It should come as little surprise to me that no matter the healthcare sector — long-term care, ambulatory or in patient, for example – most of the worries faced are the same or very similar. Many of the same levels of attention is given to many of the highly complex usual suspects – interoperability, health information exchange, accountable care, HIPAA and even mandates like meaningful use. The murmurs of those working here are often similar and there is a fairly deep collective holding of the breath in regard to advancements or developments in these areas regarding the blowing winds of how these and other issues sway constituents throughout the marketplace.
The general sentiment of individuals, those leading large hospitals and multi-location care facilities, who express their opinions and concerns to organizations like HIMSS, to name one, are the same as the concerns voiced by many of the attendees at PointClickCare’s annual user meeting, to name one, in Orlando Nov. 2-5, 2014. These same sentiments also are expressed at variety of other meetings of the minds throughout the US in similar constituent groups or with vendor and other allegiances.
Educational and work sessions held at these gatherings always have the same look and feel; the same as those expressed at PointClickCare’s Summit 2014. Engagement, connection, care; ACOs, HIEs, and managing their relationships; EHRs, interoperability, and managing this relationship and the flow of information (or doing so when the information does begin to flow); and change management strategies that provide guidance and advice for … managing change.
The information exchanged in venues such as these and the sessions themselves are valuable, of course, and needed to fill an enormous information void. Most importantly, these healthcare education sessions draw together folks seeking guidance and those needing insight, as well as provide a dash of leadership at times when much seems to be lacking. Finally, these educational sessions – quick and concise as many of these sessions may be – alleviate fear during a scary and tumultuous time in healthcare.
I’m a huge fan of infographics. I think they provide simple and very easy to understand explanations of often difficult to comprehend subjects, like health IT. The following health IT infographic shows the evolution of the electronic health record since 2009 when they really started to gain attention. One of the things I particularly like about this image is that it defines the difference between EMRs and EHRs, something that is often confused, which is a huge pet peeve of mine.
What’s somewhat interesting about the information here, too, is that large, teaching hospitals utilize EHRs more than other organizations. Ironically, in the past, it’s been reported and much discussed that teaching hospitals don’t actually spend much time teaching student how the use the electronic health records.
Also, the bigger the practice, the more likely they are to have an EHR. This suggests that size does matter.
There’s some other good info buried in the following piece. Take a look; I look forward to your feedback.
Reports state that only 39 percent of physicians share data using a health information exchange (HIE). There is even a lower number of only 14 percent who electronically share data with ambulatory care providers or hospitals outside their organization. While these numbers may seem astounding to some with Stage 2 fast approaching — the reason is clear. Because even though providers want to share health information electronically they are hindered by EHRs that can’t communicate with one another, lack information-exchange infrastructure, and the high expense of setting up electronic interfaces and health information exchanges.
Below are the top reasons why EHR sharing remains low for adoption:
Lack of Interoperability. The majority of providers and physicians have acknowledged lack of EHR interoperability and exchange infrastructure as major barriers to health information exchange. They have also identified the cost of creating and maintaining interfaces and exchanges as a major barrier.
Lack of Advanced Technology. Over the last few years, various HIE systems have been developed, but many have failed for technological and organizational reasons. High-level issues must be addressed to implement an HIE successfully, including disparate EHR and HIS systems. Most previous HIE research focused on high-level issues and evaluating impact on healthcare delivery, ROI, Syndromic Surveillance, etc.
Lack of Security and Streamlining. Quantitative measures are crucial to the long-term sustainability of HIEs. Interoperability of patient data doesn’t effectively address concerns on privacy, productivity, workflow and costs. Streamlining HIE access through integration with electronic health records to minimize workflow interruption, and keeping costs reasonably low for providers, may increase participation.
Lack of Affordability and Productivity. The cost and loss of productivity are major barriers to HIE adoption. While there are many compliant products on the market, not all of them provide cost savings and lead to efficiency or increased productivity.
