Results of the 24th Annual HIMSS Leadership Survey: Health IT Remains Strong

Along with HIMSS’ largest money maker of the year — its annual conference — it’s also time for the results of its annual leadership survey.

While the results, which are reflected in the infographic below, are certainly interesting there is one point that seems to raise a flag immediately.

Prior to that, however, let’s take a quick look at the results. Accordingly, about 66 percent of the all health IT leaders say their organization qualified for meaningful use Stage 1 and 75 percent of the same folks expect to qualify for Stage 2. Additionally, nearly 90 percent of those who took the survey say they be ready for the ICD-10 switch later this year.

As such, there’s quite a need to hire new IT folks to carry the torch.

Next, it appears that nearly 20 percent of respondents said their health systems’ security was breech (at least those who admitted as much) and that 22 percent of said security was a priority for the coming year, which should be the case if 20 percent of them faced a security issue.

I understand the scope of the survey and who its respondents are, but doesn’t it strike anyone else as slightly odd that all of the changes to come are related to the IT? All, or much, of the reform is designed to engage patients and bring them closer to their care providers? Shouldn’t it be implemented to help improve outcomes and to drive better results and make the system more fluid? I guess IT is going to be what get’s us there.  But along the way, couldn’t more be done at the care level as well as the IT level? Could some of the hiring take place to serve patients rather than the practice?

I digress. Apparently, for now, we’ll have to be thankful that all of this change is leading to improved job growth and fixes to the breeches that await us.

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Training Cited as Key Concern Regarding State of EHR Implementations in Healthcare Industry

A straightforward piece of news from TEKsystems Healthcare Services, a provider of workforce planning, human capital management and IT services to the healthcare industry, showing the following results a joint survey with HIMSS Analytics regarding health organizations’ readiness pertaining to the implementation of electronic health record (EHR) systems.

According to TEKsystems, the survey shows insights into the status of EHR implementations, the challenges healthcare organizations face and areas of improvement; TEKsystems and HIMSS Analytics surveyed 300 single and multi-hospital organizations and health professionals throughout the United States. Key findings include:

Current State of EHR Implementations

Achieving end user adoption

“Achieving meaningful use and truly improving the quality of patient care can only happen if end users fully adopt a new EHR system in an acceptable timeframe. Organizations expect their people to adapt quickly, yet many do not plan for end user training until late in the effort,” says , TEKsystems vice president of healthcare services. “Upfront training strategy development would allow for the identification of key competencies and performance indicators. As organizations transition from implementation to day-to-day operations, any deficiencies in the ability to meet the targets can be pinpointed to either a specific user group, department or globally as indicated by analytics and aligning remediation accordingly. Developing an effective adoption strategy is a critical step that needs to be detailed earlier in the process and carried throughout the life of the initiative. That includes finding the appropriate resources necessary for building, integrating and conducting the training.”

Bringing in the right people and skills

“The supply of HIT talent is not keeping pace with the demand –  from clinical trainers, builders and consultants to project and program managers. Finding the necessary resources can be a daunting task for many organizations, but one that is essential to achieving a successful EHR implementation,” continues Kriete. “That includes finding the right principal trainers and scaling to meet the overall training and adoption needs.

Conducting an impactful training experience for the end users

“The importance of effective training cannot be overlooked. To avoid these outcomes, organizations must proactively build a customized training program that is led by educators with clinical and technical EHR experience. The training cannot simply be ‘off-the-shelf.’ It should align with the overall organizational goals, workflows, technical requirements and end-user job roles” states Kriete. “One method for ensuring a training program is effective and builds confidence within an organization is to engage end users, those using the system on a day-to-day basis, in the development of the curriculum.”

“In addition to leveraging end users in this process, efforts should be taken to combine synchronous and asynchronous learning methods to foster a learning environment that meets the needs of the adult learner and their hectic schedules and a learning environment that is not bound by space or time” says Von Baker, TEKsystems healthcare practice director.

Including end users in the process

“This study shows the majority of executives and decision makers are engaged in the implementation process, but unfortunately, this is not the case with end users. Giving end users the opportunity to provide feedback during the development of and during the training boosts their sense of ownership and increases their confidence in the system post-implementation,” comments Baker.

