn’t communicate effectively, leaving patients to abandon the computer and pick up the phone anyway.  Twenty-two percent also cited automated emails as a chief complaint, calling them impersonal and annoying.  Patients were also dissatisfied with the interfaces that patient portals present.  A third stated that it was difficult and confusing to find the information they wanted, while 11% found that their records were stuffed with medical jargon when they did manage to locate their data.
The widespread frustration isn’t due to the fact that patients resent being steered towards online communications.  They are generally eager to embrace the amenities the technology purports to provide.  Nearly a quarter of patients stated that online appointment making is their most-requested portal feature, while 22% wanted to view lab results and 21% wanted the ability to view and pay their bills online.  Nineteen percent would like to refill prescriptions over the internet, while just 10% cited email access with their providers as a must-have.
Elderly patients were most likely to seek online appointment making and prescription management, perhaps due to the fact that seniors are more likely to juggle multiple medications and providers while experiencing limited mobility. Younger patients were more likely to request access to lab and test data, but cared surprisingly little about the ability to schedule appointments through the portal.
The survey suggests that providers should spend more time explaining the benefits of portals to their patients, and pay special attention to educating patients about the availability of online access to their data.  When choosing a portal, providers may wish to focus on simple interfaces that can provide consumers, especially the elderly, with a user-friendly experience.  As healthcare organizations adapt to the increasing levels of patient engagement required by the EHR Incentive Programs, they may also wish to educate staff members about effective communication strategies and timely, helpful responses to patient inquiries that arrive through the portal systems.



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Mobile devices in the hospital: How much is too much? | mHealthNews

Mobile devices in the hospital: How much is too much? | mHealthNews | EHR and Health IT Consulting | Scoop.it

Seven years ago, Parkview Medical Center launched a bedside medication verification program with single-use wireless devices. The program proved popular with clinicians, who could quickly and easily make sure their patients were getting the right medication at the right time.

With the foundation in place for an mHealth platform, the 350-bed acute care hospital is now adding on critical tools. Parkview officials recently added HIPAA-compliant messaging to the devices, enabling care team members to receive lab orders, reference patient information and communicate with other clinicians at a moment's notice.

Steve Shirley, the Pueblo, Colo.-based hospital's CIO, said the evolution of the mobile device from a one-use platform to a multi-functional tool was a careful process. Officials didn't want to overload the platform with too many functions, making the devices more cumbersome than useful, but they did want to give doctors and nurses what they need to improve workflows.

[Related: Health systems that are designing their own apps.]

"For us, patient safety was the absolute reason that we got into the (mHealth) environment," he said. "It's just so critical. One mistake can be fatal. We had to make sure that what we were giving (clinicians) improved that process."

And an important new tool in that toolbox is instant communications.

Parkview's partner in this process is PatientSafe Solutions. The San Diego-based company supplies the hospital with PatientTouch devices, which operate on Apple iOS. What began as a medication administration project now also handles specimen collection, blood product administration, care team intervention and communication, as well as integration with the lab and pharmacy departments. The latter functions are handled by PatientSafe's new Emma system, which consolidates alerts, notifications and text, image and audio communications through voice-over-IP.

"Since time immemorial, nurses and doctors have been running around with a folded-up sheet of paper in one hand, trying to find other members of the care team … and when they get a chance they have to sit down at a nurse's station somewhere and enter that information into the EMR. That's a critical gap in healthcare," said Steve Davidson, PatientSafe's chief medical information officer. "To be able to bring all that data into a single point of capture of information … and to add a communication tool so that the members of the care team can share this information – that's what (nurses and doctors) want."

Both Shirley and Davidson pointed out that mobile devices in the hospital won't solve any problems if they complicate the workflow rather than improve it. A doctor or nurse who has to stop what he or she is doing and play around with a device is going to eventually ditch the device and go back to old habits. In Parkview's case, Shirley said, officials were able to start with one-use devices; once they were comfortable with that use, more functions were added.

Communication tools were the next phase in the process, Davidson said.

"Human-to-human communication has always been siloed on one channel, while human-to-IT communication has been siloed on another channel, forcing the clinician to pull it all together and integrate it in their head," he said. "This pulls it all together onto one (platform) that enhances the cognitive workload."

Shirley sees the communication platform as the logical next step in a mobile device. "The ability to understand who the care team is really takes us into a new workflow," he said. "It eliminates that randomness."

But they also have to be careful. "We had visions of loading all kinds of apps" on the device, he said. "We realized than that we were starting to put a lot of stuff onto one device, and had to be careful."

"The number of internal devices jumping onto wireless is just massive," Shirley added. "We have to make sure we're not doing too much."

To that end, Shirley said he talked to hundreds of clinicians about the PatientSafe platform before the hospital integrated the Emma system, and found that many were worried. They didn't want electronic medication verification taken away from them or compromised by new tools, he said.

That's why it's important to phase in new uses on a device, he said.

"Once they could see what they can do with (the PatientTouch devices) and see that it doesn't interrupt their workflow, they were ready," he said.



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North America may see 75 million telehealth visits in 2014 | EHRintelligence.com

Patients and providers in North America may conduct up to 75 million telehealth visits in 2014, a Deloitte report predicts, representing an increase of 400% over 2012 levels.  With 100 million electronic visits (eVisits) taking place worldwide by the end of the year, the global healthcare system may be saving more than $5 billion as smartphones and mHealth change the way patients seek care.
Telehealth is reaching a tipping point as providers implement more sophisticated health IT infrastructures that can automate and organize many aspects of remote care, the report explains.  Reliable broadband internet access and advances in practice management tools, as well as the rise of third-party vendors offering add-on telehealth services, allow providers to integrate remote consults into their routine workflows, while the prevalence of smartphones, tablets, and other devices among patients has allowed engagement on an unprecedented scale.
“The business environment in 2014 is primed for significant growth in the volume and value of eVisits,” the report says.  “Trends such as the increasing global physician shortage and the increasing availability of health insurance for the formally uninsured are also likely to drive increased interest in eVisit technology.  eVisits enable less travel time and cost and increased convenience and faster treatment for patients, so demand should be strong.”
Electronic visits can include much more than video calls or pictures of a rash attached to an email.  Deloitte predicts that most telehealth interactions are likely to be text-based: patients may fill out forms or questionnaires that identify routine conditions such as strep throat or sinus infections, which will prompt a clinician to provide a prescription without ever meeting face-to-face.  With 110 million office visits a year related to low-level conditions like sore throats, earaches, and skin rashes, these quick and efficient remote interactions could ease the burden of overworked primary care providers with little time to spare.
As telehealth becomes more widespread, lawmakers and healthcare stakeholders are working to untangle the web of prohibitive regulations that restrict providers from fully embracing remote care.  Changing reimbursement structures are making it easier for providers to bill for telehealth activities, but many providers are still wary of being on call for remote care.
Providers will need to be educated about the value of remote consults if telehealth is to succeed, the report says.  “Media coverage tends to focus on the benefits for patients and payers.  However, for eVisits to take root, physicians will need to invest in improving their technology infrastructure and staff up for a potential flood of new online interactions.  As long as liability for virtual diagnoses is handled properly, physicians will likely enjoy many other features of eVisits, including the ability to share clinical data and information virtually with colleagues, the ability to help more patients in less time and across greater distances, and the potential for more flexible work arrangements.”



