Electronic health records (EHRs) were supposed to transform the healthcare industry in the same way that digital technology has transformed the rest of our lives – organize and simplify. EHRs held the promise of easier access to patient health history, greater patient engagement, and improved clinical decision making and outcomes. And yet, despite the potential, electronic health records thus far have proven to be just another industry headache. Doctors contend with complicated and incompatible systems that stifle collaboration and enhanced patient care. Patients lack adequate access to their own records and methods to conveniently communicate with their care team.
While patients and doctors struggle, EHR system vendors benefit from the stagnant and uncompetitive market, charging exorbitant installation and maintenance fees, with no real incentive to innovate. It is a broken system, but it can be fixed, with the tech industry’s penchant for disruptive innovation. There is great opportunity for tech companies to develop fixes that will benefit customers and reignite development in digital healthcare.
Electronic medical records are currently locked away in walled gardens that inhibit vital information exchange between care team members and patients. These walls need to be broken down to allow for the collaboration that patients expect between their care team members. EHRs based on Software-as-a-Service (SaaS) platforms would allow vendors and medical providers to cut installation and maintenance costs, while offering genuine compatibility and simplicity. SaaS platforms are also cost efficient, with transaction-based business models that only require subscription and access fees. A SaaS health record system would be cost-effective, compatible, and ultimately serve the doctors and their patients.
Currently, one patient can have several associated identifiers from different physicians, hospitals and EHR vendors. Data is often duplicated and workflow becomes complicated for providers. An industry-wide standard could work, but there is no guarantee that a solution can be selected and implemented nationwide in a timely manner. An outside approach would offer much-needed perspective and an injection of fresh ideas into the conversation. Silicon Valley could assist by developing simpler, tech-based solutions, with industry stakeholders providing input. For instance, a master patient index, successfully driven by heuristic real-time matching algorithms, would offer similar functionality to the universal account log-ins offered by Facebook and Google and further simplify access to electronic health records.
EHRs should behave more like part of a “clinical network” that combines simplified workflows with stronger communications. Lab tests, referrals, pre-authorizations and results can be delivered instantly, retooling today’s overcomplicated systems with a more effective transactional eco-system. The network simplifies physicians’ day-to-day activities, and aggregates the collected data into an electronic health record. Tapping into the success of social and business platforms, such as Facebook Messenger and Slack, secure communication between patients and their complete care team, built around these universal health records, adds a layer of proactive care management that was previously unattainable.
As any holiday TV-loving baby boomer can attest, the island of misfit toys is not a happy place. In the 1964 stop-motion animated television show, “unwanted” were destined to live out their toy lives without the joy of playtime with the child they were built to please. Unfortunately, some EHR products share certain misfit qualities which can make their use more difficult for a busy provider.
So how do you know if you are using a misfit EHR? Here are a few signs:
There is little to no communication with others or outside entities, and you are stuck with the same, less than perfect software environment that is dysfunctional and aging fast.
No one calls to see how your EHR is doing and no one responds to your outcries for help.
Sound familiar? This is essentially your situation when you have committed to an outdated and under-supported EHR system for your practice. You are land-locked by an older system that is not cloud-based or does not leverage the many cloud resources for communication and interoperability.
So, your technology is old, the code base has been put on the shelf by the EHR vendor and no updates are coming. This is despite the rapid changes surrounding your practice and the healthcare industry in general.
You feel isolated, and when you call for support you get little to no relief, as the vendor has moved on to bigger and better customers. In the TV show, Santa promised to come back to save the misfits, just as your EHR vendor promised customized support, ongoing upgrades and improved efficiency. But the costs are prohibitive and your confidence in the vendor is low.
Maybe it is time to get off the island, and hitch a ride with a new vendor. If a new EHR is on your holiday list, here some criteria you should consider:
Leverage the power of the cloud to connect to labs, e-prescribing networks, HIEs and other data hubs such as the Commonwell Health Alliance. With a cloud-based EHR system these connections are built into the application, and any new features or connections to other entities become available to all users, no upgrades, no updates required to your infrastructure.
Don’t buy expensive hardware, servers and IT support staff to manage them. All you need to run a cloud-based EHR is a desktop web browser or mobile device.
Though many Medicare and private payer reimbursement programs that require practices to begin moving to value-based compensation already have set sail, most small practices are still treading water near the shore when it comes to this new wave of payment models.
