Guest post by Num Pisutha-Arnond, managing partner, Curas, Inc.
Now that we are approaching the final stage of meaningful use, what has all of this regulation, incentives and penalties gotten us? The answer to that is unclear. Instead, what we are starting to see is a more introspective look at electronic health records. The real question has nothing to do with meaningful use, which was an externally mandated set of systems and requirements. Today, practices find themselves internally motivated to examine exactly what they would like to get out of this system that you have spent a lot of time, money and effort putting in. How can they improve operations, their finances, patient care and experience? What is the practice itself trying to accomplish? The answer to that varies significantly by specialty, practice size, geography, and your goals and priorities as they relate to your practice.
Because we’re already beginning to see life after meaningful use, and have been for the past 18 to 24 months, we can provide insight into some common goals and how practices are moving beyond meaningful use to achieve what cannot be measured by the criteria set forth by CMS.
The primary goals that we have experienced with our clients can be broken down into a few categories:
Better patient care
Better patient experience
Improved practice profitability
Provider and staff quality of life
Better patient care
Items related to this category often include the creation of patient dashboards/reports and patient recalls/campaigns to stay engaged with patients. However, the most effective, and often tougher initiative to implement, is a point of care system that lets providers and staff know when a patient should possibly have a certain test or procedure performed without having to search for data across different progress notes or screens.
Better patient experience
Most practices and vendors immediately jump to patient portals, kiosks and apps when discussing these goals. However, these are just a few of the tools that can be used to improve patient experience. In some cases, these tools may actually not enhance the experience if they are lacking in usability or if they are deployed in an uncoordinated manner. What is needed is a look at the overall patient experience from when they first call to the practice to when they have left the practice and need to be contacted by the practice. In some cases, the existing software and tools that have been implemented will work if the process is refined. In other cases, new software and tools may be needed. In others, you might even consider eliminating some of the technology to make a better experience for the patient.
How many doctors have you seen in your lifetime? Don’t know or remember? You’re not alone – the average American patient will see nearly 19 different doctors during their lifetime. Nineteen different offices. Nineteen different medical charts. Nineteen different phone numbers. Nineteen different calls to track down your records. Now, can you even remember your last five doctors?
The future: Imagine this, you visit your doctor – or any doctor for that matter – and they quickly pull up your medical history. Vaccinations when you were a child? Check. Currently on a hypertensive medication? Check. Pre-disposed to a medical condition? Yep, that’s in there, too. No more arriving 20 minutes early to the doctors’ office to fill out the industry-average seven pages of paper forms. Your records – past and present – are already being reviewed by your trusted provider.
Beyond the sheer convenience, the accuracy and completeness of having your entire medical history available at the fingertips of your provider can impact your well-being and scope of care. Can you accurately remember all procedures you’ve had? And when? Or all the medications you’ve ever taken? With dates? Imagine if you were a senior. Not just daunting, but nearly impossible. Instead of going over just snippets of what you actually remember, your doctor is empowered to holistically review your entire medical history with the potential to make more informed decisions about your health.
Seem like a pipedream? If you were to ask a mere decade ago, most would have agreed. As recently as 2007, 88 percent of physicians were still charting on paper. And those physicians on an EHR system – who were paying a premium – were almost exclusively using a localized, server based platform with no connectivity. For cost perspective, according to HealthIT.gov, the average upfront cost of implementing an EHR is $33,000 per provider plus an on-going fee of $4,000 yearly, a cost-prohibitive amount for most private practices.
Fast forward to 2009 and the passage of the HITECH Act which provided billions of dollars of incentives for providers to implement an electronic health record. In addition to the incentives, new vendors appeared on the market who provided electronic health record platforms completely free-of-charge, allowing providers to reinvest the incentives in their practice as additional staff, new equipment, etc.
Guest post by Ali Din, senior vice president, dinCloud.
With support having ended for Windows Server 2003, many organizations are left asking how to proceed with the soon-to-be obsolete server operating system. For organizations held to regulatory compliance standards, this question holds additional complexity. One of the industries undoubtedly scratching its proverbial head this week as support ends is healthcare.
Over the past few years, HIPAA, the Health Insurance Portability and Accountability Act of 1996, and HITECH, The Health Information Technology for Economic and Clinical Health Act, have largely determined the trajectory of IT and operations in healthcare. Perhaps most notably, HIPAA has helped govern patient security as healthcare institutions were incentivized to migrate health records to an electronic format through meaningful use. As EHRs, cloud and mobility solutions abounded, HIPAA guidelines dictated privacy and security standards for the industry. Today, many healthcare organizations are faced with a similar transition. Like all organizations, healthcare institutions have the option to migrate their servers to a supported operating system, which typically includes a corresponding hardware upgrade. Alternatively, they can migrate these workloads to the cloud. However, as reported by the Wall Street Journal, “analysts say that the technology [Windows Server 2003] is more prevalent in healthcare, utilities and government,” demonstrating that inaction seems to be more prevalent in the healthcare sector than one would think.