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How to overcome obstacles in the way of patient engagement | EHRintelligence.com

The patient engagement requirements in Stage 2 Meaningful Use place responsibility on eligible providers as well as patients for a successful attestation. This has many eligible hospitals and professionals uncomfortable because for the first time a component of meaningful use is largely out of their control and dependent the actions of individuals with no stake in the financial incentives going to facilities and practitioners.
What’s more, the digital focus of the EHR Incentive Programs — that is, the electronic part of EHR — requires that patients be computer literate and comfortable with accessing their health information online rather than in person or over the phone.
Earlier this week, a featured story provided details about Odessa Memorial Health Center in upstate Washington and the comparative challenges presented by Stage 1 and Stage 2 Meaningful Use. Although the organization’s Clinical Service Director Megan Shepard, RN, CSD, told EHRIntelligence.com that the first phase of meaningful use required more significant of a change than the second phase, she did highlight one component of Stage 2 that proved troublesome and that was patient engagement.
“We’re a very small community and most of the population is elderly,” Shepard explains. “They didn’t grow up with computers, so they are struggling with why they need to go to a computer when the hospital already has the medical records there. Many don’t have email or a computer at home. The younger generation is used to it, but the population in our area mostly doesn’t do these things.”
The critical access hospital had to develop a strategy for breaking through the generational barriers keeping patients from easily accessing their health information and the hospital from receiving much-needed incentives.
The first line of attack is the frontend staff. “When they first come into our facility, our front desk tells them about it and asks them if it is something they would be interested in doing. Then from that point we put their names in the computer,” says Shepard.
The next wave of outreach involves a very personal touch thanks to one very personable member of the CAH’s clinical staff.
“Every Monday morning we have one of our staff — he’s actually our x-ray tech — who is very personable and can generally speak to people on their level handle the calling,” describes Shepard. “He calls them and asks them how they are doing, leading them into a conversation about their health and the patient portal. He breaks it down to a level that they can understand.”
It is a hard sell for some patients who simply do not care enough for electronic access, Shepard maintains. This reality has led Odessa Memorial Health Center to take an additional step and present some alternatives to how digital access could be useful for other members of patients’ care teams — their families:
We even went a little further than that: “If you don’t want to get in there, do you think your husband would want to get in there? How about your daughter — do you want her to have access to your medical records in case something were to happen to you.” We’re not just going after the patients but also their families. As we get them signed up that way and then on to “breaking the glass” to get in, we have got them. If they don’t want to, maybe they want their family to be more involved in what’s going on.
A patient’s care is seldom a purely individual experience. By including other concerned parties into the mix, eligible providers have the opportunity to meet the patient engagement requirements and improve the exchange of health information among members of the patient’s care team.



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Why do some hospital revenues rise while others see a crisis? | EHRintelligence.com

Seeing the words “hospital” and “revenue cycle” in the same sentence is more likely than not to produce a gloomy, bitter outlook for healthcare professionals.  Hospitals have always been overworked, understaffed, and short of resources, working day and night just to keep their heads above water in challenging communities that continually demand more than they can give.  Whether they are for-profit or not, everything the hospital does or wants to do revolves around the operating budget: a yearly struggle to squeeze blood from a stone.
EHR implementations, federal mandates such as meaningful use and ICD-10, and the changes involved in the Affordable Care Act (ACA) might seem to be nothing more than added burdens that are fated to seal the collapse of the healthcare system as we know it, but not all hospitals are faltering under the weight.  Some are even posting healthy profits, surprising analytics and executives alike.  Why are some hospitals starting to thrive in this era of continual reform while others are sinking irreparably into debt?
Seeing technology as an opportunity
CMS and the Office of the National Coordinator (ONC) have been urging healthcare organizations to see EHRs as a productivity-boosting cure for patient safety concerns, care coordination, and data analytics.  While the EHR Incentive Programs certainly have their detractors, and the benefits of health IT might not be fully realized just yet, the healthcare organizations that can successfully implement and leverage their EHRs and other health IT systems have a better chance of positioning themselves for financial success than those who let their adoption programs get away from them.
Consider the implementation of an Epic EHR, which serves to illustrate the clear dichotomy between EHR success and failure.  While the University of Arizona Health Network plunged into the red with $28.5 million in debt after poor planning, unanticipated delays, and a lack of leadership sent their EHR adoption program awry, a health system like Novant Health in North Carolina, which carefully planned its roll-out to include time for troubleshooting and thorough training, was able to build confidence and absorb the high costs of the EHR without a catastrophe.
Investment in revenue cycle tools that identify waste, manage human resources, and simplify the collection of increasing patient responsibilities is also becoming a must for organizations that want to keep a positive profit margin.  Ninety-three percent of hospitals that classify themselves as struggling financially are looking to revenue cycle management (RCM) technology to plug gaps in their financial management programs and position themselves for upcoming pay-for-performance reimbursements.
“Most hospital CFOs have no choice but to leverage next generation financial system solutions including software and outsourced services in order to keep their organizations solvent,” said Doug Brown, Managing Partner of Black Book Market Research. “The reimbursement challenges ahead to get paid may require several new applications, and the frank reality is that outdated, understaffed and failing current solutions could quickly close a marginally performing hospital for good.”
Adapting to the changing flow of patients
Technology may be one important component for financial success, but the “people piece” is just as critical.  While some hospitals are seeing empty beds and shrinking revenues as they cling on to traditional models of patient care, others are eagerly courting ACA patients that are flooding into the healthcare system at astonishing rates.  Sixty percent of newly insured patients have already visited a primary care provider, and systems like Tenant Healthcare Corporation are thanking this new tide of patients for their positive outlook.
Tenant CEO Trevor Fetter said that patients that purchased ACA insurance exchange plans accounted for 2,700 admissions and more than 24,000 outpatient visits during the second quarter of 2014, aiding a 40% year-over-year growth in revenue.  Fetter added that in states that have chosen to expand Medicaid, uninsured and charity admissions declined by 54.3 percent and Medicaid admissions increased by 22.9 percent, highlighting a significant source of new revenue.
“In a way, I’m delighted to have this fantastic quarter,” he said to D Healthcare Daily. “But it would’ve been nice to show a quarter like this pre-ACA because it would’ve demonstrated that the business is solid and the strategies are working. The ACA is just icing on the cake.”
The sudden increase in patients and associated revenue may taper off as the pent-up demand for healthcare services from the previously uninsured eases off, but with a rapidly aging population and an increase in the prevalence of chronic diseases, hospitals will have a higher volume of needy consumers on their hands for many years to come.
Leveraging accountable care and reformed payment structures
Accountable care may still have its skeptics, but an increasing number of hospitals are taking pay-for-performance reimbursements, care coordination, and population health management to heart.  Forecasts predict that 130 million patients will be covered under an accountable care organization (ACO) or pay-for-performance arrangement by 2017.  In Wisconsin, 90% of the population will have the option almost immediately.
For healthcare organizations looking to turn these changes to their advantage, the American Hospital Association (AHA) recommends that organizations identify their existing sources of capital and develop a baseline financial projection before testing the impact of major changes to their reimbursement strategies.  Understanding the risks and rewards of accountable care before jumping into pay-for-performance structures can help organizations focus their efforts and avoid failures experienced by some projects such as a portion of the CMS Pioneer ACOs.
“The process requires vigilant monitoring, flexibility and updating as markets evolve and strategies are implemented,” the AHA says. Although the current planning environment has new variables and uncertainties, the need for the time-honored, fundamental financial planning approach remains unchanged.  This approach is grounded on the guiding principle that cash flow must be sufficient to meet the strategic capital needs of an organization within an acceptable risk tolerance.”
Hospitals that can embrace these changes with a detailed roadmap and a solid handle on the risks will be able to face the revenue challenges in front of them with a clearer head and a strategic plan.  The outlook for healthcare organizations remains rocky, but providers that are flexible enough to embrace the changes to the healthcare industry have a good chance of finding their way through the shoals.
“I believe the rating agencies look at this sector as volatile,” said Steve Underdahl, President and CEO of Northfield Hospital, which managed a 5.1% profit margin in 2013, one of the highest in the Twin Cities region and 1.6% higher than 2012. “My sense is that bond rating organizations look at all of the variables and unknowns associated with health care reform, new care delivery models and new customer expectations, and find the future of our industry difficult to predict.”



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Could Clinicians Create Better HIE Tools?

Could Clinicians Create Better HIE Tools? | EHR and Health IT Consulting | Scoop.it

A tense and flustered discussion took place on Monday, August 11 during a routine meeting of the HIT Standards Committee Implementation Workgroup, a subcommittee set up by the Office of the National Coordinator (ONC), which takes responsibility for U.S. government efforts to support new IT initiatives in the health care field. The subject of their uncomfortable phone call was the interoperability of electronic health records (EHRs), the leading issue of health IT. A number of “user experience” reports from the field revealed that the situation is not good.

We have to look at the depth of the problem before hoping to shed light on a solution.

An interoperability showcase literally takes the center of the major health IT conference each year, HIMSS. When I have attended, they physically arranged their sessions around a large pavilion filled with booths and computer screens. But the material on display at the showcase is not the whiz-bang features and glossy displays found at most IT coventions (those appear on the exhibition floor at HIMSS), but just demonstrations of document exchange among EHR vendors.

The hoopla over interoperability at HIMSS suggests its importance to the health care industry. The ability to share coordination of care documents is the focus of current government incentives (Meaningful Use), anchoring Stage 2 and destined to be even more important (if Meaningful Use lasts) in Stage 3.

And for good reason: every time we see a specialist, or our parent moves from a hospital to a rehab facility, or our doctor even moves to another practice (an event that recently threw my wife’s medical records into exasperating limbo), we need record exchange. If we ever expect to track epidemics better or run analytics that can lower health case costs, interoperability will matter even more.

