The following is a fascinating infographic from UC Berkeley School of Information highlighting, very nicely, the information contained in an EHR; the difference between an EMR and an EHR; top specialties to adopt electronic health records, as well as top (and not top) states to adopt the technology.
The information here clearly speaks for itself. According to Berkeley’s School of Information, “data science holds great promise for patient health, but patient data is only actionable in so far as it is digital. This is where EHRs come in. By 2019, the majority of physicians will have adopted a basic EHR system, and with good reason, too. EHRs may reduce outpatient care costs by 3 percent.
This “Electronic Health Records & the Data of Health Care” infographic from datascience@berkeley explores the health data revolution; if nothing else, I thought it was worth a share.
Approximately $20 billion is lost annually in the United States because of medication errors, with the average hospitalized patient subject to at least one medication mistake per day.Alert fatigue is often cited as a reason for these errors—even though alerts generated by clinical decision support (CDS) systems call attention to important information (such as potential drug interactions), excessive alerts wear clinicians down, resulting in boy-who-cries-wolf scenarios. The result: clinicians instinctively override the alerts instead of implementing an override monitoring plan.
Consider the following:
In 2009, researchers at the Boston-based Beth Israel Deaconess Medical Center and the Dana-Farber Cancer Institute looked at the safety alerts generated by 2,872 clinicians through 3.5 million electronic prescriptions over a nine-month period. Of the 233,537 alerts, 98 percent were drug-drug interaction issues, and more than 90 percent were overridden.
A more recent 2013 study, published in the Journal of the American Medical Informatics Association, showed improved override rates with only about half of alerts overridden by providers, with half of those overrides classified as appropriate. Authors concluded that further refinement of these alerts could improve relevance and reduce alert fatigue.
A Driver in Need of a Clearer View
The afore-mentioned studies conclude that clinicians are indeed overriding medication alerts at alarming rates. Although the industry has made significant progress in addressing alert fatigue during the time the data from these studies was being analyzed, these studies clearly support what most healthcare professionals already suspect: The practice of ignoring and overriding medication alerts is widespread and can potentially lead to undesirable consequences.
The term “patient engagement” has emerged as this year’s buzz phrase much the same way “patient portals” were a couple years ago and even similar to “electronic health records” and “meaningful use” before that. Volumes of articles, case studies, white papers and educational sessions have been dedicated to the topic of patient engagement and even at this years’ annual HIMSS conference patient engagement as a topic discussed was the rule and not the exception. With every step through the maze of booths in Orlando it seemed as if the words – “patient engagement” — were whispered and shouted from every direction.
Patient engagement is now synonymous with health IT, yet the topic is proving to be one of healthcare’s stickiest wickets because no matter whom or how many people you ask there seems to be a different response or definition to the term and how it is achieved.
With all of this uncertainty and confusion about patient engagement, I set out to see if I could define the term by asking a number of health IT insiders what they thought “patient engagement” meant, or what it meant to them. Their insightful and educational responses are what follow.
CrowdMed is a website that uses the “wisdom of crowds” to solve medical cases quickly and accurately online. We provide a place for patients to post their symptoms and broadcast their cases to our medical detective community, which includes doctors, med students and patients themselves. Our medical detectives collaborate to solve each case and suggest possible diagnoses. Our system assigns a probability to each diagnosis based on our research and the behavior of the medical detectives who worked on the case. Once enough medical detectives have participated in a case, we deliver an extensive report to the patient. Just like that, we’ve gotten a patent a second, third, 50th opinion without any invasive tests and unnecessary doctor visits.
We tested our system on cases with known diagnoses that cost patients hundreds of thousands of dollars, lasted many years, and taken dozens doctors to solve—my case included. We were able to solve these cases in a matter of weeks, at a fraction of the cost.
Now we’ve helped diagnose 200 of the world’s most difficult medical cases, and that’s only the beginning. By designing a site that simplifies complex medical data, connects patients with the people who understand this data, and uses statistics and technology to uncover answers, we’re making medical diagnoses more accessible to everyone.