Those who have not yet migrated from Windows Server 2003 will be exposed to significant security risk and may compromise HIPAA compliance, as it is unlikely the operating system will remain a HIPAA supported platform.
The implications of not migrating extend beyond just the affected server. One unpatched vulnerability can compromise an organization’s entire infrastructure.
End of support means that Microsoft will no longer issue patches and security updates for Windows Serer 2003, and the resulting security risk is so severe, US-CERT, a branch of the Department of Homeland Security, issued a security alert warning of the “impact” of end of support. The alert states, “organizations that are governed by regulatory obligations may find they are no longer able to satisfy compliance requirements while running Windows Server 2003.”
Like the security risk, cost for extended support will also compound for healthcare organizations. Microsoft is charging $600 per server for the service, which will quickly add up.
With the risk and cost associated with not migrating, why are so many healthcare organizations approaching the deadline with no foreseeable migration plan? Like many goings-on in the industry, it’s complicated.
One factor is that some mission critical applications may not transition to a supported platform. That leaves IT administrators choosing between migration and applications that, in some cases, may be in daily use by their workforce.
And, finally, if it ain’t broke (yet), don’t fix it. Like many industries, healthcare organizations are often seeing heightened demand placed on smaller teams, which doesn’t leave ample time for proactivity. In these scenarios, migration planning may not have been prioritized with budget or resource allocation.
However, with end of support approaching in just a few days, regardless of the reason why these organizations didn’t migrate, they will soon be faced with the consequences.
Interoperability between healthcare’s disparate systems seems to be the stickiest of wickets, and a Holy Grail that every soul in the sphere is trying to find. Given the number of conversations about the topic, there’s often little discussed about its actual importance. Perhaps this is an assumed measure or an outcome that should be clearly understood as positive, but every relevant aspect of every story should be covered, not simply assumed. Because far better reporters and publications have done a far better job of describing the interoperability issue and its place in the current healthcare landscape, I decided to ask one question of the community, in an search of a foundational answer to: How is interoperability critical to healthcare innovation?
The prospective provided here, from some of healthcare’s most knowledgeable insiders, offers some interesting insight into a topic that seems more or less overlooked in the larger conversation of achieving interoperability or its capabilities.
Rick Valencia, senior vice president and general manager, Qualcomm Life Interoperability is the future of healthcare innovation, especially as we move toward an era of connected, team-based care. We need to create platforms and devices that enable the seamless, frictionless flow of data to allow doctors, patients, providers and care teams to collaborate efficiently to make critical care decisions. As care moves from the hospital to the home and more patients are remotely monitored, we need solutions that enable continuous care, informed interventions, and better management of at-risk populations. Without interoperability, we can’t innovate. Without innovation, we can’t improve the health of our nation.
Interoperability is critical to innovation in healthcare IT, particularly when it comes to connecting the care delivery ecosystem to provide safer transitions of care between acute and senior care. While some individuals may require short-term rehabilitative care, others may need home-based care, assisted living or long-term and hospice care. As seniors move through these different stages or between acute care and post-acute care, these transitions pose challenges for healthcare providers. Ideally, all the information that clinicians need to treat the individuals will be available when they arrive at their new destination. However, this is not always the case. Healthcare providers must invest in an infrastructure and emerging technologies, such as electronic health records and mobile communications, which support seamless transitions; interoperability plays a vital role. Compared to single-purpose or “best-of-breed” software solutions, comprehensive platforms can optimize many parts of the business, from enabling better-connected resident care and documentation, to delivering high quality data insights for financial management and risk mitigation. In the end, this will allow for better health outcomes, help reduce unnecessary hospital readmissions, ensure organizations are financially sound and keep healthcare costs down.
Guest post by Alexandra Sewell, executive director, enterprise marketing, Comcast Business.
Meaningful use is one of the largest drivers of healthcare IT, with the potential for far-reaching effects. Many healthcare organizations are well on their way to achieving meaningful use, working through related cost, training and resource challenges.
But there is still work to be done. Meaningful use can require significant network infrastructure investment to support electronic health records (EHRs) and other technologies. At the same time, budgets are shrinking, so providers must be strategic about how they allocate IT dollars.
Improving Patient Outcomes
EHRs give doctors a complete view of the patient — from demographics and vital signs to medications, allergies and more. EHRs are a central component to complying with meaningful use Stage 1 requirements and help doctors easily view and transmit records, which can lead to more accurate patient diagnosis and treatment.