But take a look at extensive testing done by a team for the Journal of the American Medical Informatics Association, recently summarized in a posting by health IT expert Brian Ahier. When they dug into the documents being exchanged, researchers found that many vendors inserted the wrong codes for diagnoses or drugs, placed results in the wrong fields (leaving them inaccessible to recipients), and failed to include relevant data. You don’t have to be an XML programmer or standards expert to get the gist from a list of sample errors included with the study.

And that list covers only the problems found in the 19 organizations who showed enough politeness and concern for the public interest to submit samples–what about the many who ignored the researchers’ request?

A slightly different list of complaints came up at the HIT Standards Committee Implementation Workgroup meeting, although along similar lines. The participants in the call were concerned with errors, but also pointed out the woeful inadequacy of the EHR implementations in representing the complexities and variety of patient care. Some called for changes I find of questionable ethics (such as the ability to exclude certain information from the data exchange while leaving it in the doctor’s records) and complained that the documents exchanged were not easy for patients to read, a goal that was not part of the original requirements.

However, it’s worth pointing out that documents exchange would fall far short of true coordinated care, even if everything worked as the standards called for. Continuity of care documents, the most common format in current health information exchange, have only a superficial sliver of diagnoses, treatments, and other immediate concerns, but do not have space for patient histories. Data that patients can now collect, either through fitness devices or self-reporting, has no place to be recorded. This is why many health reformers call for adopting an entire new standard, FHIR, a suggestion recognized by the ONC as valid but postponed indefinitely because it’s such a big change. The failure to adopt current formats seems to become the justification for keeping on the same path.

Let’s take a step back. After all those standards, all those certifications, all those interoperability showcases, why does document exchange still fail?

The JAMIA article indicated that failure can be widely spread around. There are rarely villains in health care, only people pursuing business as usual when that is insufficient. Thus:

  • The Consolidated CDA standard itself could have been more precisely defined, indicating what to do for instance when values are missing from the record.

  • Certification tests can look deeper into documents, testing for instance that codes are recorded correctly. Although I don’t know why the interoperability showcase results don’t translate into real-world success, I would find it quite believable that vendors might focus on superficial goals (such as using the Direct protocols to exchange data) without determining whether that data is actually usable.

  • Meaningful Use requirements (already hundreds of pages long) could specify more details. One caller in the HIT Standards Committee session mentioned medication reconciliation as one such area.

The HIT Standards Committee agonized over whether to pursue broad goals, necessarily at a slow pace, or to seek a few achievable improvements in the process right away. In either case, what we have to look forward to is more meetings of committees, longer and more mind-numbing documents, heavier and heavier tests–infrastructure galore.

Meanwhile, the structure facilitating all this bureaucracy is crumbling. Many criticisms of Meaningful Use Stage 2 have been publicly aired–some during the HIT Standards Committee call–and Stage 3 now looks like a faint hope. Some journalists predict a doctor’s revolt. Instead of continuing on a path hated by everybody, including the people laying it out, maybe we need a new approach.

Software developers over the past couple decades have adopted a range of ways to involve the users of software in its design. Sometimes called agile or lean methodologies, these strategies roll out prototypes and even production systems for realistic testing. The strategies call for a whole retooling of the software development process, a change that would not come easily to slow-moving proprietary companies such as those dominating the EHR industry. But how would agile programming look in health care?

Instead of bringing a doctor in from time to time to explain what a clinical workflow looks like or to approve the screens put up by a product, clinicians would be actively designing the screens and the transitions between them as they work. They would discover what needs to be in front of a resident’s eyes as she enters the intensive care ward and what needs to be conveyed to the nurses’ station when an alarm goes off sixty feet away.

Clinicians can ensure that the information transferred is complete and holds value. They would not tolerate, as the products tested by the JAMIA team do, a document that reports a medication without including its dose, timing, and route of administration.

Not being software experts (for the most part), doctors can’t be expected to anticipate all problems, such as changes of data versions. They still need to work closely with standards experts and programmers.

It also should be mentioned that agile methods include rigorous testing, sometimes to the extent that programmers write tests before writing the code they are testing. So the process is by no means lax about programming errors and patient safety.

Finally, modern software teams maintain databases–often open to the users and even the general public–of reported errors. The health care field needs this kind of transparency. Clinicians need to be warned of possible problems with a software module.

What we’re talking about here is a design that creates a product intimately congruent with each site’s needs and workflow. The software is not imported into a clinical environment–much less imposed on one–but grows organically from it, as early developers of the VistA software at the Veterans Administration claimed to have done. Problems with document exchange would be caught immediately during such a process, and the programmers would work out a common format cooperatively–because that’s what the clinicians want them to do.



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Interested in using Google Glass in health? Pristine.io's Kyle Samani shares his insights - iMedicalApps

Interested in using Google Glass in health? Pristine.io's Kyle Samani shares his insights - iMedicalApps | EHR and Health IT Consulting | Scoop.it

Traditional telemedicine requires a large financial investment in heavy equipment with dedicated cameras and computers. They often are not as accessible to physicians, with an extreme lack of portability. Mobile phones and tablets have helped lower this barrier substantially, but they have limitations as well. For example, they still require your hands to operate – less than ideal in, say, the operating room or in the field.

Enter Pristine.

Pristine’s EyeSight platform runs on Google Glass. Their HIPAA-compliant app streams audio and video to other providers and viewers. Their platform is already in use at the University of California, Irvine (UC Irvine), and will be incorporated into their curriculum for medical students. The platform encompasses a variety of use cases, including wound care teams, emergency response teams, anesthesia cases, surgery, and ICU settings.

We interviewed Pristine CEO Kyle Samani at the most recent American Telemedicine Association conference in Baltimore, on what inspired Pristine’s team to build EyeSight.

How did you get started with this company?

For the past 3 years, I worked on an EMR product in Austin; then in February of last year, [Google] announced their Explorer program, and then I immediately thought that this was going to be big for hands-free healthcare. I knew this would be big. I called every doctor I knew [and thought of] cardiology apps, opthalmology apps, ER apps. So I picked what the biggest app would be that would have the broadest impact and be the biggest potential business.

We decided to pursue video.

How did you end up creating EyeSight?

When we looked at Glass, [and its] novel aspects, the fundamental challenge [we asked] is, “Why not an iPhone?” [These apps] have to compete with an iPhone. There’s not many apps that are much better than an iPhone. Glass’s screen is very small, [with] no good input mechanism. Why is Glass good for an EMR, versus an iPhone which has a robust way to interact with stuff?

[And] Glass is so limited [that to] do something like an EMR, [which] has large lists of stuff that are not clickable…it’s not the right form factor.

So we [looked at the traditional telemedicine] camera, well, I looked around and there are so many damn carts! These things are so expensive huge and heavy! We asked nurses how they like them, and they kinda didn’t like using them, and I heard not much enthusiasm for the carts. [Google Glass] is 7 ounces versus 70 pounds, and it’s handsfree.

How can people get Pristine’s EyeSight on their Glass?

We talk to folks on their phone [in the form of a conference call], sign a contract, we buy all the Glasses from Google, we work with [their] IT staff, we preconfigure with all the apps, [and] configure it to [their] Wifi network. [There is] no setup or configuration whatsoever. Just turn it on and go.

We realized that people aren’t ready for a two-year commitment, so we offer a 90-day or 120-day pilot program, a short commitment, and if they’re not satisfied, they can send it back.

You can [send] text [messages] around, [send] instructions, and send three lines or five lines of instruction to show on the Glass. You can also do a “tele-illustration” so the person receiving the video can draw on the screen, and it shows up on Glass. Video is the core component. [It works with] all devices: iPhone, iPad, Mac and PC.

Anything else our readers should know about Pristine?

Telemedicine is so heavy. These carts are $30k, and the robots are $70k. Outrageously expensive! We want to make telemedicine affordable and easy. Light and simple. Glass is the most expensive thing we sell you.  This thing will be effectively disposable in a few years, and the goal is to make telemedicine as light as possible, [with] no setup, no configuration, no heavy crap. [And it comes with] a paging system.