Continuing to support end users after go-live

“The work does not stop once the implementation is complete. Providing post go-live support is critical to ensure the end users fully adopt the system. Best practice is to create performance support tools for end users to have ready access to how-to reference guides when the needs arise – self service.  The right blend of performance support tools depends on the organizations culture, internal drivers (i.e. varied workflows, varied specialties, and geographically dispersed facilities), and available technology. Underestimating the amount and degree of post go-live support can cause a decrease in productivity and performance and increase end-user frustration,” concludes Baker.

About TEKsystems Healthcare Services

TEKsystems Healthcare Services is dedicated to providing workforce planning, human capital management and IT services to the healthcare industry. Utilizing its suite of services, including EHR Implementation Support, ICD-10 Support and Data Services for BI, Reporting and Data Warehousing, they help healthcare organizations accomplish critical initiatives related to meaningful use, compliance, analytics, network transformation and revenue cycle management.

The Sequester: Analysis of Its Impact on Healthcare

Thanks to Ken Perez, senior vice president of marketing and director of healthcare policy at MedeAnalytics, for forwarding me the following very concise, yet detailed information about the sequester and its impact on healthcare from a white paper he drafted on the subject.

For those of you wanting to know more about how the sequestration came to be and the purpose for the reduction in spending over the next 10 years, Perez and MedeAnalytics do a great job describing the reasoning for it and its potential impact to the healthcare community in “The Sequester: Analysis of Its Impact on Healthcare.”

Thanks, Ken, for offering us a nonpartisan view of the sequester. We appreciate the objectivity to what’s become a very subjective debate. If after reviewing the following information and you have any questions or comments, leave them in the comment section. If they are for Perez, I’ll make sure he gets them and can respond.

Background of the Sequester

The Budget Control Act of 2011 (BCA) was the compromise legislative solution that enabled the United States to get through the debt crisis of the summer of 2011. The act was passed by the House of Representatives on Aug. 1, 2011, by a vote of 269-161, and by the Senate on the following day by a vote of 74-26. The BCA was signed into law by President Barack Obama on Aug. 2, 2011 as Public Law 112-25.

The intent of the BCA was to rein in long-term federal spending and raise the debt ceiling. To those ends, it put in motion $917 billion in cuts to discretionary spending (excluding Medicare) over 10 years and raised the debt ceiling by $900 billion.

In addition, the BCA created a 12-member Joint Committee of Congress (also known as the “Super Committee”) to produce proposed legislation that would reduce the deficit by at least $1.5 trillion over 10 years.

The act mandated a sequestration process (or sequester) that would be triggered if the Joint Committee was unable to agree upon a proposal with at least $1.2 trillion in spending cuts. Ultimately, to no one’s surprise, the Joint Committee failed to reach an agreement, and the sequestration process was triggered. Per the sequester: 1) The President could request a debt limit increase of up to $1.2 trillion; and 2) across-the-board cuts equal to the debt limit increase would apply to both mandatory and discretionary programs, with total reductions split equally between defense and non-defense functions.

The across-the-board spending cuts would be implemented from FY 2013 through FY 2021, a period of nine years, and apply to both mandatory and discretionary programs. The cut to Medicare would be capped at two percent and limited to cuts to provider payments.

Exempt from the cuts were Medicaid, welfare programs (e.g., food stamps), and other low-income subsidies, as well as Social Security, veterans’ benefits, civilian and military retirement, and net interest payments.

What would be the annual reduction by function of the sequester? Per Table 1, starting with the total reduction of $1.2 trillion to be applied over the nine-year period, a specified 18 percent for debt service savings is deducted, and then the result is divided by nine to arrive at the annual reduction of $109.3 billion for each year for FY 2013 through FY 2021. In every year, the annual reduction is split evenly between defense and non-defense functions, resulting in a $54.7 billion reduction for each function.