Hospitals with EHR systems can better capture data regarding patients’ co-morbidities and other risks. This helps clinicians manage patients, resulting in more positive clinical outcomes and improving mortality rates for heart attack, respiratory failure, and lower intestine surgery. EHRs can help improve the overall quality of patient care.
Picture Archiving and Communication System (PACS) technology provides economical storage and convenient access to a range of images from multiple imaging devices, transmitting them digitally and eliminating the need to manually file, retrieve or transport film jackets.
To comply with Stage 2 of meaningful use, healthcare providers must offer patients the ability to view, transmit, and download their health information. And while not explicitly mandated by meaningful use core objectives, many organizations are integrating their PACS and EHR systems so images, such as MRIs and CT scans, can be shared between physicians and with patients through patient portals. However, the size and volume of these imaging files place stress on hospital networks, creating data capacity and data center connectivity issues.
The proposed rule for meaningful use Stage 3 was announced on Friday, March 20, 2015, and is now available for comment by stakeholders. Here are five highlights of the Stage 3 proposed rule and what I see as three provider wins:
2017 is now a Flex Year– Meaningful use Stage 3 was originally slated to begin in 2017 for providers that had completed Stage 2; now 2017 is a flex year. This means that providers who would have progressed from Stage 2 to Stage 3 in 2017 now have the option to stay in Stage 2 an additional year. Only providers who use an EHR certified to the 2015 ONC standards will be allowed to attest to Stage 3.
Every provider will be Meaningful Use Stage 3 in 2018 even if 2018 is the provider’s first reporting year – In order to simplify the meaningful use program, all providers will be in the same stage. This will allow group practices to focus on a single set of measures for all providers.
Meaningful Use Stage 3 is the final stage of meaningful use– However, CMS is clear that because it expects technology and care standards to evolve over time it will consider (and we expect) that there will be future rulemaking related to meaningful use Stage 3 somewhere down the line.
All providers will report for one calendar year – in an effort to continue to align meaningful use with other government reporting programs such as PQRS, all providers will report for a full year based on the calendar with one exception. Medicaid first year providers will still be allowed to report based on a 90-day period measurement period. In the past CMS has shortened measurement periods based on provider feedback and we expect that to be true about this year. This year (2015) was slated to be a full year for most providers, but we expect it to be scaled back to a quarterly measurement period because of the continued side effects of the poor implementation of Stage 2 last year. For 2017 and beyond, we expect the implementation will be smoother and we don’t foresee more flexibility on measurement periods beginning next year.
There are eight objectives and some objectives have more than one measure – the total number of measures that providers will be required to report is 16.
Wins for Providers in the Meaningful Use Stage 2 Proposed Rule
I see three wins for providers in the meaningful use Stage 3 Rule, including:
Information Technology holds the promise to spur innovation in the healthcare industry. However, if IT investment is focused on simply meeting mandates and not on driving a specific differentiated business objective, then it begins to look a lot like what we are seeing today – extensive capital and resources spent on implementing and supporting IT initiatives that, so far, have provided little to no financial returns. But this does not mean that the promise of IT is empty. Instead, it calls attention to the need to look at IT not as a way to “check the box” and either collect federal incentive dollars or avoid eventual penalties, but rather as a key tool to remain competitive in the market as well as provide quality care.
In light of recent federal mandates under meaningful use regarding the implementation of electronic health records, many EHR vendors are now propagating the idea that their software is not only compliant with regulatory statutes, but is also a singular comprehensive and strategic IT investment. However, this is just half the truth.
Under the pressures of time and expiring incentives, many healthcare executives have leapt after EHR investments without understanding the real strategic reasons for making IT investments for their enterprises. Otherwise savvy and well-meaning healthcare leaders are allowing EHR vendors to convince them that an EHR is the answer to their business needs and will provide them with an edge over competitors in the market. In reality, EHRs fail to provide a competitive advantage once most or all hospitals in a geographic market have implemented the tool. How can an organization claim it is superior in IT if it is operating the same systems as every other provider in the market? EHRs must be approached as a one-time operational input or business asset similar to hospital equipment and not the core component of a broader IT solution needed to support a sustainable business strategy. As with most investments, it is what you do with it which matters, not that you simply own it.
HIMSS released the results of the 26th Annual HIMSS Leadership Survey of more than 300 participants, examining key trending issues impacting the business of healthcare including patient considerations, security concerns, insurance models and policy mandates. This survey revealed that 72 percent of respondents report that consumer and patient considerations, such as patient engagement, satisfaction and quality of care will have a major impact on their organization’s strategic efforts over the next two years.
The strategic value of information technology (IT) continues to be top of mind with healthcare leaders as 81 percent of respondents indicated IT is considered a highly strategic tool at their organizations and 76 percent noted that their IT plan fully supports their overall business plan. Participants also answered questions related to how IT was being used to facilitate the goals of the Triple Aim – a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. While more than two-thirds of respondents (68 percent) indicated an improvement within the patient health experience, more than half also felt that IT was reducing the cost of healthcare (53 percent) and improving population health (51 percent).