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Debating effect of Stage 2 Meaningful Use on EHR adoption | EHRintelligence.com

At first glance, the findings from a recent study are positive with respect to the progress being made by hospitals in the adoption of EHR systems. But those same findings also raised doubts about the readiness of eligible hospitals in the EHR Incentive Programs to meet the requirements of Stage 2 Meaningful Use.
As reported last week, that nearly 60 percent of hospitals have adopted a basic or comprehensive EHR system must be balanced by the roughly 6 percent of the same hospitals reporting being able to meet the meaningful requirements in Stage 2.
“Despite the substantial increase in EHR adoption, meeting stage 2 meaningful-use objectives will require work for the vast majority of hospitals,” wrote Adler-Milstein et al. “Our findings suggest that functions related to electronic data exchange, both with other providers and with patients (in particular, providing summaries of care during transitions and giving patients the ability to view online, download, and transmit their health information) are critical gaps.”
So the question was put to readers: Could Stage 2 Meaningful Use actually end up slowing EHR adoption rather than advancing it?
Two respondents agreed that the progress of EHR adoption was likely to be impacted by the increased requirements on eligible providers in Stage 2:
As a consultant and implementing some of these changes myself in the registration area at different hospitals we have not had much issue. However, in other areas this has not been the case and extensions were granted so xyz hospital had more time to comply and figure out how to do so as the EMR companies that are guiding these changes don’t necessarily have the “how” down either.
Sometimes these requirements in theory make absolute sense, but when actually having to go and make the change, it’s not as straightforward as it should be and does not have the desired affect intended driving down the adoption statistics.
Cerner analyst, trainer, project manager
Could Stage 2 slow EHR adoption? Absolutely. As part of a team supporting education for Stage 2 MU in our hospitals, I share the day-to-day frustrations with physicians as they are practically mandated to use technology that, at it’s very best, takes time to log on, find the patient, search for an order, read through the patient’s diagnostics with yet another system, and then the application either freeze or loose a server.
With the time constraints on Stage 2 MU, and trying to bring Wave 1 sites ready for attestation, the companies guiding these changes to meet government requirements are learning while implementing. This sort of reminds me of the Affordable Care Act electronic system for choosing a healthcare plan.
Registered nurse/healthcare informaticist
Conversely, another respondent drew a connection between the uniqueness of both Stage 1 and Stage 2 Meaningful Use in requiring a remarkable change — the first in switching from paper to electronic charts and the second in pulling patients into the process of promoting the exchange of health information:
The EHR adoption has been implemented and well underway for approximately 75% of all the hospital systems and clinics in the US. We have approximately 25% more hospitals up and running with their EHR of choice. Those hospitals up and functionalizing their EHR have already received their MU 1 incentive dollars. The last 25% will be looking to meet their MU 1 criteria.
The momentum of EHR adoption within the hospital/clinic context will not diminish. Now the private practice transition may take a bit more time. I am confident that as the patient portals become more familiar to the medical customers/patients they will want their doctor’s office documentation to tie in with their EHR at large.
This monumental transition from multiple paper charts to one EHR is well recognized and progressing. There is much more to work on and within the healthcare field, from the business aspect, documentation aspect and actual procedural care aspect. There is much to look forward to, addend, revise, create, and learn. Healthcare has been reborn in a sense and has a wonderful explorative future.
Epic credentialed trainer
With the final quarterly reporting period in progress for Stage 2 hospitals, it will not be long until data prove how capable these organizations were in meeting the next phase’s requirements for meaningful use.



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How EHRs can promote safety of medical devices using UDIs | EHRintelligence.com

Responding to a request from the Senate Finance Committee seeking input on how to increase the usefulness and availability of health data, the Pew Charitable Trusts are calling for improvements in the way that information about medical devices is captured and shared by healthcare providers and payers.
The comments addressed to Senators Ron Wyden (D-OR) and Chuck Grassley (R-IA) highlight in particular the important role EHRs could play in assessing the performance of medical devices so long as certain “necessary conditions” are met.
One such condition involves enabling the interoperability of EHR systems, which would support both the collection and sharing of information in large databases (i.e., registries).
“There are also a number of other challenges that must be overcome to enhance the use of registries in the United States today,” writes Josh Rising, MD, Director of Medical Devices. “First, despite the dramatic uptake of electronic health information sources, these systems cannot easily transmit data among one another.”
The lack of interoperability has led to the development of one-off solutions for extracting health data from EHR systems on a facility-by-facility basis or the manual parsing of data, says Rising. To remove this obstacle between EHR systems, the Pew Charitable Trusts is urging the Senate Committee to evaluate the work of Office of the National Coordinator for Health Information Technology (ONC) on EHR interoperability.
Another condition to be met is the integration of unique device identifiers (UDIs) into the electronic record and insurance claims, which is on the horizon.
According to Rising, incorporating UDIs into the patient health records will provide a number of tangible benefits — from being able to track potentially malfunctioning devices to supporting more informed clinical decisions regarding implantable devices. “This information is especially critical when patients switch providers or see multiple physicians, all of whom may need information on the specific device,” he adds.
The Pew Charitable Trusts have called attention to the efforts of the ONC and the HIT Policy Committee in proposing the creation of a standardized field in EHRs for listing UDIs and incentives for eligible providers in meaningful use including this information in the electronic record.
The last condition necessary for enhancing the safety and innovation of medical devices deals with sharing information widely.
“The utility of these new tools relies on the dissemination of findings to patients, providers, regulators, payers, manufacturers and researchers,” Rising maintains. “These data will provide patients and physicians with information on the safety and effectiveness of medical products, enable payers to assess the quality of product used by beneficiaries, and give manufacturers information to improve the next generation of products.”
Releasing information regularly and publically should allow patients, providers, manufacturers, and payers to identify potential problems related to medical devices and hopefully prevent threats to patient safety.



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AMA seeks further delays for Open Payments system | EHRintelligence.com

Citing lingering flaws in the Open Payments system brought back online last week by the Centers for Medicare & Medicaid Services (CMS), the American Medical Association is calling on the federal agency to give providers more time for registering and using the system in order to review and identify the need for corrections to claims.
The Open Payments system is a byproduct of the Sunshine Act and aims to provide greater transparency about the financial relationships between healthcare organizations (e.g., device manufacturers, pharmaceutical companies) and providers.
Unveiled earlier this month, the system experienced significant enough flaws to warrant CMS taking it offline temporarily. But just last week, the federal agency announced that the system was back online and that physicians and teaching would have until September 8 to review their records before the Open Payments system became available to the general public on September 30.
AMA is strongly opposed to this proposed timeframe:
CMS reports that it has reopened the Open Payments database as of today, but indicates it will only allow physicians until September 8th to complete registration and seek correction of data. Yet, the agency has not fixed the major problems that continue to mark the roll-out of this database including confusing and inaccurate information, lack of reliable functionality, and excessive time required to register and review reports. This inadequate response will lead to inaccurate publication of data.
How CMS handled taking the Open Payments system offline was another pain point identified by the provider association:
CMS created widespread confusion by taking the Open Payments database offline without notice to physicians or physician organizations and without any indication of when the database would be available again. According to media reports, the Open Payments system was taken offline the evening of August 3rd due to significant technological problems. CMS inadequately communicated about website failures, not releasing a public statement about the system being offline until August 7th and not providing any indication of when the database would be available again, causing confusion among physicians.
Based on these concerns, AMA has proposed a deadline of March 31, 2015, to ensure both participation by physicians and the integrity of data contained in the Open Payments system.
“The lack of faith physicians have in the system at this point in time, is making them wonder if taking time away from patients to go through the process is even worthwhile,” the association’s President Robert M. Wah, MD, said publicly.
Perhaps the experience of the Department of Health & Human Services and CMS with Healthcare.gov have money concerned about the federal government’s ability to roll out a healthcare-related system that is reliable and effective.



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Little To Show For 26 Billion Health IT Investment

Little To Show For 26 Billion Health IT Investment | EHR and Health IT Consulting | Scoop.it

The electronic sharing of information (health information exchange) plays a critical role in improving the cost, quality, and patient experience of healthcare. However, there is very little electronic information sharing among clinicians, hospitals, and other providers despite more than $24 billion in incentive payments to hospitals and eligible professionals who "meaningfully use" electronic health records, and another $2 billion spent on interoperability standards and EHR certification over the past five years.

This according to a health policy brief written by Janet Marchibroda, director of the Health Innovation Initiative at the Bipartisan Policy Center published by Health Affairs and supported by the Robert Wood Johnson Foundation.

Marchibroda explains, “While considerable investments in health IT have been made, advancement of interoperability and electronic information sharing across systems has been slow,” and “Additional action is needed to provide the information foundation necessary for higher-quality, more cost-effective, patient-centered care in the United States.”