The purpose of EHR and HIE is to make patient specific information available at the point of care to improve the delivery and quality of care. Interoperability of patient data no doubt has many advantages, including improved care coordination, elimination of paperwork, reduction in duplicate tests and reduction of medical errors. It is imperative to develop a long-term plan for standards and interoperability that will support competing public and private-sector Interoperability efforts. We should also encourage clear regulation on compliance with federal privacy and security laws. There should also be national benchmarking to share best practices and lessons learned. There should be significant cooperation among primary-care providers, medical specialists, long term care providers and hospitals to outline common information sharing needs promoting a value-based care.
Implementation of electronic health records is considered a national priority in this era of healthcare reform. However if EHRs are not implemented correctly they can be painful.
EHRs that are not implemented effectively can affect productivity and revenue. The extra documentation requirements and intricate workflows create distance between physicians and their patients. Physicians have reported that they spend too much time on EHRs and that they don’t get enough time to interact with their patients. But physicians often communicate that spending time on EHRs is crucial to creating a trusted set of structured data that can guide their business. Every click that providers make creates important data points that can be used to inform the efficient delivery of their practice.
Every EHR saves a large amount of data inside it regarding patient health, effectiveness of treatments, system efficiency and provider tendencies. Despite the extra time and effort that is dedicated to electronic documentation, many practices and physicians do not make full use of this precious data set that they have produced.
If a practice can get its EHR adoption right they can make a number of positive results, some of which are mentioned below:
By overcoming the difficulties providers can see more patients and will be able to generate more billed revenue using its existing staff. Furthermore, if a provider is using its EHR efficiently then the improved documentation produces billing at higher rates, combined with increased patient flow. This represents significant potential revenue.
Quick Cash Flow
Many of the practices work on revenue cycle management, but few make it flawless. With increased charge accuracy and reduced time for denials, there will be an increase in the yield with timely reimbursements by the payers.
Guest post Kathleen Myers, MD, FACEP, is an emergency physician and founder/chief medical officer of Essia Health.
A few years ago, JAMA published a drawing by a 7-year-old girl after a recent visit to the doctor. It showed the girl on the examination table. Her older sister was seated nearby in a chair, as was her mother, who was cradling her baby sister. The doctor sat staring at the computer, his back to everyone – including the patient. The picture was carefully drawn with beautiful colors and details, and you couldn’t miss the message: Technology is making us physicians less human.
This powerful picture paints the role of the medical scribe in re-humanizing healthcare: If a medical scribe had been there, the doctor would have been able to focus 100 percent on the little girl while the scribe entered the necessary documentation into the computer.
Medical scribes specialize in charting physician-patient encounters in real-time in the electronic health record (EHR) during medical exams, freeing physicians from the data entry burden. They are typically bright, tech-savvy college students or recent graduates interested in pursuing a career in medicine and other healthcare disciplines. Many of them go onto medical school and become physicians themselves, having gained invaluable experience and insights into real-world medicine through scribing.
When I first started using an EHR, I realized that I didn’t want to be the doctor depicted in that drawing. And I was sure other doctors felt likewise. So I started a medical scribe program in my emergency department physician group as a way to integrate EHRs while re-humanizing healthcare – helping physicians maintain a more personal relationship with their patients, helping hospital customers ensure high-quality care for their patients and helping create a meaningful place for people to work. It wasn’t long before I realized that the model I started to solve our needs internally had significant potential in the marketplace, so I turned our program into a company that could serve the medical scribe needs of other healthcare providers.
In the nearly 10 years I’ve personally been using a scribe, I have observed how they are improving the practice, as well as the business, of healthcare. And our customers have confirmed these benefits time and time again.
First, patient satisfaction increases when they receive a physician’s full and focused attention. In fact, studies show improvement of 40 percent to 45 percent in Press Ganey patient satisfaction scores to overall levels 90 percent and higher when scribes are used.
As clearly identified in the PCAST Report on Health Information Technology (2011), and as echoed in the recent GAO report Electronic Health Record Programs — Participation Has Increased, but Action Needed to Achieve Goals Including Improved Quality of Care (2014), healthcare continues to have a data problem. The country has invested significantly to advance EHR adoption.
In simpler terms, healthcare data is messy and makes for building of accurate, actionable metadata a problem. It’s clear that the next generation of standards that are being developed by the numerous committees and acronyms and professional societies tackling measure development, harmonization and testing will now need to address the relevance of each measure.