“This year’s survey showed that more than one-third of participants report that their organization was able to demonstrate improvement in all three areas covered in the Triple Aim as a result of their IT use,” said John H. Daniels, vice president, strategic relations for HIMSS. “These numbers are critical as they prove the continued progress healthcare is making as IT integrates with value-based care strategies and the growing influence of the patient in health encounters. It will be important for providers to capitalize on this momentum to ensure improved patient satisfaction as the sector begins the transition from Stage 2 to Stage 3 of meaningful use.”
The Leadership Survey also indicated that IT is supported from the top down– 79 percent of respondents indicated their organization’s executive team is highly supportive of IT and 72 percent of respondents indicated their organization’s board of directors was also on board with IT growth within their organizations.
The following is an announcement from CMS about potential modifications to the meaningful use program, announced Apr. 10, 2015:
On April 10, 2015, the Centers for Medicare & Medicaid Services issued a new proposed rule for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs to align Stage 1 and Stage 2 objectives and measures with the long-term proposals for Stage 3, to build progress toward program milestones, to reduce complexity, and to simplify providers’ reporting. These modifications would allow providers to focus more closely on the advanced use of certified EHR technology to support health information exchange and quality improvement.
The proposed rule is just one part of a larger effort across HHS to deliver better care, spend health dollars more wisely, and have healthier people and communities by working in three core areas: improving the way providers are paid, improving the way care is delivered, and improving the way information is shared to support transparency for consumers, health care providers, and researchers and to strengthen decision-making.
The proposed rule is a critical step forward in helping to support the long-term goals of delivery system reform; especially those goals of a nationwide interoperable learning health system and patient-centered care. CMS is also simplifying the structure and reducing the reporting requirements for providers participating in the program by removing measures which have become duplicative, redundant, and reached wide-spread adoption (i.e., are “topped out”). This will allow providers to refocus on the advanced use objectives and measures. These advanced measures are at the core of health IT supported health care which drives toward improving the way electronic health information is shared among providers and with their patients, enhancing the ability to measure quality and set improvement goals, and ultimately improving the way health care is delivered and experienced.
In today’s concierge economy there is an increasing number of things available on-demand at our beck and call. TV shows and movies, car services, local dining hot spots, even directions, are all accessible at the ready. With the proliferation of voice commands, typing has even been removed from the equation in certain instances. Patient portals aren’t quite there yet but the consumerization of IT has forever changed user expectations and unfortunately, left many industries struggling to catch up.
For the healthcare industry specifically, it’s been a hard pill to swallow as organizations have gone after the various government incentives offered through the HITECH Act. As those organizations have found out, the trail from paper-based records to fully digital portals can be a long and weary journey, but if the lofty consumer expectations can’t be met, the impatient patients will rear their ugly heads and make meaningful use requirements an even more elusive prey. The good news is that there are ways for healthcare organizations to make their patient portals seamless and efficient without having to develop an extravagant user experience that is on par with an Apple operating system.
When developing a patient portal, first and foremost, ease of use is of the essence to minimize the time needed for patients to accomplish tasks. Patients have very short and finite attention spans that are easily surpassed if they have to jump through too many hoops. Stage 2 meaningful use requirements included secure messaging, the ability to access and download electronic information, reminders sent for preventative and follow-up care, and general education materials.
These are all very basic tasks, but the parallel consumer experiences are incredibly user friendly, fast and intuitive. The key point to make is that the majority of patients really only need one of those criteria met for patient portals … speed. If patients can get what they need quickly, they are often satisfied. It’s not a social network, it’s a tool, so building patient portals with speed in mind is key to driving the patient engagement percentages required to meet the meaningful use standards. Given that so many of these processes are document heavy, streamlining the document viewing process is a key piece of the pie.
That document viewing part of the puzzle centers on the fact that patients benefit if only one method is needed to view the multitude of documents used in the healthcare realm. Records, prescriptions, X-rays and charts; the list goes on and on, not to mention the different digital formats in which the documents are often stored. Add to that the complexities involved when different organizations have different approaches to creating and storing these documents and the potential for complications and problems starts piling up quickly. Unfortunately, the place where all of these complexities converge is the patient. Portals need to be able to handle all of these document types with ease and again, quickly. HTML5 technology is a huge boost to this process as it enables browser-based document viewers to be easily integrated into patient portals. This means that any patient with an Internet connection and a standard browser can easily access any of their documents. There is no need for additional software downloads, such as Microsoft Word or Adobe Acrobat or even an image viewer, which is often the last straw for patients before giving up on the system completely.