We’re crowdsourcing medical diagnoses.
During my junior year of college I got sick. My appetite disappeared. I had difficulty remembering things. I always felt cold, and I started losing my hair.
I visited the university health center. They sent me to a doctor, who sent me to a specialist, who sent me to more specialists for testing. I was biopsied, scanned and blood tested—often multiple times a month. The uncertainty, stress and financial burden this placed on me was crippling—especially as a college student.
After months of poking and prodding, I finally got my diagnosis: a thyroid disorder with a very simple treatment. I take one pill in the morning, every day. Compared to all the terrible possible diagnoses and treatments my doctors were considering, this was a huge relief. The process of finding the name for my condition, so that I could get the proper treatment, turned out to be far more painful than the treatment itself.
No matter what the discussion is or who you are talking with, this often seems to be the big question. It’s not enough to say “what;” what matters is, “What’s Next?”
Healthcare: This area is the largest, fastest growing and perhaps the fastest changing element of our economy and lives. As a result, just about every conversation we have about healthcare involves a “What’s next?” discussion.
At Fathom, we have the privilege of spending a lot of time exploring what’s next in healthcare marketing and communications. Based on our conversations, observations and research, here is a list of the top 10 tech trends every hospital and healthcare professional should know about.
Predictive analytics. Real time isn’t fast enough. Predictive analytics—or the systematic use of data to predict patient behavior—will usher a big shift in the quality of care. By analyzing hospital data, social media conversations and search patterns, hospitals can predict patient behavior and needs. Hospitals can predict and be ready for flu outbreaks. By analyzing historical admissions data, weather patterns and census data, hospitals can predict emergency room volume and staff for it. Healthcare systems can even look ahead 10 or 20 years and predict the need for cancer care or assisted-living facilities with population data.
Wearables. Wearable devices can monitor blood pressure, heart rate, insulin levels and more. Forget the simple devices we use today: The next generation of wearables will elevate health monitoring to the next level. All this information can also be shared in real time with a healthcare provider, making it part of a larger trend: Partnership between patients and providers.
Given the tremendous and on-going changes currently taking place in health IT, especially the recent delay in ICD-10, and the ever on-going issues surrounding meaningful use, we remain in a turbulent, yet revolutionary time in the industry. As changes continue to come and behaviors, habits, further reform is activated and enforced, there will only be more of a focus on where we are headed from a technology standpoint.
Given the multiple balls health IT leaders are currently juggling and the rapid changes they are facing from new technology and managing tools that were once thought to be saviors of the sector – patient portals come to mind – I and they are left to wonder what’s next for health IT. With that lingering question, I asked a few folks working directly in the space what they think will occupy the minds of health IT leaders for the short term.
The delay in ICD-10 implementation was met with equal parts relief and frustration. As the healthcare IT industry is evolving, government and regulatory authorities have come up with several certifications to enhance the quality of care for patients. For example, meaningful use incentives have created an artificial market for dozens of immature EHR products. Many EHR vendors have been preoccupied with backlogged implementations and have neglected the usability and innovation of their EHR products. Most concerning to current EHR users are unmet pleas for sophisticated interfaces with other practice programs and complex connectivity, pacing with accountable care progresses and the rapid EHR adoption of mobile devices. Many popular “one size fits all” EHR products have failed to meet the needs of several medical specialties.
Distracted by the process of certifying their EHR products for Stage 2 of meaningful use, not all software vendors have been able to deliver on their Meaningful Use 2 promises to anxious providers; 40 percent of the practices are replacing their EHR systems, as their current systems are cumbersome to use, not integrated, not able to meet regulatory compliance, outdated, have interoperability challenges, inefficient customer support, lacks specialty specific workflow and are not mobile enabled.
Stacy Leidwinger, vice president of product marketing, RES Software
A top concern in healthcare right now is securing patient health records. Although the clinical details themselves contain little financial value, the records contain personal patient details that can easily result in stolen identity or credit card information.