More than a decade ago, a coalition of purchasers, payers and providers came together across Wisconsin to form the Wisconsin Collaborative for Healthcare Quality (www.wchq.org). Groundbreaking initiatives like Get with the Guidelines, Leapfrog and JCAHO revealed that “quality” and “healthcare” could be used in the same sentence (or displayed on a website). These efforts were largely inpatient-focused. Measurement in the outpatient setting, long considered the keystone of payment reform, was an unsolved riddle. WCHQ, at the urging of the IOM, IHI and others accepted the challenge of tackling performance in the ambulatory arena.
At the direction of some very engaged employers, and with input from most of the state’s payers, WCHQ was charged with one very simple goal — apples to apples quality measurement, regardless of health IT infrastructure. The focus had to include both processes of care and outcomes. Oh, and if health systems didn’t have any health IT in place, data still needed to be included for these groups in the measurement effort. What transpired over an 18-month period was remarkable. With unwavering support from administrative and clinical leadership, health systems rolled up their sleeves and dug into their very messy data. Each Monday, we would devise a fiendish list of new tasks to be completed in the next four business days.
Guest post by Anil Jain, MD, FACP, chief medical officer, Explorys, and staff, Department of Internal Medicine, Cleveland Clinic.
Nearly every aspect of our lives has been touched by advances in information technology, from searching to shopping and from calling to computing. Given the significant economic implications of spending 18 percent of our GDP, and the lack of a proportional impact on quality, there has been a concerted effort to promote the use of health information technology to drive better care at a lower cost. As part of the 2009 American Reinvestment and Recovery Act (ARRA), the Health Information Technology for Economic and Clinical Health (HITECH) Act incentivized the acquisition and adoption of the “meaningful use” of health IT.
Even prior to the HITECH Act, patient care had been profoundly impacted by the use of health informationtechnology. Over the last decade we had seen significant adoption of electronic health records (EHRs), use of patient portals, creation of clinical data repositories and deployment of population health management (PHM) platforms — this has been accelerated even more over the last several years. These health IT tools have given rise to an environment in which providers, researchers, patients and policy experts are empowered for the first time to make clinically enabled data-driven decisions that not only at the population level but also at the individual person level. Not only did the 2010 Affordable Care Act (ACA) reform insurance, but it also has created incentive structures for payment reform models for participating health systems. The ability to assume risk on reimbursement requires leveraging clinical and claims data to understand the characteristics and needs of the contracted population. With this gradual shift of risk moving from health plans and payers to the provider, the need to empower providers with health IT tools is even more critical.
Many companies such as Explorys, a big data health analytics company spun-out from the Cleveland Clinic in 2009, experienced significant growth because of the need to be able to integrate, aggregate and analyze large amounts of information to make the right decision for the right patient at the right time. While EHRs are the workflow tool of choice at the point-of-care, an organization assuming both the clinical and financial risk for their patients/members needs a platform that can aggregate data from disparate sources. The growth of value-based care arrangements is increasing at a staggering rate – many organizations estimate that by 2017, approximately 15 percent to 20 percent of their patients will be in some form of risk-sharing arrangement, such as an Accountable Care Organization (ACO). Already today, there are currently several hundred commercial and Medicare-based ACOs across the U.S.
There is no doubt that there are operational efficiencies gained in a data-driven health system, such as better documentation, streamlined coding, less manual charting, scheduling and billing, etc. But the advantages of having data exhaust from health IT systems when done with the patient in mind extend to clinical improvements with care as well. We know that data-focused health IT is a necessary component of the “triple-aim.” Coined by Dr. Donald Berwick, former administrator of the Centers for Medicare and Medicaid Services (CMS), the “triple-aim” consists of the following goals: 1) improving health and wellness of the individual; 2) improving the health and wellness of the population and 3) reducing the per-capita health care cost. To achieve these noble objectives providers need to use evidence-based guidelines to do the right thing for the right patient and the right time; provide transparency to reduce unnecessary or wasteful care across patients; provide predictive analytics to prospectively identify patients from the population that need additional resources and finally, use the big data to inform and enhance net new knowledge discovery.
