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.
Dr. Lucy Hornstein, solo practitioner at Valley Forge Family Practice in Phoenixville, Penn., was not a proponent of electronic health records. An active physician blogger and published writer, she spent quite a few of her words on the technology’s uselessness.
They were expensive, overly complicated and tough to use and provided little return on the investment for users. Besides, most physicians, in her opinion, only implemented them because of meaningful use and the federal incentives they received for using them.
Paper, she had long decided, was good enough for her and during the first 21 years of practice in her own practice, she had no plans to change. It was only after the loss of one of her two staff members that she soon realized that she’d have to re-hire just to maintain her practice at its current load. However, that wasn’t an option for her. Neither, she thought, was adding an EHR to handle the management of the records because other than her perception of the technology, the self-described “dinosaur” didn’t have the budget for such an endeavor. She had zero for such technology.
Even if she had a change of heart and adopted the technology, she had not seen one system that was not cumbersome, not hard to use, intuitive to maneuver and or that offered her the option to meet the needs of her small practice while running the business efficiently.
Are EHRs dead? Well, Healthcare IT News’ Eric Wicklund recently reported that EHR vendors “will have to find a way to modify their products to focus on data that the patient and his or her care team want, or they’ll become obsolete.” Will EHRs become so obsolete so soon after the height of their heyday? When further explained, some of the reasoning makes sense.
According to panelists at the Partners HealthCare’s 10th Annual Connected Health Symposium, we’re in the time of “para-EHR,” defined as all of the phone calls, texts, e-mails and other doctor-doctor and doctor-patient communications that are not entered into the EHR. They could include everything from Skype chats between doctors to Post-It notes to data residing on mobile devices and sensors.
As such, complete records are not being entered into the EHR, and most patient communication takes place outside the EHR setting. But, are EHR’s dead and flat line or do they have some life left in them? I posted the question to Jim Gerrity, director at Ciena.
Are EHRs dead? “The short answer is ‘no,’ however, what is contained in today’s EHR will most likely evolve. Let me expand on this a bit: Paper-based records are still the most widely used method in the healthcare industry, but that’s changing rapidly. EHRs are proving to significantly improve clinical efficiency and coordination and being adopted increasingly by healthcare institutions around the world. A relatively recent example in the U.S. was their great usefulness to provide continued care during and immediately after Superstorm Sandy … e-records backed up and accessible at disaster recovery sites. As one writer put it, EHRs are ‘ushering in a new era in how medical data is stored and shared.’ But is this transition to EHRs required?