In the US, nearly 3 trillion dollars per year is spent on healthcare, which translates to everyone from physicians and pharmacists to well-organized crime syndicates targeting healthcare, usually through the use of stolen patient records and identities.
Two of the weakest points in healthcare security are 1) people tending to underestimate security risks, therefore, becoming vulnerable to social engineering, and 2) the fact that endpoints can’t be physically secured in many cases while continuing to provide needed value. Patients need to take a more serious approach in choosing a healthcare organization by making it clear that they “trust” their provider.
Lindy Benton, CEO of MEA|NEA, has worked in the healthcare information technology for more than 20 years. Before joining MEA|NEA, Lindy served as divisional executive at Sage Healthcare, managing 1,400 employees, and prior to that she worked at Cerner for 15 years. MEA|NEA has nearly 20 years’ experience in providing revenue cycle enhancement solutions for payers and providers, as well as managing the secure exchange of health information, providing critical functionality to payers, medical and dental providers and other agents. Its solutions facilitate secure electronic requests for medical records and documentation to connected network providers for payment integrity, risk adjustment, audit tracking, performance/quality measures, claim attachments and more. Similarly, its technology enables providers to gain productivity via the electronic capture, storage and submissions of healthcare documentation – and to more effectively manage their revenue cycle and reduce claim denials.
Here she speaks about MEA|NEA, electronic attachments and secure health information exchange, how MEA|NEA serves healthcare and some of the most pressing issues facing healthcare’s leaders today.
Tell me more about yourself and your role at MEA|NEA.
I have worked in the healthcare information technology for more than 20 years. I am currently the CEO of MEA|NEA, a provider of electronic attachment and health information exchange solution.
Who uses the company’s products, and how are they enhancing their health systems and practices?
We have three major client sets. One is providers. They represent the point of origin for most medical records. One is payers or managed care organizations. They are often the requestors of medical record information about the members enrolled in one of their health plans. And the third we call partners who are those organizations who sit in-between the originators of medical record information and the requestors of medical record information. The enhancements you ask about are intuitive and real. We enhance the exchange of medical record protected health information – or phi – by making it 100 percent electronic, trackable and auditable.
In what ways is MEA|NEA evolving and where are you seeing the most change, the most rapidly?
With the increased focus on outcomes in healthcare in America, we are seeing an increase in the demand for medical record reviews. We see this increasingly being driven by the federal government, but the commercial sector is also participating. There are companies whose sole purpose is to audit the care being provided to patient populations and the reimbursement of charges related to that care. “Payment integrity” is commonly referenced in the industry today, and that wasn’t the case until recently. We are leading in process efficiencies to support these changes.
Tell me more about your involvement with CMS. How have the company and its strategy changed since the adoption of electronic claims submission through Medicare?
In January 2012 we began delivering medical records to Medicare contractors as one of a few organizations certified by CMS to do so. Today there are 23 certified organizations and we are the largest serving the acute-care hospitals of the nation. We are the 2nd largest overall. Since 2012 we have been selected by four organizations who are listed on the www.cms.gov website as their technology partner. We have a strong relationship with key leaders inside of CMS and we plan to continue to invest there. With 15 percent of US healthcare being tied to Medicare, this is a key component of our future in the medical marketplace.
Guest post by Ken Perez, vice president of healthcare policy, Omnicell.
Section 4503 of the Balanced Budget Act of 1997, enacted on Aug. 5, 1997, replaced the Medicare Volume Performance Standard (MVPS) with the sustainable growth rate (SGR) provision, a formulaic approach intended to restrain the growth of Medicare spending on physician services. The SGR formula incorporates medical inflation, the projected growth of per capita gross domestic product (GDP), projected growth in the number of Medicare beneficiaries, and changes in law or regulation.
The SGR requires Medicare each year to set a total budget for spending on physician services for the following year. If actual spending exceeds that budget, the Medicare conversion factor that is applied to more than 7,400 unique covered physician and therapy services in subsequent years is to be reduced so that over time, cumulative actual spending will not exceed cumulative budgeted (targeted) spending, with April 1, 1996, as the starting point for both.