The Impact on Medicare of the Original Sequester

According to a September 2012 report from the Office of Management and Budget (OMB), the sequester would pare Medicare in FY 2013 by $11.8 billion, with the following distribution of the cuts:

The American Taxpayer Relief Act of 2012

In early January 2013, Congress averted the so-called “fiscal cliff” by passing the American Taxpayer Relief Act of 2012, Public Law 112-240, which, among many things, pushed out the implementation of the sequester until March 1, 2013, reducing the total cut for FY 2013 by $24 billion or 22 percent to $85.3 billion.

The Enactment of the Revised Sequester and Its Impact on Healthcare

Through March 1, 2013, President Obama and congressional leaders were unable to reach an agreement to avert the automatic spending cuts of the revised sequester.

According to the Congressional Budget Office and per Table 2, for FY 2013, the total cut of $85.3 billion includes $42.7 billion in cuts to defense, $9.9 billion in cuts to Medicare, and $32.8 billion in cuts to other non-defense programs.

Medicare accounts for 12 percent of the total cut and 23 percent of the nondefense portion. How might the $9.9 billion in cuts to Medicare be allocated? In the absence of further guidance from the OMB, a reasonable approach would be to apply the same proportions as the aforementioned September 2012 OMB report. This would yield the allocation reflected in Table 3, with Medicare Parts A and B sustaining the lion’s share of the cuts.

Medicare Part A could be cut by $4.9 billion, which could include an estimated $3.1 billion cut to the Hospital Inpatient Prospective Payment System (IPPS). This cut to the IPPS would translate into an estimated $0.9 million reduction in Medicare reimbursement for the average hospital.

Medicare Part B could be cut by $4.4 billion, which could include an estimated $1.7 billion cut to physician payments and a $0.7 billion cut to the Hospital Outpatient Prospective Payment System (OPPS).

According to the rule for sequestration, reductions in Medicare will begin in the month after the sequestration order is issued, i.e., April 2013, thereby delaying some of the effect on outlays until the ensuing fiscal year. Thus, for the federal government’s FY 2013, which ends September 30, 2013, the following could be the actual cuts:

Conclusion

The sequester clearly affects healthcare providers in FY 2013 in a material way. Unless it is repealed by Congress, the BCA — with its annual $109.3 billion sequester cuts for each of the next eight years — will raise the specter of two-percent funding reductions for hospitals and physicians on a yearly basis.

Because of the significance of healthcare to the federal budget and the nation’s economy, the broader philosophical and fiscal debate between the two political parties on what is the best way to reduce the deficit and engender economic growth will continue to impact the reimbursement rate-setting process.

HIMSS’ Must See Sessions from those Who Will Be In Attendance

As a service to readers of Electronic Health Reporter I decided to ask its readers which sessions they most wanted to see at HIMSS13. For the record, I have attended HIMSS more than once so I understand how overwhelming it can be. However, I also understand that there are plenty of great resources available to those in attendance regarding which events to attend. Certainly, what I offer here is by no means authoritative nor is it objective.

Thus, I leave it up to you to decide what you are going to do while in New Orleans. All I can say is thanks for reading. I hope this helps.

Other sessions of note:

Social Media Is King When It Comes to Marketing a Medical Practice to Patients and Engaging Them

There continues to be a great deal of talk about the need to marketing a medical practice to patients as a way to engage patients and build a loyal patient following.

However, the strategies that practice leaders can take to engage those they serve seems somewhat elusive.

With Meaningful use reform continuing to bear down and patient engagement ever more important because if it, I decided to ask a few readers of Electronic Health Reporter what tactics they would take to encourage practices to market their practices and, ultimately, engage their patients.

Here are a couple of the responses I received:

Susan M. Tellem, RN, BSN

Physicians need to market their practices using free and easily accessible practices. For example:

Vicki Radner, MD

Likewise, Radner says. “Get social! Social media can and should be part of each physicians’ marketing plan. Create a blog post, Facebook entry and a tweet that describes your practice and its technology in a client-centered way. For example, ‘Want more control over your medical story? Sign up for the patient portal.’”

Clearly, social is king. I’m not surprised. Each of the responses I received were similar in nature. I would recommend the same approaches to anyone who asked because they are effective and because they are free.

In the current market, we go where those we want to serve are and we capture their attention by informing them, educating them and engaging them. Social media does just that and with a little premeditated thought, a marketing campaign can be quickly and easily implemented.