Hospitals and eligible professionals that have yet to meet their meaningful use requirements are facing a good news/bad news scenario. First the bad news: The clock is ticking, as major deadlines loom. The good news: It’s not too late to hop aboard the MU train, although some running might be required. If you’re among those seeking MU attestation this year, here are key points you need to know.
Before you take one more step, make sure your technology vendor is 2014 certified. Regardless of whether you are attesting to meaningful use Stage 1 or Stage 2, all eligible professionals (EPs) and eligible hospitals (EHs)/Critical Access Hospitals (CAHs) are now required to use an ONC 2014 Edition Certified technology to successfully attest to both MU1 and MU2.
You might have been under the impression that Stage 1 corresponds with the 2011 Edition and Stage 2 corresponds to the 2014 Edition. This is not the case, but your confusion is understandable.
What happened? When meaningful use was first introduced, the Centers for Medicare and Medicaid Services (CMS) published MU Stage 1 and the Office of the National Coordinator for Health Information Technology (ONC) published the 2011 Edition Certification; then MU Stage 2 and the 2014 Edition Certification Criteria were released within days of one another.
Guest post by Darin VanderWell, Director of Product, DocuTAP.
Rumors about the next phase of the Centers for Medicare and Medicaid Services (CMS) EHR Incentive Program has prompted concern among healthcare providers. To truly understand meaningful use Stage 3 and its impact, it is important to differentiate between the rumors and the truth.
The final rule for meaningful use Stage 3 has yet to be published, so discussion on its effects are based on available drafts. Even those drafts are in question since the December 2013 announcement that Stage 3 would be delayed until 2017. One reason cited was to allow more time to research the impacts of Stage 2 before finalizing Stage 3. The delay will be particularly important for that research, since compared to Stage 1, 2011 Edition, there are so few Stage 2 vendors certified currently.
As for what is expected, the attention turns from data capture and access (Stage 1) and information exchange (Stage 2) to improved outcomes in Stage 3. One expected goal is to simplify and reduce the reporting requirements on those attesting. Some of that change can be achieved by consolidating the program’s current objectives, which I expect hospitals and providers will welcome, provided it truly reduces the reporting burden and does not coincide with other, new objectives and reporting requirements.
Stage 3’s goal of improving outcomes will be incredibly interesting – through November 2013, CMS had disbursed nearly $18 billion in incentive payments. Until now, the program’s success has been judged by the number of participants adopting certified EHRs. At some point during Stage 3 (or thereafter), we will know whether those payments have truly improved outcomes.
Given the recent focus on the value of health IT (HIMSS recently asked those of us covering the space to respond to its importance; you can see my response here: HIMSS Asks: What is the Value of Health IT?), the topic remains an intriguing one. With ever-present changes to the landscape, we’re in the midst of major and continual upheaval about how technology can serve, yet improve care quality and outcomes.
The use of electronic health records, for example, continues to permeate the space. But even as pervasive as the technology is — during 2006 through 2013, the percentage of physicians using any EHR system increased 168 percent, from 29.2 percent in 2006 to 78.4 percent in 2013, according to the CDC. Nearly half of physicians (48.1 percent) were said the be using the more comprehensive “basic system” by 2013, up from 10.5 percent from 2006, but that doesn’t mean the solutions are completely meeting the needs of physicians.
That said, I asked Sean Morris, director of sales for Digitech Systems, for some perspective. He’s worked in health IT for more than 20 years. He agrees with me, that penetration of EHRs remains less than 50 percent. Even so, as physicians have moved aggressively toward the technology, in large part because of meaningful use, not all of the systems that have been deployed are working as expected.
“EHRs were the new shiny thing and everybody wanted to chase after them,” Morris said. “But issues came up as people began to evaluate and use the technology. They discovered that there’s really no bridge from the information stored in EHRs charts and other records outside the EHR. They need to bring it together without killing their practice.”
As the age of EHRs begins to fade past its prime and as practices begin to evaluate second generation solutions, Morris said history is likely going to repeat itself unless practices begin to deploy solutions that help them use all of the data stored in the records.
Morris said that in many cases, current EHRs don’t actually need to be replaced, rather built upon.