While admirable in their care goals, these quality care-based reimbursement programs can pose some insurmountable challenges for small providers. In fact, they require a whole new way of providing care for some practices, as well as creating new documentation of integrated data analysis, development of care coordination with other providers, payer reporting applications, and often times new technologies that can support these new provisions.
What’s more, all this change also can be quite expensive for small practices and wreak havoc on current business practices.
Set the course No doubt about it, though, the move to value-based care is on. According to the 2015 Physician Compensation Survey, conducted by Physicians Practice magazine, 63 percent of physician compensation is currently tied to productivity; 37 percent to value metrics and 29 percent to patient satisfaction scores.
The Centers for Medicare and Medicaid Services (CMS), however, has expressed its goals of having more providers participating in value-based plans each year, with a goal of 50 percent by 2018. And it has further incentivized physician participation by specifying increasing reductions in payments for non-participation that began in 2013.
So unless they want to start leaving money on the table, practices have no choice but to take the plunge into such new compensation programs.
Lift the Anchor Before diving in and potentially draining money and resources to participate in such programs, physicians need to look around and assess their current situation to determine how the new reimbursement model might work in their practice. For example, they need to evaluate current technology, vendors, resources and physician support to determine what changes they need to make, as well as what internal infrastructure they can use.
The long awaited road to true healthcare IT system interoperability is being implemented at Good Samaritan in Indiana, enabling the 232-bed community healthcare facility to better deliver on its commitment to delivering exceptional patient care. The system will also enable the hospital to substantially increase their practice’s revenue while containing healthcare system integration costs.
“We strive to be the first choice for healthcare in the communities that we serve and to be the regional center of excellence for health and wellness,” said Rob McLin, president and CEO of Good Samaritan. “We are proud to be the first hospital in the country to implement this great integrated health record system that will allow us to provide a much higher level of continuity of care for our patients, as they are our top priority.”
The integration is being made possible with Zoeticx’s Patient-Clarity interoperability platform that will integrate WellTrackONE’s Annual Wellness Visit (AWV) patient reports with Indiana’s Health Information Exchange (IHIE) and the hospital’s Allscripts EHR. IHIE is the largest HIE in the US, serving 30,000 physicians in 90 hospitals serving six million patients in 17 states.
Revenue Generator for the Hospital
WellTrackONE and Zoeticx will enable patient’s AWV data to flow from the application to Allscripts EHR and the IHIE system. With Zoeticx’s Patient-Clarity platform and WellTrackONE’s software, the healthcare IT integration passes on increased revenue from the Centers of Medicare & Medicaid Services (CMS) and decreased IT costs for medical facilities.
Medicare pays medical facilities $164.84 for each initial patient visit under the AWV program and $116.16 for each additional yearly visit. With the AWV integration in place, the hospital is now able to meet CMS’s stringent requirements for patient reimbursements.
It is estimated that the Good Samaritan will be able to generate $500 to $1,200 per AWV patient from follow up appointments for additional testing and referrals for approximately 80 percent of the Medicare patients that are flagged by the AWV for testing, imaging and specialty referrals within the hospital.
This subscriber number is expected to trend upwards into 2050 and will create billions in new healthcare revenue through the US as the population ages. The hospital is not charged any costs for the system until it is reimbursed by CMS.
Overcoming Healthcare System Limitations
The hospital began offering Medicare’s AWV’s a few years ago, but had to develop its own tracking protocols, which impacted its budget and staff resources. The system it had created also operated poorly, allowing hospital staff to only view about 10 percent to 15 percent of patient data.
Good Samaritan medical teams were also constrained by interoperability, having to enter new illness findings and other medical info manually and fax PDFs to other facilities where they would have to again be entered into a different system. The hospital also had all of the data contained in WellTrackONE and Allscripts’ system, but no way to integrate the two, let alone achieve that integration with IHIE. Providers were also spending valuable patient face time trying to find specific patient data buried in the EHR system.
“Our systems were working fine, independently of each other,” said Traci French, director of business development and revenue integrity. “But we could not achieve true interoperability between the two systems. The best we could do was basically reshuffling PDF documents. The next challenge was to integrate that data with the exchange. We needed to get data to providers where they needed it, when they needed it.”
Guest post by Robert S. Oscar, R.Ph. CEO and president, RxEOB.