Because most payment in the U.S. healthcare system today is volume based versus outcomes or value based, “there is little financial incentive to share information across settings to reduce costs or improve the quality of care.” Although new care models are expected to expand the business case for interoperability and information sharing, Marchibroda reports “so far these new models of care have relied upon old models of information sharing, including the use of phone, fax, or mail, or siloed information-sharing networks.”

The major obstacles to electronic sharing of information include the lack of a business case, the financial cost associated with exchange, a lack of standards adoption and interoperability of systems, continued concerns about privacy and security, and concerns about liability.

A study published by Health Affairs found that, of physicians surveyed in 2013, only 14 percent electronically sharing data with providers outside of their organizations. Meanwhile, a 2012 study published by Health Affairs indicates 51 percent of hospitals surveyed were sharing information with ambulatory care providers outside of their organizations, while 36 percent were sharing information with other hospitals outside of their organizations. And, another study cited by the brief revealed only 10 percent of ambulatory practices and 30 percent of hospitals were found to be participating in operational health information exchange efforts.

“In order to achieve electronic information sharing, EHRs and other clinical software must be ‘interoperable’ or have the capability to exchange information using agreed-upon standards, and those providing care and services must be willing to share information,” Marchibroda argues. Yet, to date, the requirements for both interoperability and electronic information sharing under the HITECH Act to date have been “fairly limited,” and Marchibroda specifically references Stage 1 of the meaningful use program.

“Stage 1 made it optional for providers transferring a patient to the care of another provider to furnish that provider with a summary of care record 50 percent of the time, and noted that such information need not be transmitted electronically,” she states.

Marchibroda does describe Stage 2 MU requirements as “more robust” and sees Stage 3 as a “significant opportunity to advance the interoperability of EHR technology and electronic information sharing among providers.”

Ultimately, the study concludes, “Additional action is needed to provide the information foundation necessary for higher-quality, more cost-effective, patient-centered care in the United States.”



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How did a rural NH hospital achieve Stage 2 Meaningful Use? | EHRintelligence.com

Critical access hospitals (CAHs) tend to lack the resources of other hospitals which can put them at a disadvantage when pursuing health IT initiatives such as meaningful use. However, the collaboration of executive, clinical, and administrative staff at Cottage Hospital in rural New Hampshire was resource enough for the CAH to attest successfully for Stage 2 Meaningful Use, one of very few eligible hospitals of any size to do so.
Especially critical to Cottage Hospital’s success was the handoff between IT and clinical staff as the technical implementation of the CAH’s certified EHR technology moved to the actual use of the technology by providers. Led by Director of IT Rick Frederick and Clinical Informatics Specialist Tamra Deming, the successful implementation and adoption of Stage 2 EHR technology was the end result of proper preparation and clear communication between both departments.
In this one-on-two interview with Frederick and Deming, the two explain how Cottage Hospital was able to attest for Stage 2 Meaningful Use and prepare for what’s next.
How important is having support from the top down to the hospital’s success in meaningful use?
Rick Frederick: We had full support from the top for meaningful use, so that is one battle I didn’t have to fight. I didn’t have to go asking for money. All I had to do was say what it would cost us in hardware to achieve this milestone. So we bought the hardware and came up with a plan for how to quickly implement the stuff. Fortunately, at that point we had brand-new servers so we used the old ones to test the MEDHOST software in a non-production environment. Once we figured that out, we installed the software, tested it, and handed it off to the informaticists.
Tamra Deming: Hearing other people’s stories and some of the things they’re going through, not everyone has that on their side. We are very fortunate. From there we took each measure and sat down as a group to decide what was most appropriate to be assigned to which department.
How did each of your departments handle the transition to Stage 2?
RF: Because we have strong informaticist talent here at Cottage, we broke off the IT beds and clinical beds. The part I took charge of were the IT beds which started with figuring out what was necessary to get the software and hardware set up to support what we needed to get going. From then on, we handed it over to the informaticists using the meaningful use specifications to figure out where all the gaps were between the software and where we need to be.
TD: Each week we would meet and go over where we were with each measure. There were particular stakeholders who had to speak to that measure and why they thought it was meeting or not meeting and watching for any trends. All through attestation, we met on a weekly basis to go over that and identify any risks or opportunities that we might have missed on the initial go-around. We continue to meet even today every two weeks just to make sure that our data are still meeting expectations for meaningful use. It was really an all-hands-on-deck effort.
How did the technical infrastructure change to support the requirements of Stage 2?
RF: A little more than a year before we planned to test, we started gathering information about what was going to be needed from a hardware perspective, and it turned out that we needed a fair amount of hardware because Stage 2 Meaningful Use was so much more data-intensive. The servers that we had running the EHR were not up to the task. We took the spec that MEDHOST provided back then and added another 25 percent of processing power on top of it — that’s how we came up with how much we thought we might need or possibly even going forward with Stage 3.
How do you ensure success moving forward with the full year of Stage 2?

TD: During our attestation, of course there was all this pressure to meet every day. Now that we have passed our 90-day attestation period and moving on to the full year where you still have to maintain the same standards and same data, I find that that pressure is not on there as much as it was before. So we have to make sure that everyone stays just as involved as they were during the attestation period because moving forward it is just going to get harder and harder. It is something we’re constantly going to be chasing our tails with



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ONC highlights EHR adoption by community health centers | EHRintelligence.com

The Office of the National Coordinator for Health Information Technology (ONC) is looking to the progress made by community health centers whose adoption of EHR technology is nearing 90 percent as any indicator of significant improvements to delivering high-quality care to patients.
In a post on Health IT Buzz, Kerry Souza, ScD, MPH, and Michael Wittie, MPH, highlight data released by the Health Resources and Services Administration (HRSA). According to the recently publishing 2013 data, more than 1,200 national program grantees are providing care to 21.7 million patients.
A total of 87.8 percent of these federally funded health centers are using EHR systems and an even 54 percent are operating patient-centered medical homes (PCMHs). Although the percentage of PCMHs remains unchanged since 2012, the corresponding number for EHR adoption has increased by nearly ten percentage points in one year, up from 79.3 percent in 2012.
“Health centers are not just using health IT, they are using it as part of clinical transformation,” write Souza and Wittie. “Community health centers across the country are also using EHRs to capture and use patient work information to learn more about their patients’ work and health.”
Of the 1,202 grantees, only 50 reported not having an EHR installed. The aforementioned 87.8 percent (1,055) have an EHR system available to all providers at all sites and the remaining 8.1 percent (97) have EHR system availability limited to some sites or some providers.
Here’s a rundown of the EHR functionalities in use among the 1,152 federally funded health centers with EHR technology available to providers:
• Patient history and demographic information (99.9%; 1,151)
• Clinical notes (99.9%; 1,151)
• Computerized provider order entry (CPOE) for lab tests (98.6%; 1,136)
• CPOE for radiology tests (80.3%; 925)
• Electronic entry of prescriptions (99.5%; 1,146)
• Reminders for guideline-based interventions or screening tests (97.2%; 1,120)
• Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (85.9%; 990)
• Notifiable diseases: notification sent electronically (48.3%; 556)
• Reporting to immunization registries done electronically (74.9%; 863)
• Ability to provide patients with a copy of their health information on request (95.9%; 1,105)
• Capacity to provide clinical summaries for patients for each office visit (99.5%; 1,146)
• Protection of electronic health information (99.9%; 1,151)
Apparently, federal funding through HRSA can serve as an indicator of EHR implementation and utilization. Now, if only those remaining 50 sites would get on board, the program would be a perfect success from a health IT perspective.