In part because of the effective lobbying efforts of physicians, Congress has temporarily suspended application of the SGR by passing legislative overrides or “doc fixes” 17 times from 2003 to 2014. (It utilized five different pieces of legislation in 2010 alone to avoid cuts exceeding 20 percent.) As a result, actual spending has exceeded budget every year during these years. Because the annual fee update must be adjusted not only for the prior year’s variance between budgeted and actual spending but also for the cumulative variance since 1996, the next proposed update, effective April 1, 2015, is a reduction in Medicare physician fees of 20.9 percent.
Those hoping for a permanent repeal of the SGR—which is pretty much everybody, given the almost universal disdain for it—entered 2014 with a sense of optimism that this would be the year. These hopes were fueled by bipartisan and bicameral support of SGR reform proposals that emerged at the end of 2013 and significantly lower estimates by the Congressional Budget Office (CBO) of the cost of a long-term doc fix.
Ultimately, the inability to figure out how to pay for the SGR repeal blocked the passage of the permanent reform bills, and Congress settled for yet another short-term patch. On March 27, 2014, the House of Representatives, under a suspension of normal rules, approved via a voice vote H.R. 4302, the Protecting Access to Medicare Act of 2014. The bill provides a patch to the SGR that would avoid a 24.4 percent reduction to Medicare’s Physician Fee Schedule (PFS), effective April 1, 2014, replacing the scheduled reduction with a 0.5 percent increase to the PFS through Dec. 31, 2014, and a 0 percent increase for Jan. 1, 2015, through March 31, 2015. Four days later, the Senate approved H.R. 4302 on a bipartisan 64-35 vote, and President Barack Obama signed the bill into law.
Love this recent image by Capterra, identifying the top 20 most popular EHR software solutions. As former vendor employee, these are the data that I was always forced to defend or promote. The company I once worked for is still among one of the top 10 vendors in the space, according to the following graphic, so I take some pride in having helped build it into what is today (if only marginally).
Perhaps this list is a bit subjective. Popularity of the vendor is measured by a combination of its total number of customers, users and social presence. So, even if the company’s products are not all that great (which may or may not be the case), at least they’re doing something right socially.
Capterra developed the list in part because of mass migration to EHRs — “Providers across the country are scrambling to make sure they’ve implemented the right EHR solution for their hospital or practice, while many more are still looking to identify the right solution.”
Capterra cites a Robert Wood Johnson Foundation that states that nearly 40 percent of U.S. physicians adopted at least a basic electronic health record system, and according to another survey in 2013 by Black Book, one in six medical practices were in the process of changing from their first EHR solution.
Essentially, accordingly, EHR solutions have to be “user-friendly, functional and able to withstand a growing market to retain customers.”
To determine these 20 electronic health record leaders, Capterra used a popularity index based on the number of customers, number of users, and social presence of each of the EHR companies.
Increased engagement through patient portals remains a health initiative and a benchmark for meaningful use incentives, yet a large number of patients report being unaware of their ability to access medical information and communicate with healthcare providers through this medium.
A recent study by TechnologyAdvice shows nearly 40 percent of patients are unsure if their primary care physician has a patient portal website available, while another 11 percent are confident their physician “does not” offer one. In all, less than half of the 430 patients surveyed — 49.2 percent — report actually being shown a patient portal by their primary care physician either during a visit or outside a visit.
“With incentives tied to digital patient engagement and a general shift to integrated platforms taking place, all signals point to patient portals becoming increasingly prominent in the patient-physician relationship. However, it appears many physicians are not doing enough to educate patients about their portals and provide incentives for their use,” said TechnologyAdvice editorial coordinator Cameron Graham, who authored the study. “This lack of patient portal awareness appears to be slowing down a significant digital switch in patient-physician communication, considering the study also shows there is little change in the way patients prefer to interact with their doctors.”
Nearly 43 percent of patients say they prefer that doctors contact them by phone for general communication and to provide test results. These preferences are true even for the 18 through 24 age group, though, the younger respondents did report a greater preference for scheduling appointments online.