Prior authorization exists to reduce drug costs, to manage appropriate brand medication prescribing, and to curb medication abuse. Despite its good intentions, this extra step to determine whether or not a drug is appropriate for a patient’s symptoms has gained a reputation of inconvenience for both physicians and consumers.
In a 2013 study by SUNY Upstate Medical University, it was revealed that U.S. primary care physicians and their office staff have experienced significant increases in time consumption as a result of prior authorization and its associated requirements. For consumers, hours can be wasted waiting to find out whether or not they are allowed a particular prescription under the conditions of their health plan.
Reducing this negative aspect of prior authorization is paramount for the betterment of overall health costs and medication adherence. By streamlining the time spent between medical record lookup and prescription delivery, healthcare organizations and consumers can begin to experience more efficient prior authorization. If efforts made toward better big data advancements, mobile health (mHealth) and health IT are prioritized, doctors can confirm drug eligibility faster to help their patients recover faster.
Below are five reductions that can come from implementing electronic prior authorization (e-PA):
Reduced Labor Costs: When a doctor pulls up a patient’s medical records he must sift through numerous data points to determine which drugs are approved and which drugs are going to require prior authorization. The hours spent processing this data is costly for healthcare staffing, but lost time can be reduced by moving the process online and implementing electronic methods. This can allow physician offices and PBMs the ability to review, submit and determine authorization almost immediately.
Reduced Consumer Delays: A consumer will typically experience the unattractive side of prior authorization at the pharmacy. If a doctor issues a prescription without knowing the patient’s medication history or pushes a popular name brand drug without suggesting a generic, the consumer will likely get sidelined with prior authorization processing at the point of sale. Having an e-PA process that can review and determine which drugs a patient is already approved for before they head to the pharmacy can reduce customer wait times and greatly increase consumer satisfaction.
Guest post by Lucy Doyle, Ph.D., vice president, data protection, information security and risk management, McKesson, and Karen Smith, J.D.,CHC, senior director, privacy and data protection, McKesson.
Today there are opportunities and initiatives to use big data to improve patient care, reduce costs and optimize performance, but there are challenges that must be met. Providers still have disparate systems, non-standard data, interoperability issues and legacy data silos, as well as the implementation of newer technologies. High data quality is critical, especially since the information may be used to support healthcare operations and patient care. The integration of privacy and security controls to support safe data handling practices is paramount.
Meeting these challenges will require continued implementation of data standards, processes, and policies across the industry. Data protection and accurate applications of de-identification methods are needed.
Empowering Data Through Proper De-Identification
Healthcare privacy and security professionals field requests to use patient data for a variety of use cases, including research, marketing, outcomes analysis and analytics for industry stakeholders. The HIPAA Privacy Rule established standards to protect individuals’ individually identifiable health information by requiring safeguards to shield the information and by setting limits and conditions on the uses and disclosures that may be made. It also provided two methods to de-identify data, providing a means to free valuable de-identified patient level information for a variety of important uses.
Depending on the methodology used and how it is applied, de-identification enables quality data that is highly useable, making it a valuable asset to the organization. One of the HIPAA- approved methods to de-identify data is the Safe Harbor Method. This method requires removal of 18 specified identifiers, protected health information, related to the individual or their relatives, employers or household members. The 18th element requires removal of any other unique characteristic or code that could lead to identifying an individual who is the subject of the information. To determine that the Safe Harbor criteria has been met, while appearing to be fairly straightforward and to be done properly, the process requires a thorough understanding of how to address certain components, which can be quite complex.
The second de-identification method is the expert method. This involves using a highly skilled specialist who utilizes statistical and scientific principles and methods to determine the risk of re-identification in rendering information not individually identifiable.
We need to encourage and support educational initiatives within our industry so more individuals become proficient in these complex techniques. At McKesson, we are educating our business units so employees can better understand and embrace de-identification and the value it can provide. This training gives them a basic understanding of how to identify and manage risks as well as how to ensure they are getting quality content.
Embracing Social Media and New and Improved Technologies
One of the challenges we face today in de-identifying data is adapting our mindset and methodologies to incorporate new emerging technologies and the adoption of social media. It is crucial to understand how the released data could potentially be exposed by being combined with other available data. New standards are needed.
While de-identifying data can be challenging and complex, the task is made easier when we remember and adhere to our core directive to safeguard data. With this in mind incorporating new technologies is part of an ongoing process of review.