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Managing the administrative technicalities of meaningful use | EHRintelligence.com

Having the right kind of technology is essential to achieving the various stages of meaningful use. Certified EHR technology (CEHRT) must be in place and used by clinicians to capture required data. But simply having and using the EHR system are not enough.
Eligible providers must also take the next step to report their data correctly to the Centers for Medicare & Medicaid Services (CMS) in order to receive incentive payments. This is where the technical side meets the administrative one. It is also where a breakdown in coordination and management could lead to failure.
Critical access hospitals (CAHs) and other resource-strapped facilities are especially taxed by the administrative requirements of the EHR Incentive Programs, claims health IT consultant explains Marcia Cheadle, Senior Director of Meaningful Use and Advanced Clinicals for Engage.
“We also partner with our hospitals on the administrative side of meaningful use,” she explains. “All of those requirements that are not necessarily technical in terms of the software EMR but are as critical in the registration side of the program so that sites can have a seamless attestation program.”
A major administrative technicality for CAHs involves account reporting to the federal government, something unique from the prospective payment system in place for other healthcare organizations.
“The CAHs in particular are challenged there because of the way the government views their cost accounting, which is different than the PPS,” says Cheadle. “They also have to go the fiscal intermediary related to the depreciation of assets required for each of the stages. So we partner very closely to make sure that the information they have is available for receiving incentive funding in addition to protecting them should an audit occur.”
The division of Inland Northwest Health Services supporting these and similar hospitals work to ensure that the latter have access to accurate data about their progress in meaningful use from a high and low level.
“We provide our partner sites a web-based portal view of their day-to-day operations as it relates to meeting the threshold requirements for meaningful use,” Cheadle reveals. “The hospitals have different stakeholders who can go in and see how from an adoption perspective their clinicians are able to utilize the program and demonstrate meaningful users.”
On top of this, the consultancy handles changes in requirements that emerge as a result of CMS updates to meaningful use via frequently asked questions (FAQs) or other notices, freeing their organizations they support to focus on the clinical side of meaningful use more fully. Likewise, the group coordinates with vendors and state government to ensure their readiness for receiving meaningful use data or prepare for changes in data specifications.
Most recently, Stage 2 Meaningful Use has ramped up the need for these administrative activities. Getting an eligible providers on to an EHR certified for Stage 2 takes planning and communication. “Most vendors recertified and so we needed to enable each of our systems for that certification program,” Cheadle maintains. “That required coordination of the vendor programs as well as testing and providing education to each site on what the clinicians would experience with the new upgrade.”
Requirements in the second phase of the EHR Incentive Programs also required similar planning and communication because of the need for health information exchange (HIE).
“The second big technology change was related to both the transitions of care and patient portal,” Cheadle continues. “Not only in general were those new modules, but they also required a degree of interoperability from a technology standpoint that was not truly there in the Stage 1 platforms, so the coordination of that from a technology standpoint was necessary.”
Technology is front and center in meaningful use, but proper administration is what ensures that attestation are successful and incentive dollars are received.



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Apple's HealthKit app will be linked to Epic's MyChart - iMedicalApps

Apple's HealthKit app will be linked to Epic's MyChart - iMedicalApps | EHR and Health IT Consulting | Scoop.it

When Apple announced HealthKit a few months ago, I wrote how the relationship they were forging with Epic — the electronic medical record that covers a majority of the US patient population — had the potential to be a game changer.

Epic’s MyChart app enables patients to communicate with their physicians, schedule appointments, and view their lab results.  Although it doesn’t have a sophisticated input scheme built in, it does provide the all important bridge from patient portal to the chart your physician views.

I mentioned how it would be transformative if Apple was able to link HealthKit directly to Epic’s MyChart, so a patient’s bluetooth blood pressure cuff  would automatically send the data to their Epic Chart.

Reuters is reporting this is exactly what appears to be happening. Apple is currently trying to navigate the legal minefield of personal health tracking to bring the collection of health metrics to a large population based level.

Further, Allscripts, another EMR, is reported to be in play for a similar type of integration.



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What do most accountable care organizations have in common? | EHRintelligence.com

In the context of healthcare reform, accountable care organizations (ACOs) are clear examples of an effort to shift from volume to value and for providers to assume greater risk. Given their relatively recent creation, gauging the effectiveness of these care models to help achieve the triple aim remains difficult, but new findings from the eHealth Initiative do provide details about the characteristics that many ACOs share with each other.
In a presentation earlier this week, the non-profit organization unveiled details from its 2014 survey of ACOs, which focused on the health IT infrastructure and workforce in place to support these patient-centered forms of care delivery.
The first takeaway is the newness of most of the responding ACOs. Little more than one-third of respondents (35%) indicated being in operation for more than two years with a larger percentage (40%) hovering around one to two years. A similarly large percentage (33%) are funded and administered by health systems. Medical groups are the next leading category at half that percentage (16%).
Although a majority receive funding and governance from health systems and medical groups, the shared savings model still predominates in terms of contracting with 84 percent reporting the use of this model. Next in line are fee for service (FFS, 45%) and sharing savings and losses model (28%).
The number of physicians working as part of these ACOs is reportedly high. Eighty percent of responding ACOs indicated having more than 500 physicians (41%) and 101 to 500 physicians (39%) on staff. These physicians tend to practice in primary care (90%) or specialties (84%) although physicians at acute care hospitals (57%), health systems (53%), and other hospitals (51%) are popular. Less likely physicians specialize in long-term care (22%).
Concerning the number and kinds of patients served, the largest percentage of ACOs care for 10,001 to 50,000 lives (38%) followed by those caring for a patient population between 50,001 to 100,000 individuals. Medicare beneficiaries (85%) are the most likely to receive care through ACOs, which makes sense considered that many ACOs are part of the Medicare Shared Savings Program (MSSP).
In terms of health IT, ACOs use myriad technologies to track quality, manage their patient populations, and handle physician payments and contracts:
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Guest Article: OLAP remains a great healthcare analytics architecture, even in the Big Data era

Guest Article: OLAP remains a great healthcare analytics architecture, even in the Big Data era | EHR and Health IT Consulting | Scoop.it

I’ve been getting many questions these days about big data tools and solutions, especially their role in healthcare analytics. I think that unless you’re doing large scale analysis of biomedical data such as genomics, it’s probably best to stick with traditional tried and true analytics tools. Online Analytics Processing (OLAP) can be invaluable for medical facilities to use when interpreting data and health informatics because most of that data is in relational, key-value, or hiearchical databases (such as MUMPS). I reached out to Ron Vatalaro, who works with the University of South Florida Morsani College of Medicine and writes about health informatics, to summarize which commercial tools are good to consider for modern OLAP architectures. Here’s what he said:

Online Analytic Processing (OLAP) is used in computing to quickly respond to multi-dimensional analytical queries. It is a subset of business intelligence, which also includes report writing, relational database, and data mining. OLAP tools make it easy to analyze data from multiple perspectives through one of its following three basic operations: consolidation (roll-up), drill-down, and slicing and dicing.

OLAP and data warehousing are interacting with and shaping health informatics by allowing for new analytical opportunities, in addition to the customary statistical approaches. It is one thing to collect vast amounts of data, but gaining insights as to how to best use the data to save lives and dollars is where the rubber meets the road. It is up to informatics professionals to glean meaningful information from the data sets and OLAP tools make it easier to breakdown and analyze big data.

Clinicians and hospital administrators can analyze the data for both individual patient care and to make optimized decisions to better serve all patients undergoing treatment at the facility. Dimension tables can be vital to testing hypothesis using textual, non-numerical data. For instance if administrators what to determine if the colors of walls or views from the window in patient’s rooms correlate to stay durations, nurse calls or return rates –  these tools can assist in drawing such conclusions.

EHR and OLAP

EHR and OLAP work hand-in-hand to deliver across-the-board improvements in world-wide health reform. It is important to understand the role data plays in the healthcare business model, and in what ways EHR systems are capturing and relaying this data. When it comes to the massive amounts of information coming into the healthcare data infrastructure, the use of comprehensive analysis becomes invaluable. Thus when the output from EHRs can be meaningfully dissected the results can lead to the following benefits: better continuity of care, increased patient participation, enhanced practice efficiencies/cost savings,  better accuracy, reduction of errors and more convenience for patients and healthcare providers.

The story your data is telling can present a double-edged sword. One of the benefits of being able to slice-and-dice down big data is to root out inefficacies; however, these same inefficiencies can lead to loss income due to meaningful use and pay-for-performance (P4P) policies. That being said, it is important to have comprehensive analytics to track and root out potential problems proactively, and to know what data third parties, such as insurers, are also looking at.

There is also the data healthcare providers cannot control, for instance, the decisions among patients to maintain their own health and well-being. There are government and insurance provider-backed incentives that reward “good behavior” among individuals who prioritize their health (not to mention the benefits of a healthy lifestyle). Categorizing and engaging individuals who do not care to advocate for their own benefit through unhealthy behaviors, (such as poor diet, alcohol abuse or tobacco use) and identifying any external factors that may exacerbate these issues (such and geographic, ethnic or socio-economic) can enrich lives and benefit the overall environment of healthcare. In these circumstances EHR and OLAP work together to the mutual benefit of society and the healthcare industry.

OLAP and Pharmacy Systems

To aid in pharmacological data management OLAP can play a major role in using the vast amounts of information from managed care organizations (MCO) management information systems (MIS) in a meaningful way. Information regarding member/provider functions, claims administration, clinical management, rebate administration and financial details are managed by systems generally referred to as online transaction processing systems (OLTP). Such systems have allowed the collection of billions of prescription records year-over-year. However, with the need for massive amounts of data to enable more effective drug therapy treatments, pharmacy management systems can fall short of the necessary processing power. That’s where OLAP systems step in to make decision support tools from the OLTP systems. These tools can interact with the data by making changes to the OLTP system, extracting data from the patient population and the prescribers of the medication.