Guest post by Dean Wiech, managing director, Tools4ever.
Once again, the media abuzz with a massive theft – 1.2 billion email addresses and password – by a hacking group supposedly based out of Russia. In a case like this, it does not matter how secure your password is – lots of characters, number, upper and lower case, etc. — because the hackers accessed the providers and pulled the information. This type of attack is much different than someone breaking into your computer or smart device and stealing the confidential information from there where a thief might be able to directly access all your accounts. In this case, they “might” be able to access your email account and then again, they might not.
There a couple of interesting items left out of all the various stories. First, were the passwords encrypted? It seems that any self-respecting form that is strong passwords in conjunction with a user name would do something as simple as an encryption algorithm and not store them in plain text. If they were encrypted, were they stored using an irreversible hash with a leading edge algorithm? Many techniques are readily available to insure encryption with hashing, salting and obfuscation, cannot be easily broken, if at all.
The other thing that has not been explicitly mentioned is what sites were hacked. We hear that upwards of 500,000 websites could have been hacked, but no one is coming forward to name any specific sites. Were Facebook, Gmail, Hotmail or other major sites compromised? If so, why are they not sending out notifications to change passwords in a similar fashion to what eBay did back in May when they were attacked?
Let’s assume, for a moment, the providers figured no one could ever hack into their systems so the passwords were stored in plain text along with the email addresses. How can we protect ourselves from these diabolical hackers? The answer is quite easy – change your passwords on all of your accounts and do it on a regular basis. If all 1.2 billion users that had their information stolen did this tomorrow, the hacked information would become useless overnight.
Results of the inaugural 2014 HIMSS Cloud Survey show the widespread adoption of cloud services among healthcare organizations across the U.S., with 80 percent of the 150 respondents reporting they currently use cloud services. The top three reasons for adopting cloud services include lower maintenance costs, speed of deployment and lack of internal staffing resources. The survey shows a positive growth outlook for cloud services as almost all healthcare organizations currently using cloud services plan to expand their use of these tools.
Half of the cloud adopters are hosting clinical applications in the cloud, primarily using Software as a Service (SaaS). Other typical cloud services include health information exchange (HIE), hosting human resources applications and data as well as backup and disaster recovery.
“Cloud services have been long praised as a tool to reduce operating expenses for healthcare organizations. The data presented in our inaugural survey demonstrates the healthcare industry’s eagerness to leverage this resource,” said Lorren Pettit, Vice President of Market Research for HIMSS Analytics. “With such a positive market outlook, we hope vendors will leverage the business intelligence gleaned from this report, continue working with providers to meet their needs, and help healthcare organizations provide the most cost-efficient care.”
Healthcare organizations take into consideration a number of factors when selecting a cloud services provider. The top concerns for healthcare organizations seeking cloud services are the cloud services provider’s willingness to enter into a business associate agreement (BAA) as well as physical and technical security.
Even after a cloud services provider has been selected and the cloud services have been adopted by the healthcare organization, there are still challenges. Two-thirds of healthcare organizations have challenges, including a lack of visibility into ongoing operations, customer service, as well as costs and fees.
Half of the respondents also identified performance issues, such as slow responsiveness of hosted applications as a problem, but were willing to work with their existing cloud service provider to resolve their issues, rather than switch to a new one.
Lance Speck, general manager of Actian cloud and healthcare, speaks here about healthcare big data and how it can be used in healthcare to improve processes from care coordination to coding for ICD-10. In his day job, he is focused on delivering healthcare solutions to help payers and providers address an estimated $450 billion annual opportunity created through data analytics, ranging from fraud analytics to patient re-admission reduction to staff optimization to accountable care reporting and clinical auto-coding. For more than 20 years, Lance has served in a variety of management, sales and product roles in the software industry including a decade focused on SaaS, cloud and healthcare.
How can big data analytics improve patient care?