When done properly, de-identification enables high quality, usable data, particularly when the expert method is used. De-identification should not be viewed as an obstacle to data usage, but rather as a powerful enabler that opens the door to a wealth of valuable information.
For decades, the use of paper medical records was the “norm” and the sharing of those records with another provider typically involved a photocopier and a briefcase for the patient to carry them to the next doctor. Today, electronic medical records are becoming the standard, but the exchange of health data between disparate networks and software systems has remained elusive.
While some data exchange is taking place in health care today, it’s only occurring in isolated pockets, typically within one region or health system, making it largely ineffective. Solving this challenge requires transparency, collaboration and innovation for continued success–attributes CommonWell Health Alliance embodies.
Transparency across the Industry
Competition in almost every sector thrives on keeping information separate and technologies proprietary. However, for many industries – like banking, telecom and internet, working across competitor lines to exchange data has enriched and expanded their reach. Health care needs to take a lesson from these industries.
Working in data silos will not improve the exchange of health data; rather, it will create friction in the industry. Patients expect their doctors to have the information they need to provide them with the best treatment. Doctors struggle to access this important data outside their four walls. The industry has an opportunity to step up and make it possible for providers to access a three-dimensional view of the patient’s health history, and in turn, create a new wave of opportunities for the health IT industry.
Collaboration among Health IT Industry Players
Collaboration throughout the IT industry is essential to creating a ubiquitous nationwide interoperable Health IT Infrastructure. This focus on infrastructure will drive standard adoption and open up the gates to national record sharing. Electronic health record (EHR) vendors offering services across the healthcare continuum are a key piece of this puzzle, which is why CommonWell formed to join forces with all health IT stakeholders dedicated to the vision that patient data should be accessible no matter where care occurs.
Collaboration with the public sector is also crucial. The government plays a strong role in narrowing the technical standards in health IT, but the bar must be raised on leveraging real-world data exchange. Additional ONC activities are complementary to the existing Federal Advisory Committees (FACAs) as noted below:
Bipartisan legislation known as the 21st Century Cures Act—which passed in the U.S. House of Representatives this past July—includes mandates that systems be interoperable by the end of 2017 or face reimbursement penalties.
In early October, the Office of the National Coordinator for Health IT (ONC) released its final draft of “Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap.” The three overarching themes of the roadmap including:
Giving consumers the ability to access and share their health data
Ceasing all intentional or inadvertent information blocking
Adopting federally-recognized national interoperability standards.
The ONC has also formed a Health IT Policy Committee and Health IT Standards Committee which each include smaller workgroups that meet to ensure ongoing collaboration among the private and public sector. In fact, many members of CommonWell and other private-sector interoperability initiatives participate and/or lead these committees and workgroups.
The days of life science companies focusing on physicians and medical professionals as their main “customers” are numbered. Larger healthcare market trends, better access to real world data and increasing costs are driving the shift to a new customer – the patient.
As total spending on medicines globally reaches the $1 trillion level annually, payers are, not surprisingly, placing greater emphasis on ensuring they are receiving value for their investments. Payers are bringing closer scrutiny to all parts of the healthcare system they are funding. Patients, too, are spending more in today’s system and in turn are changing their expectations about value and outcomes. As a result, we are seeing a new focus on real world evidence as payers and patients seek proof that the medicines are contributing to improved patient outcomes, reduction in hospital admissions or re-admissions, and more efficient use of resources.
In response, life science companies are seeking new and more effective ways to leverage data and analytics across the clinical-commercial continuum and to adapt their go-to-market strategies to reflect their focus on patient outcomes. Capturing results-oriented data and making it usable is critical for this new model to work and for the patient to receive the most appropriate care.
With this shift to outcomes-based results and real world evidence, many questions arise around the data and analytics. Who defines “value” and what does success look like? Is it long-term value or short-term results? Additionally, how should this information be distributed to and evaluated by the various stakeholders? How do we achieve a level of consistency when data sources are not yet fully interoperable?
As the pharma industry starts to work through the answers to these questions and begins to redefine go-to-market strategies and commercial models, effective utilization of data and analytics will prove to be one of the greatest competitive advantages.
Defining Value in the New Healthcare Era
This focus on patient outcomes has broader implications for the industry with data sources now being aligned with the patient to enable decisions across the enterprise including drug development, market access, and commercial performance.
This article is part of the “Think Further” series sponsored by Fred Alger Management. For more “Think Further” content, please visit www.thinkfurtheralger.com.
