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.
Guest post by Andy Nieto, health IT strategist, DataMotion.
The HITECH Act’s goal of improving clinical outcomes for patients using technology through meaningful use is admirable and quite overdue. However, where the Office of the National Coordinator for Health Information Technology (ONC), and to a much greater extent, electronic health records (EHR), have missed the mark is in the deployment and execution.
The stated goal of meaningful use Stage 1 (MU1) was to deploy, integrate and use EHRs to gather and document “structured and coded” healthcare data. Rather than take ONC’s directives as a framework to improve provider care tools, they viewed it as a “minimum requirement” and missed the spirit of the initiative. EHRs remain cumbersome, challenging and inefficient.
Providers now spend more time clicking boxes and typing than they do speaking to their patients. To make matters worse, the data gathered is maintained in the EHR’s “unique” way, making exchange and interaction challenging and interfaces costly.
Guest post by Daniel Piekarz, vice president of life sciences business development at DataArt.
The life sciences industry will be defined in 2014 by the growing market demand to apply newly developed technology, including big data analysis, to healthcare and medical device practices. While many of the amazing technological advances in the space are driven by a desire to aid humanity, the industry is also caught between increased economic and regulatory pressure that is forcing many to electronically collect heaps of data while looking for custom technology solutions that will allow them to leverage this valuable data and adhere to new industry standards.
Over the next year, trends that reflect newly available technology will start to develop. The adoption of healthcare big data technology will become a major theme in the sector this year, just as it has in several other industries. Many new technology offerings have been created to tie together data from multiple sources that can be accessed by researchers and physicians to allow them to easily exchange information. This also aids in research and development practices by offering another valuable tool to gather and analyze data.
Tied to the big data trend is the emergence of personal healthcare data aided by physicians’ adoption of EHR technology. By allowing patients to own and access their healthcare data on a healthcare information dashboard, patients can more easily understand risks and preventable care options. Pooling anonymized patient data together can also lead to better analysis, and physicians are already starting to work with vendors to develop big data diagnostic tools. These new technology advancements have started to create a generation of patients more committed to their own healthy future than ever before. Through an intelligent system database, patients and physicians can better understand patterns and symptoms that affect their healthy lifestyles. While this type of big data solution is gaining a foothold, there is still resistance from some doctors due to their concern over critical review of their procedures.
Today’s healthcare IT departments have a relatively tall order when it comes to effective EHR data management. In an environment that often requires them to be simultaneously budget-conscious, growth-minded and patient-driven, healthcare IT must also address the often-competing data management needs for:
Data at rest
Data mining and analytics
Popular EHR system vendors have made significant strides to address several of these data management issues. Unfortunately, they can only go so far given the current state of many healthcare IT environments. Some departments may still require custom software applications, complete with specially configured servers, storage and network hardware to support them.
The past five years have seen monumental changes in the world of healthcare information technology. As 2013 comes to a close, it seems appropriate to look forward to the developing trends for 2014 and beyond and how they will impact vendors, providers and patients.
Open Source Technology Use and Development Will Accelerate
The continuing acceptance and use of open source software is the most important healthcare trend, since it ties directly into every point on this list. Open source software has become part of the healthcare mainstream and is used in many areas of the healthcare industry. Open source software is behind everything from the EHR system doctors use to enter patient data to the web browser or smartphones and tablets patients use to check their records through patient portals. Even the much talked about Healthcare.gov website utilizes open source software.
The benefits of open source development over proprietary software will continue to fuel its expansion over the next few years. Open source software has many advantages for providers and patients, including interoperability, speed of problem resolution, flexibility and more frequent updates.
An example of how open source software provides these benefits can be found in the area of EHR systems. One of the most common complaints by physicians and staff about EHR software is that the software is difficult to use. Now that EHR adoption has become widespread, there is much more thought and resources going into refining the user interface. With proprietary software, the amount of developer resources that can put into refinements may be limited to that one vendor’s resources. With open source software, countless companies and individuals are constantly collaborating to make the software easier to operate and more user-friendly for everyone.
According to a recent survey conducted by Purdue Healthcare Advisors, a nonprofit healthcare consulting organization, hospital executives are reluctant to implement ACOs — 46 percent — and they have no plans to implement an Accountable Care Organization (ACO)-like model in the near future.
Conducted in October 2013 among 206 hospital executives at a director level and above, the survey also reveals that executives are struggling with finding solutions for lower reimbursements and increased costs, while still maintaining an acceptable level of quality care.
“This survey has identified a significant need for advocacy and education to support hospitals and help them survive the wave of changes brought on by the Affordable Care Act,” said Mary Anne Sloan, director of Purdue Healthcare Advisors. “Hospital executives are charged with enhancing patient care and managing margins with a shrinking workforce and diminishing patient volumes.”
Hospital executives find ACOs to be unstable and financially risky
Executives are waiting for ACO models that are more stable and mature to avoid having to reinvest funds to implement changes or updates, according to the survey. The executives who do not have plans to implement an ACO model in the future (46 percent) cited the following reasons:
Guest post by Bettina Experton, MD, MPH, president and CEO, Humetrix.
Mobile technology core to HIT implementation, a silent revolution which took place on September 23 this year when the HIPAA omnibus rule took effect, giving Americans the right to obtain electronic copies of their health records. But how can this new right be exercised at scale to transform healthcare nationwide? How do we help patients better coordinate their care and ensure their safety by getting their health records in their own hands?
The scalable computing device of choice in the hands of many is a smartphone, now owned by more than 50 percent of the population, and for many the only computing device they use daily to access information on the Internet. Clearly, electronic access to health records would be best provided on the very mobile device most of us carry at all times, especially when navigating a complex health care system with multiple and dispersed providers.
Electronic copies of health records on CDs or flash drives are not only tools of the past, but also perpetuate the barriers and complexity most of us have to face when requesting copies of our records. Desktop and portal-only solutions are also not the optimum approach to consumer-directed health information exchange, since these cannot be available at the point of care where patients need to share their medical history in the most convenient and expedient way. Mobile is, therefore, central to health information exchange policies and new care delivery models built on patient-centered care, and should not be an afterthought or secondary implementation to dated patient portal systems.