Like all things done for the first time, there may be some excitement and some fear. This is perfectly normal. Practice and repetition will help, ad in the beginning, while you are building your campaign you’ll be able to practice.

Something else to consider when creating a marketing campaign for a practice is to find people who are conducting successful campaigns and start to follow their example. There are real leaders already doing great things as far as educating and engaging patients. Do a little research and find people you can relate to then use their strategies to build your own program.

I’d love to hear more strategies for marketing a practice to patients. If you feel like sharing yours, feel free to leave a comment below.

Electronic Health Records: Money Pit or Bang for the Buck? The Economics of EHR

Electronic Health Records: Money Pit or Bang for the Buck? The Economics of EHR
Farrell

Guest post by David Farrell, PA Consulting Group.

In the past decade, academics and industry experts have published conflicting reports on whether electronic health records (EHRs) actually save money. Recent studies based on large, historical data from diverse providers suggest that EHRs haven[i]’t decreased costs[ii] [iii]  – contrast this with cost benefit analyses published back in 2003 that predicted EHRs would save around $15,000 to $20,000 per primary care physician per year[iv][v]. In addition, multiple vendors, academics and industry experts have published positive case studies on how EHR provides a positive return on investment or saves money in areas such as billing and staffing costs.

So why the divergence? Are providers simply not achieving what we expected in 2003? Are the positive case studies overly selective? Is it a case of what’s true for some is not true for all?

EHRs actually enable more productivity and satisfy more demand, and this is what drives cost. For providers, this also means driving up revenues.

Supply and Demand

One reason healthcare costs have not uniformly decreased is that more (efficient) supply from EHRs leads to more demand.

Firstly, consider the Jevons Paradox: energy efficiency leads to greater consumption (e.g. as air conditioning becomes more efficient and affordable, more air conditioners are purchased.) Taking a healthcare analogy, data center capacity has grown exponentially and EHR functionality has improved in recent years. In response, providers are storing larger amounts of detailed patient data and accessing greater capabilities. For example, providers are integrating IT and medical devices for real time patient data monitoring, storage and beyond. Additionally, a 2012 study supports this theory in that physicians ordered 40 percent to 70 percent more radiology exams with EHRs than with paper records. The efficiency and capability of EHRs (supply) have driven up the demand.

Secondly, I’ll paraphrase Parkinson’s Law: work expands to fill the time available. Demand for services in (public) healthcare will always outstrip the supply. This is because there is a backlog of patients waiting for currently available services and once this backlog is cleared, expectations of what should be provided will increase. It is therefore important to recognize that current health care reforms may not automatically decrease costs with EMRs in place, as demand will then increase too.

Increased demand means increased cost.

Productivity

So if cost doesn’t uniformly decrease with EHRs, does anything improve? Productivity does. A 2009 Wisconsin Medical Journal Study[vi] found that physician productivity increased about 20 percent and remained at that sustained level of productivity following EHR implementation. This means that more patients were seen on a given day. Not bad, considering the average wait time to see a physician in the U.S. is 20 days.

Increased productivity, however, leads to increased costs.

Payers vs. Providers

Another way to explain the divergence may lie in who we’re actually talking about. Do we mean payers like Medicaid/Medicare or providers like primary care physicians or hospitals? Studies often reference cost but fail to discuss revenue increases that an EHR system delivers to providers. Seeing more patients means more revenue to providers. In addition, providers with integrated EHR and billing benefit by eliminating billing errors and enabling better revenue protection. Payers, however, don’t share these financial benefits as more procedures means their costs are rising.  Indeed, payers may not realize the full cost savings of EHR until providers move away from pay-per-procedure to quality based payments.  Quality based payments of course, are next to impossible without the enabling reporting capabilities of EHR systems.

So when we talk about the cost of EHR systems, it’s important to distinguish who we’re talking about. In addition, when comparing pre- and post-EHR situations, instead of simply asking: “What’s the cost?” we should also be asking “What do we get for this cost?”