OLAP Iterations

OLAP systems are classified by the following groupings:

  • Multi-dimensional (MOLAP): Known as the classic form of OLAP, this iteration is often denoted as simply OLAP. Instead of storing data in a relational database, MOLAP uses optimized multi-dimensional array storage. It relies on pre-computation and storage of information in the cube. Tools typically employ a pre-calculated data cube, including all possible responses to a certain range of questions. These tools have a very quick response time and can quickly write back data into the data set. They are useful for data sources that are static, therefore more useful for analyzing information from medical devices, since they operate on pre-determined parameters and are subject to less variability. It also works well for data that is more latent, or less frequently processed.
  • Relational (ROLAP): In this iteration, base data and dimension tables are stored as relational tables and new tables are generated to store the aggregated information. It relies on a specialized schema design that manipulates the data stored in the relational database to make it appear to have traditional OLAP functionality. Rather than using pre-calculated data, tools pose the query to the standard ROLAP database and its tables to bring the necessary data back to answer the question. As this methodology is not limited to the contents of a cube, tools have the functionality to ask any question. This type of analysis is good for information that is dynamic or frequently changing using its star scheme. Therefore, this type of analytic processing is good for information such as patient data, which has many variables and is subject to frequent changes and fluctuations.
  • Hybrid (HOLAP): The hybrid iteration is somewhat of a broad term, with a number of different interpretations, but all agree that a database will separate data between specialized and relational storage. HOLAP combines the capabilities of MOLAP and ROLAP to address their weaknesses. Tools can also use relational data sources and pre-calculated cubes. HOLAP tools can help to understand how patients and devices interact together, especially over time.

5 OLAP Tools Strengths and Weaknesses

There are a wide-variety of data management tools available to assist healthcare organizations in online analytics processing. There are

  • Microsoft: The company’s Microsoft Analysis Services support MOLAP, ROLAP and HOLAP. However, it can only run on a Windows operating system, so organizations using Linux, UNIX, or z/OS won’t be able to use it.One of the benefits to healthcare professionals using the system is that it integrates well with widely used software, such as Excel, that may be more comfortable to use among those with more of a healthcare background than a technical background.
  • Oracle: Oracle offers two OLAP servers ─ Essbase and Oracle Database OLAP Option. In addition to supporting MOLAP, ROLAP and HOLAP, they also support semi-additive measures, write-back, and partitioning. Oracle Database OLAP Option is compatible with Windows, Linux, UNIX, and z/OS, but Essbase cannot run on z/OS. Oracle offers the Service-oriented architecture (SOA) as a part of its data analytics service, which is specifically designed for healthcare integration.
  • IBM: Cognos TM1 is IBM’s OLAP server. While IBM Cognos offers MOLAP, ROLAP, and HOLAP data storage modes, IBM TM1 only offers MOLAP storage. TM1 is compatible with Windows, Linux, and UNIX, but not z/OS. IBM offers an assortment of assistance tools for healthcare data such as DB2 Intelligent Miner, industry specific guides, along with third party support form Blue Line.
  • SAP: The SAP NetWeaver BW is the SAP OLAP server. Semi-additive measures, write-back, and portioning features are supported, but only MOLAP and ROLAP storage modes are offered. SAP offers support tutorials for using their NetWeaver tools for health insurance claim eligibility and health checks such as cholesterol levels.
  • MicroStrategy: The MicroStrategy Intelligence Server offers MOLAP, ROLAP, and HOLAP data storage modes, in addition to MicroStrategy Office and Dynamic Dashboards offline capabilities. It is compatible with Windows, Linux, and UNIX, but not z/OS. MicroStrategy is positioning itself as the go-to platform for healthcare business intelligence, leveraging its mobile capabilities as an asset.

How OLAP fits with ‘Big Data’ Hype

As Shahid mentioned in his introduction, there has been a growing buzz around Big Data in IT (generally). Due to the massive influx of consumer information being shared openly over a variety of platforms, there has been a great deal of demand among businesses to capture that information to try and gain market insights and create customer profiles. This flood of information has many implications in healthcare, as tele-health and interoperability are gaining prominence. However, data quality is not the same a data quantity, and quantity (as the name suggests) is essentially what Big Data is all about.

Being able to capture standardized and actionable insights from large sets of data is the important distinction that OLAP brings to the table. Without the insights that structured data can bring, what you are left with is merely a technology (Big Data), rather than architecture (OLAP). That being said, there are differing schools of thought as to what role OLAP will play in the future of data management. It can be said that OLAP cubes lack the agility that a Big Data solution offers, although the presence of one does not mutually exclude the other.



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AHA: Medicare should expand data transparency, availability | EHRintelligence.com

CMS should make much more of its Medicare data available to the industry, argues the American Hospital Association (AHA), in order to encourage data transparency that will, in turn, foster accountable care, clinical analytics, and reduced costs across the healthcare system.  In a letter to Senators Ron Wyden (D-OR) and Charles Grassley (R-IA), AHA Executive Vice President Rick Pollack urges CMS to meet the rapidly growing demand from providers for clinical and claims data, as well as the thirst from consumers for intuitive ways to compare cost and quality.
“Healthcare-related data is a growing but largely untapped resource for accelerating improvement in health care quality and value,” Pollack writes. “The ability to make that data available and useful in a meaningful way will impact health care delivery and consumers for years to come. As we move toward greater transparency, it is important that we balance the benefits of making that data broadly available against the need to ensure the privacy and security of individual patient data.”
The widespread availability of data from across the care continuum is vital for assessing the quality of healthcare delivery, yet Medicare makes only 5% of its physician claims data available to the public.  What data CMS does release is often not in a format that is accessible to providers or to consumers, and the request process can be lengthy and confusing.  For Medicare’s data to make a measurable impact on quality and cost, CMS should provide quarterly releases of key datasets, Pollack says, and streamline the process of allowing qualified entities to access information.
The letter follows similar remarks contributed by the American Medical Group Association (AMGA) noting that data transparency and health information exchange are the foundation upon which accountable care will be built.  “Currently, data is fragmented among provider, payer, and government silos, and often jealously protected,” writes Donald W. Fisher, PhD, President and CEO of the AMGA. “This non-system of measurement was barely adequate in a fee-for-service system where providers were not at risk and consumers generally enjoyed low-cost sharing obligations. It is completely inadequate in a value-based system where providers accept risk for improving care and reducing costs and patients are increasingly responsible for paying a greater share of their care.”
Both organizations highlight the importance of data standardization in order to conduct clinical analytics.  “Different measures – even measures that purportedly assess the exact same aspect of care – can result in radically different conclusions about the relative performance of different providers,” Pollack adds. “This simply leads to confusion and diminishes the incentives to improve care. The use of nationally standardized measures tested for validity and reliability, such as those endorsed by the National Quality Forum, limits these problems.”
As the era of “big data” advances, government agencies and healthcare providers must work together to ensure standardized, comprehensive, and transparent data is available to stakeholders as a tool to compare prices and quality for consumers and peers.  The healthcare industry must take action to reduce the fragmentation of data sources, the AHA says, while CMS must make a concerted effort to update and revise its data to keep it current and relevant.
“To accurately assess performance, support risk-based contracting and identify opportunities for improvement, it has become increasingly important to collect and analyze data along every point of the care continuum,” Pollack concludes. “This is an important issue for providers, consumers, Congress and the federal government. The AHA stands ready to assist in any way we can.”