There is almost nothing I’m certain of except that life is an uncertain thing and that it seems to change a lot. Even in the most predictable of settings, even the minutest changes in detail can have a lasting and overwhelming effect on nearly everything in its atmosphere. In healthcare, a space seemingly immune to the status quo, things seem to get a whole lot more complicated. The same can be said of life and death, health and well-being. On their own, they are not so difficult to understand and often, in most cases, predictable and redundant; until the final days, of course, then things begin to get a little more complicated. When we’re fine, we’re fine. Life is good and most of our concerns seem trivial.
Then health gets involved and the minutest change in detail can send our lives in a spiral so much so that we barely recognize our place in it let alone who we are and where we belong. When such an occurrence arises, we begin to rely on beeps and buttons, software and technology in ways never before imagined for the intersection of our lives.
Clearly, the health IT landscape will be completely different five years from now. From where we stand today to where we’re headed, we’ll likely look back on this moment and wonder how we survived such archaic times. Just a couple years removed from the age of the electronic health records, technology that already seems dated and antiquated, is no longer monolithic and domineering to the space as it likely seemed in 2010.
Our future selves might stand on the threshold of 2020 and say that we were being single minded. The technology — EHRs were supposed to save healthcare and are now nothing but foundational. The technology was supposed to simply aggregate information collection, provide for the ability to quickly share information system wide and around the world; and give us the capability accessing all of a patient’s information at the tips of the proverbial finger.
When the promise of those solutions faded (yes, their stars have faded) and as our attention forced us into new technologies (primarily because of consumers’ desire) we are now seeing developments in technology creating touch points that impact patients “where they live” and has become the new force behind healthcare technology.
Consumers will drive healthcare’s future. Probably not a secret at this point, but a point that is hard for the old guard. They’ve had enough of being left out of the ownership process regarding their own health. They’re tired of being locked out of their own records, and kept access to their own information. Such data would not exist without those helping produce it. New consumer technologies have and will further level the field. Consumer tech will continue to spur innovation, at light speeds. Data will flow between healthcare parties and its consumers; HIPAA protections will be waived and open access for the social good will become the norm. Standard and traditional approaches when dealing with patients, in a generation or so, will be completely different and far less segmented, as they are now.
The Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) today released final rules that simplify requirements and add new flexibilities for providers to make electronic health information available when and where it matters most and for health care providers and consumers to be able to readily, safely, and securely exchange that information. The final rule for 2015 Edition Health IT Certification Criteria (2015 Edition) and final rule with comment period for the Medicare and Medicaid Electronic Health Records (EHRs) Incentive Programs will help continue to move the health care industry away from a paper-based system, where a doctor’s handwriting needed to be interpreted and patient files could be misplaced.
“We have a shared goal of electronic health records helping physicians, clinicians, and hospitals to deliver better care, smarter spending, and healthier people. We eliminated unnecessary requirements, simplified and increased flexibility for those that remain, and focused on interoperability, information exchange, and patient engagement. By 2018, these rules move us beyond the staged approach of ‘meaningful use’ and focus on broader delivery system reform,” said Dr. Patrick Conway, M.D., M.Sc., CMS deputy administrator for innovation and quality and chief medical officer. “Most importantly we are seeking additional public comments and plan for active engagement of stakeholders so we take time to get broad input on how to improve these programs over time.”
HHS heard from physicians and other providers about the challenges they face making this technology work well for their individual practices and for their patients. In recognition of these concerns, the regulations announced today make significant changes in current requirements. They will ease the reporting burden for providers, support interoperability, and improve patient outcomes. Providers can choose the measures of progress that are most meaningful to their practice and have more time to implement changes to program requirements. Providers are encouraged to apply for hardship exceptions if they need to switch or have other technology difficulties with their EHR vendor. Additionally, the new rules give developers more time to create user-friendly technologies that give individuals easier access to their information so they can be engaged and empowered in their care.
As part of today’s regulations, CMS announced a 60-day public comment period to gather additional feedback about the EHR Incentive Programs going forward, in particular with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which established the Merit-based Incentive Payment System and consolidates certain aspects of a number of quality measurement and federal incentive programs into one more efficient framework. We will use this feedback to inform future policy developments for the EHR Incentive Programs, as well as consider it during rulemaking to implement MACRA, which we expect to release in the spring of 2016.