According to a recent PwC survey, 95 percent of healthcare CEOs are exploring better ways of using and managing big data; however, only 36 percent have made any headway in getting to grips with big data. All agree that big data analytics has the potential to improve the quality and cost of care, but many are still struggling with finding the right ways to infuse analytics into everyday operations. Assuming they realize that they already have access to the data, what do they do with it? What are the areas that will have the biggest impact? Where do they start?
Start with the basics. Organizations should focus in infusing big data analytics where a big impact can be recognized. They should ask themselves:
Is there enough value in solving the problem?
Can the problem can be predicted?
Can the problem be prevented?
Can the predictive action be delivered accurately, and in a timely fashion to make a difference?
Very early in the process, organizations should address how they plan to incorporate big data into the everyday workflow of clinicians, financial staff and other healthcare stakeholders for organizations to:
Use predictive analytics against historical and external data to anticipate patient occupancy needs to adjust staffing levels to have the right care available at the right time.
Use science to determine with accuracy health trends in specific communities and take action to prevent costly
Determine patients’ risk of readmission before they are discharged to improve patient outcomes and reduce costs and penalties by nearly $70 billion.
Realize that for this insight to be effective, you must put this information into the hands of the clinicians and the patients in the format that fits their daily flow.
How can healthcare providers transition to ICD-10 as simply as possible?
Significant increases in the use of electronic health records (EHRs) among the nation’s physicians and hospitals are detailed in two new studies published today by the HHS Office of the National Coordinator for Health Information Technology (ONC).
The studies, published in the journal Health Affairs, found that in 2013, almost eight in 10 (78 percent) office-based physicians reported they adopted some type of EHR system. About half of all physicians (48 percent) had an EHR system with advanced functionalities in 2013, a doubling of the adoption rate in 2009.
About six in 10 (59 percent) hospitals had adopted an EHR system with certain advanced functionalities in 2013, quadruple the percentage for 2010. Unlike the physician study, the hospital study does not have an equivalent, established measure of adoption of some type of EHR system; it only reports on adoption of EHRs with advanced functionalities.
“Patients are seeing the benefits of health IT as a result of the significant strides that have been made in the adoption and meaningful use of electronic health records,” said Karen DeSalvo, M.D., M.P.H., national coordinator for health information technology. “We look forward to working with our partners to ensure that people’s digital health information follows them across the care continuum so it will be there when it matters most.”
In May 2014, the Department of Health and Human Services released findings of their most recent study pertaining to reimbursement amounts provided to outpatient physicians for evaluation and management services. The study uncovered that Medicare overpaid outpatient physicians close to $7 billion and most improper payments were results of errors in coding and insufficient documentation (Table 1, highlights the percentage of claims that were wrongfully claimed for in 2010.). However this is not a problem isolated to physicians from the outpatient clinics, as physicians from inpatient clinics could also be found guilty of miscoding and insufficient documentation.
Recovery audit contractors (RACs) were created by the Medicare Modernization Act to evaluate the accuracy of Medicare claims. If a claim is determined by RAC to be flawed for any one of the many different reasons, the claim is denied. Although Medicare’s retrospective program of auditing bills is good, it is not perfect. There has been a huge spike in appeals of Medicare payment decisions, from hospitals mainly, since the introduction of the auditing program and delays in the appeal process has resulted in hospitals facing great financial difficulties as a lot of their funds are tied up till the appeal has been heard.
Adapted from : “Improper payments for evaluation and management services cost medicare billions in 2010”
In order to receive reimbursement from Medicare, a physician needs to follow a three-step process: 1) appropriate coding of the service provided by utilising current procedural terminology (CPT); 2) appropriate coding of the diagnosis using ICD-9 code; and 3) the Centers for Medicare and Medicaid Services (CMS) determination of the appropriate fee based on the resources-based relative value scale (RBRVS). It is not surprising that physicians often incorrectly code patient visits and procedures as there exists a truly daunting number of codes from which to choose. Moreover, coding structure and reimbursements schemes are constantly evolving and becoming more complex, resulting in a coding process that is often cumbersome and difficult.