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Is Stage 1 more challenging than Stage 2 Meaningful Use? | EHRintelligence.com

The slow uptick in the number of eligible hospitals and professionals attesting for Stage 2 Meaningful Use has raised concerns about whether the requirements of this next phase of the EHR Incentive Programs are too demanding. But for one hospital recently having completed attestation for Stage 2, the greatest challenge was actually the process of moving from paper to electronic records as part of Stage 1.
“Honestly, Stage 1 for us was the hardest because our facility was using paper before so we went directly from that to a completely computerized electronic health record,” says Megan Shepard, RN, CSD, Clinical Service Director at Odessa Memorial Healthcare Center. “We were going through all these stages all at once — going from paper to starting to use the EHR and then throwing meaningful use on top of that.”
Odessa Memorial Healthcare Center is a critical access hospital in the rural reaches of upstate Washington whose limited resources are evident in the lack of onsite IT support. To achieve meaningful use and claim valuable incentive dollars, the CAH contracts with a division of Inland Northwest Health Services, Engage, to implement and adopt a Meditech EHR system.
“What we are finding right now is that the critical access community by and large does not have the individual or community expertise, exposure, or experience to produce the technology requirements necessary to meet the federal Stage 2 program,” explains Marcia Cheadle, Senior Director of Meaningful Use and Advanced Clinicals for Engage.
According to Cheadle, the trouble with Stage 2 Meaningful Use is predominately on side of EHR vendors rather than that of providers.
“Most facilities would believe that Stage 1 is more difficult because it is all focused on implementation and adoption of programs,” she continues. “However, from a technology standpoint, Stage 2 was significantly more difficult. From a maturity standpoint in the vendor community, the systems were just not truly ready or in sync with the federal requirements.”
In the day-to-day lives of clinicians, the adoption of an EHR system after decades of relying on paper records and workflows represents a significant shift. Adding meaningful use into the mix further complicated matters.
“We had to get them to understand what was important and what we made sure we had to document so things flowed through and we could attest to meaningful use,” Shepard reveals. “For so long, physicians have been so used to writing an order and throwing it to the nurse to verify, validate, and go through the whole process. Now, it is all computerized, so getting them to enter their own orders at the very beginning was a hassle. They didn’t want anything to do with it.”
Despite the pushback, the Washington CAH could not afford to pass on the dollars made available for eligible hospitals in meaningful use.
“Simply implementing an electronic health record in a facility such as ours where are volumes are so small was a tremendous cost,” says Shepard. “Being able to get the reimbursement for it to show that we’re doing everything we need to take care of patients makes a huge difference to our facility and keeping our doors open and us alive.”
Once the obstacles were surmounted in Stage 1, Odessa Memorial Healthcare Center discovered that working toward success in Stage 2 was less of a shock than that initial transition away from paper.
“We were doing so well with Stage 1 so that Stage 2 was pretty simple,” Shepard maintains. “We just kept on doing what we were doing with a couple extra added things. Stage 2 for us wasn’t as hard as Stage 1 because of the amount of changes we were going through at the very beginning.”
Looking forward, Shepard believes the challenge for her facility centers on keeping the momentum going for meaningful use and avoiding any bad habits that could undermine their previous successes. “You have to maintain this standard, this level of care, because even though we attested we still need to attest again. It is not a one-time thing. We need to continue to meet these goals,” she adds.



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HIMSS: EHR users provide better predictions, lower mortality | EHRintelligence.com

Hospitals that have higher levels of EHR adoption and health IT use are more likely to produce better quality care with lower mortality rates, says a new report from HIMSS Analytics.  Organizations that scored higher on the HIMSS EMRAM adoption scale were better able to predict complications and patient mortality while preventing deaths from certain conditions.  As the healthcare industry slowly rises to the challenge of Stage 2 of the EHR Incentive Programs, the study may provide heartening evidence that EHR adoption can indeed produce meaningful returns.
The study examined data from 4,538 hospitals spanning the period from 2010 to 2012, correlating EMRAM scores with Healthgrades quality data.  The researchers chose nineteen categories with which to evaluate predicted mortality rates, actual mortality rates, and a z-score to measure overall improvement on the measures.  The cohorts ranged from stroke and pneumonia care to gastrointestinal surgeries, sepsis, respiratory failure, and diabetic emergency care.
They found that higher EMRAM scores were correlated with improvement in thirteen out of the nineteen categories and no difference in the remaining six. “While the findings are what we would have expected, they’re definitely encouraging to those having invested so much in an EMR and now weathering criticisms,” said Lorren Pettit, HIMSS Analytics Vice President of Market Research. “Given the robustness of the data sets used to conduct this analysis, it’s my hope that we’ve set a standard by which other attempts to evaluate the effectiveness of the EMR will be measured against.”
“The findings of this seminal study are highly encouraging to those seeking evidence supportive of the clinical benefits of the EMR,” the study adds. “Improvements in the predicted mortality rate indicate that hospitals with advanced EMR capabilities are able to capture more information about the patient. This improved data capture involving the patient’s co-morbidities and other risks allow clinicians to better manage patients seen in the hospital, resulting in more positive predicted clinical outcomes.”
Larger academic medical centers in urban areas are more likely to boast higher EMRAM scores, the report says, but HIMSS is quick to point out that the results don’t point to a causal relationship.  More research will be conducted in order to further explore the phenomenon, but for patients, the impact may be immediate.   “These results are vital to the health of millions of Americans,” said Evan Marks, Chief Strategy Officer for Healthgrades. “When selecting hospitals, patients should know how beneficial EMR technology can be to their health outcomes.”



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What work precedes clinical decision support adoption, use? | EHRintelligence.com

Clinical decision support (CDS) has the potential improve decision-making at the point of care. At least, that is the belief of the architects behind meaningful use and its increasing requirements for CDS adoption.
The Office of the National Coordinator for Health Information Technology (ONC) itself claims these types of tools “are particularly attractive for their ability to address the growing information overload clinicians face, and to provide a platform for integrating evidence-based knowledge into care delivery.”
But how do evidence-based medicine become incorporate into the health IT systems being used by clinicians? As it turns out, the process can take several months depending on the state of the information being transformed into CDS — whether it is already digital or printed and in need of encoding.
At the center of recent study by Finnell, Stanton, and Downs (2014), a team of researcher undertook the challenge of evaluating whether the thousands of guidelines comprising Bright Futures could be transferred into CDS.
Recently, EHRIntelligence.com spoke with Stephen Downs, MD, MS, Associate Professor and Director Children’s Health Services Research at the Indiana University School of Medicine. As Downs explains in this one-on-one interview, the process revealed the nuances of translating prose into practice as well as the need for more work to ensure that various specialties — pediatrics and otherwise — have CDS tools available to them.
What did the process of evaluating preventive pediatric care guidelines reveal about transforming written knowledge into electronic tools?
The easiest way to think of it is as if-then rules and unfortunately many guidelines are out there are written as prose and not as clear-cut, which is really what it comes down to. If you meet certain circumstances, you should do certain things. We evaluated whether they met the criteria that would make them relatively easy to transfer. We had to make some judgment calls about whether we thought the intent of the authors was to be recommending that something happen.
What steps were part of the process of weeding out guidelines not suited for CDS encoding?
First, we had to go through and catalogue what we thought were recommendations being made in the book. Then we had to line them all up and eliminate those that were basically duplicative.
The first criterion they paid attention to for a long time is the evidence to support the guideline recommendation you are making. There are lots of metrics out there for documenting what you think the quality of evidence is for a particular recommendation.
The second is the strength of the recommendation. That is relatively new. A little more goes into that — that’s a question of balance of benefits versus harm and the importance of patient preference. Something can have a ton of evidence, but you only want to weakly recommend it because there is a tradeoff of benefits and harms from carrying it out.
The third, which is a brand-new area we were working on in project, is how to make guidelines sufficiently clear so that you can unambiguously teach a computer how to do it.
What would it take to encode Bright Futures into CDS in the clinician’s EHR system?
I chair a group with the American Academy of Pediatrics that we call the Partnership for Policy Implementation, PPI. We work with other American Academy of Pediatrics guideline development groups to help them develop their guidelines in a way that they meet these criteria for implementation. We have not worked with the Bright Futures group, which is why those guidelines don’t meet those criteria for the most part. The academy is very interested in this and presumably we will be working more closely with the Bright Futures committee. They produce a new edition of their preventive care guidelines every few years and we hope to be more involved in the next one.
We have carried a number of the academy guidelines all the way through that pathway. I would say that that system probably has most of the 50 Bright Futures guidelines built into it — not as part of the project, but we have done that.
How does the focus on CDS in pediatrics compare to adult care?
Overall, there is less attention not only with clinical decision support but also all other aspects of electronic health records being paid to the pediatric side because there is not as much money at stake, frankly. On average, children are less expensive to take care of, so there are fewer opportunities to save money. For better or worse, that drives things.
There are certainly lots of people working on clinical decision support for adult care and they have had many successes. Adult preventive care only gets some of the attention. Preventive care is part and parcel of pediatric care. It actually gets less attention in adult medicine. Much of the clinical decision support in adult medicine is not focus on preventive care.
What’s next in terms of focus on CDS in your research?
Our focus right now is on working to make the Child Health Improvement through Computer Automation system, CHICA, a web-based service so that it can be accessed from different EHRs and become a service that is available. Also, we’re interested in expanding into the adult clinical decision support world by encoding the US Preventive Services Task Force guidelines.


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