David Farrell is an IT strategy specialist at PA Consulting Group, focusing on project management and strategy for healthcare providers. He has worked with accountable care organizations and county-run hospitals on both U.S. coasts, assisting clients in building business cases, managing project benefits and forecasting the long term infrastructure impact of EHR. 

 

[i] Physicians Electronic Access To Patients’ Prior Imaging And Lab Results Did Not Deter Ordering Of Tests , Journal Of Health Affairs, 2012, http://content.healthaffairs.org/content/31/3/488.abstract

[ii] Hospital Computing and the Costs and Quality of Care: A National Study, American Journal of Medicine,2010 http://www.pnhp.org/sites/default/files/docs/AJM-Himmelstein-Hospital-Computing.pdf

[iii] Electronic Medical Records: Lessons from Small Physician’s Practices, iHealth Reports, 2003  http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/E/PDF%20EMRLessonsSmallPhyscianPractices.pdf

[iv] A Cost Benefit Analysis of Electronic Medical Records in Primary Care, American Journal of Medicine, 2003, http://www.amjmed.com/article/PIIS0002934303000573/fulltext

[v] Implementing an Electronic Medical Record at a Residency Site: Physicians’ Perceived Effects on Quality of Care, Documentation, and Productivity, Wisconsin Medical Journal, 2009, http://www.wisconsinmedicalsociety.org/_WMS/publications/wmj/pdf/108/2/99.pdf




Better, Safer Healthcare Stories Are Inspired By Technology

Better, Safer Healthcare Stories Are Inspired By Technology
Jackson

Guest post by Steven Jackson, chief operating officer, ExperiaHealth.

Every patient story is unique with engaging plots, complicated characters, emotional twists and turns, but more often than not there is a recurring theme.  Somewhere in the healthcare narrative there are gaps in communication. In fact, according to the Joint Commission, an estimated 80 percent of medical errors are caused by breakdowns in communication.

Whether the disconnect is between internal and external care teams, a patient and a nurse, or in my case, a family member and a physician, any missed or misunderstood care directives can leave the patient and the health system vulnerable.

I was certainly feeling vulnerable when I arrived home after taking my son to the doctor and met my wife immediately at the door asking, “What did the doctor say?” As I recollected the physician visit and details of my dialogue with the doctor, I quickly realized I wouldn’t have all the answers she wanted to hear. I remembered most of the instructions, which I paraphrased quite succinctly. However, my wife, who is a very caring mother with a fondness for details, wanted to know exactly what the doctor said.

A similar story was told by a colleague. He described how his father was discharged from a local hospital after suffering a heart attack. At discharge, while tired and stressed from being in the hospital, his father and mother were given 30 minutes of clinical, complex information detailing his post-hospital care and medication needs. Later, when the couple tried recalling the discharge instructions to relay to my colleague, they each remembered the directives very differently – a misunderstanding that put his father at risk for an adverse event.

The CDC reports that nine out 10 adults who receive medical advice find it incomprehensible and do not know what to do to take care of themselves – creating a revolving door for institutions.

Stats and stories like these, as well as looming penalties for performance, are driving the development of innovative healthcare applications and patient portals that improve patient and family engagement, understanding and compliance of discharge instructions and other care directives. These same technologies are also improving patient safety and satisfaction, ultimately driving HCAHPS scores up and avoidable re-admissions down.

Cullman Regional Medical Center in Alabama recently reported a 63 percent increase in HCAPHS scores for questions related to discharge communication and a 15 percent reduction in re-admissions after re-engineering its discharge process using the Good to Go solution by ExperiaHealth. Good to Go blends multimedia technology with healthcare best practices to engage caregivers, patients and families in the care plan during and after a hospital stay.

During hospital discharge, Cullman Regional caregivers use smart devices and the HIPAA/HITECH compliant Good to Go application running on the device to capture “live” care instructions at the patient’s bedside. After the discharge session, the nurse asks the patient to listen to the captured communication, and a dialog between the caregiver and patient occurs to clarify any confusion. This conversation is also captured by the application, adapting discharge instructions in the patient’s own words and breaking down health literacy barriers. The recorded audio instructions are then made available 24/7 for the patient, family or a subsequent caregiver to listen to and review from any landline phone, mobile device or computer using unique login credentials.

In addition to audio instructions, caregivers use the solution to attach instructional videos, images and documents and post those educational resources on the patient’s personal Good to Go website to improve compliance and reduce risks. For example, if a patient has congestive heart failure, a caregiver can use the solution to capture images of baseline swelling in the patient’s leg to help him or her monitor and manage their condition. Follow-up appointments and medication lists can also be managed in one location via the patient’s personalized Good to Go website.

With access to live care instructions and multimedia education, a couple can leave the hospital feeling secure about the discharge plan, and a father can be confident replying to an inquiry by his wife after their son’s physician visit. Hospital caregivers can also feel better because they can use the solution’s monitoring tool tracks if and when patients access their instructions, allowing Cullman Regional to gauge compliance and identify potential risks for bounce backs. This valuable information also plays a vital role in performance analytics and patient follow-up call management available via the Good to Go solution, which helps unify quality, safety and satisfaction initiatives.

By taking advantage of technology already in use and at the fingertips of caregivers, patients and families, hospitals like Cullman Regional are creating impressive last impressions and extending care beyond the hospital walls. And while technology cannot replace human interaction, it can certainly help enhance the exchange and create market differentiation as well as lasting loyalty – especially for those patients whose journeys were safer because there were no communication gaps along the way.

Healthcare stories with seamless transitions are the ones with the best endings.

Preparing for Coordinated Care: An HIT Framework

Preparing for Coordinated Care: An HIT Framework
Battani

Guest post by Jordan Battani, managing director of CSC’s Global Institute for Emerging Healthcare Practices.

There’s a sea change underway in healthcare in the United States, an effort that’s focused on addressing the challenge to improve healthcare quality and outcomes for patients and the population at large, while at the same time controlling and reducing healthcare cost inflation. It’s no small task, and there is no shortage of opinions about how best to make the changes that will be required.

At the core of the discussions, however, is a general understanding that a fundamental change in the traditional orientation to healthcare, and healthcare financing is required. Episode focused, fee-for-service medicine has led to a systematic bias against coordination and collaboration.

The need for change is particularly acute in a world that is increasingly defined not by acute episodes of illness and injury, but by the constant demands placed by the burden of managing the impact of chronic disease. Transformation requires an expansion from the traditional focus on patients and episodes to include populations and the entire care journey experience from wellness, through illness and back again.

In short, an expansion:

The core competency in this new orientation is the ability to practice coordinated care and to manage the financial arrangements that support it. Medicare, and many commercial health plans, refer to this competency as “accountable care.”

Practicing in this new environment requires the ability to expand care beyond the traditional boundaries of a linear provider to patient interaction during a discrete episode of acute illness or injury. In a healthcare landscape characterized by long-term chronic disease, healthcare must include the patient’s lifestyle, environment and long-term personal health risk factors in care planning, delivery and management.

Delivering that care plan cost effectively using complex clinical technologies and innovations requires coordinating and integrating the activities and information from multiple care settings and many different providers. Financing a coordinated care delivery system requires expanding payment for activities beyond fees for the services rendered for a discrete episode to include compensation for the effort and the value delivered from collaboration, coordination and integration across the continuum of settings and providers.

Not surprisingly, the tools and capabilities required for practicing in the era of coordinated care are more complex and far reaching than those required in the traditional episode-based fee-for-service model.

Successful coordinated care requires:

In an environment characterized by multiple, conflicting and interlocking mandates and transformation requirements it’s a difficult task to take on a new set of organizational and technology strategies, and tempting to focus instead on meeting the deadlines and details of the individual programs and requirements.

There is no single road map to success and the timeline, priorities and projects for each organization will vary based on their circumstances. The only certainty is that under the current set of clinical quality, patient safety and financial pressures and requirements, organizations that fail to develop and demonstrate coordinated care capability risk long-term clinical and financial failure.

Jordan Battani is the managing director for CSC’s Global Institute for Emerging Healthcare Practices, the applied research arm of CSC’s Healthcare Group. Battani has a strong professional track record in leveraging technology solutions to deliver business value.

Trends in Doctors Accepting Patient Emails