Guest post by Michael Simpson is the CEO of Caradigm.
It’s been five years since the HITECH Act was enacted as part of ARRA, and while there’s still a lot of debate about the technical details, rules and timelines involved with electronic health record (EHR) adoption and meaningful use, it’s clear that the focus on EHRs – and incenting hospitals and professionals to use EHRs in a meaningful way – represents a critical, foundational step in transforming health care in this country.
After all, meaningful use targets the right goals – goals that every hospital, health system and healthcare professional supports, including improved quality, safety and efficiency of care; reduced disparities; more engaged patients and families as core members of the care team; improved care coordination and population health; and more secure patient health information.
More important, the stages of meaningful use drive a set of progressively more advanced capabilities that are fundamental to achieving those goals. Digitizing data was the first critical step, and the good news is that according to a recent HHS press release, about 60 percent of all hospitals have adopted an advanced EHR, leaving the paper world behind. The next steps are sharing that data – securely – among providers and patients, reporting on quality to understand and improve it, using clinical decision support at the point of care, and many other capabilities critical to transforming care and outcomes. If providers and professionals meet meaningful use requirements, we should see more transparency, greater efficiency, reduced waste and more healthy people in our communities over time.
Stage 2 Challenges
It’s a long and challenging journey, and while hospitals and health systems are making good progress against Stage 1 requirements, very few are prepared for Stage 2. In fact, according to survey data from the American Hospital Association, fewer than 6 percent of hospitals have met the criteria for Stage 2, and only 10 percent have met the requirement for patients to be able to view, download and transmit their health information online.
Why are providers getting stuck as they try to move to Stage 2? Because as the requirements become more demanding – e.g., using clinical decision support, generating patient lists, protecting patient health information, engaging patients – these organizations need a new set of technology capabilities to meet those requirements. These capabilities leverage and extend the functionality and benefits of the EHR.
Moreover, to reach the ultimate goals targeted by Meaningful Use — improved quality, efficiency, outcomes and population health — providers will need to aim even higher than meeting the requirements of meaningful use stages, strategically using data from EHRs and myriad other systems across the care continuum to enable a new level of capabilities.
Guest post by Nilesh Chandra and Nick Mathisen, healthcare experts at PA Consulting.
Nilesh Chandra
Healthcare as an industry is undergoing rapid, fundamental changes brought about by reform. The Affordable Care Act of 2010 turned the incentive system upside down for healthcare providers, moving them from fee-for-service payments to Accountable Care Models. Providers who previously made money by separately charging for each procedure and bore little financial risk for patient health, now get paid a single bundled amount for providing care for a group of people, with incentives to reduce the total cost of care and share in those savings. Taking a cue from Medicare and Medicaid, private health insurers are increasingly adopting similar payment models.
The challenges today
Nick Mathisen
Doctors and nurses who had the responsibility to help sick people get better, are now expected to keep people healthy. Hospital administrators who were measured on financial metrics like bed utilization are now expected to keep people out of hospitals. Traditional healthcare involved dealing with sick people who came in to hospitals and clinics. Tomorrow, healthcare will be about proactively engaging with healthy people and encouraging them to adopt behaviors that keep them healthy. This will involve outreach and engagement in entirely new ways that the modern healthcare industry has not done before.
The future of healthcare
The future of healthcare is outside the boundaries of what our modern healthcare industry knows how to do.
Think about it. Many industries are facing disruptive innovation where the future of the industry is completely different from what has been the norm. For example, the PC industry with the rapid shift to tablets, or retail with the increasing move to online channels. However, both of those industries have always been subject to rapid innovation and players have learned to evolve rapidly. The transformation in healthcare is more profound because it is larger in scale and it has a much greater impact on people’s lives.
So what does the future of healthcare involve and how can technology help? There are three key elements that the healthcare industry has to learn to be more efficient and proactive:
Caring for the chronically sick more efficiently with wearables
The rate of diabetes, heart conditions, obesity and other chronic conditions are projected to continually rise. The chronically ill consume a large proportion of healthcare, therefore any efficiency gained in providing care for them translates into significant savings in the overall health system. A recent study from Robert Wood Johnson University hospital found that 80 percent of all heart-attacks could have been prevented by simple changes in lifestyle. Changes in lifestyle will have a similar positive impact on other chronic conditions as well.
Guest post by James Bindseil, president and CEO, Globalscape.
Health IT has reached a pivotal crossroad: On one end, consumers’ expectations for more timely care and instant access to health files and records continue to skyrocket; on the other, security and compliance risks are more complex and threatening than ever before.
This leaves health providers in a precarious position: should they prioritize security and compliance, or productivity and care?
In a perfect world, the answer would be all four. Unfortunately, today’s health IT landscape — which is going through a rapid and significant transformation to keep up with evolving compliance mandates, new demands around access to patient files, changing government policies, sophisticated security threats and new technologies — is far from perfect.
One of the most pressing issues lies within the policies and technologies provided by today’s IT teams. In fact, in many instances, the policies and tools implemented by IT to keep patient data safe and secure often end up having the opposite effect: they make it incredibly difficult for providers to deliver fast and efficient care in a secure, compliant manner.
For example, let’s imagine a day-in-the-life of a hospital care provider, who faces immense pressure to deliver top-notch care to as many people, and in as little time, as possible. On day one, an off-duty doctor is called at home to provide his take on the best care plan for a specific patient. How will he review the pertinent information while working remotely? In another scenario, the doctor is running from patient to patient, and is unable to take the necessary time to record his actions. Taking the work home on a USB drive seems like the best option. The next day, the hospital needs to quickly share files with the patients’ previous provider to care for an urgent medical issue.
There it lay. Faded graphite thoughts etched from corner to coffee-stained corner. Face down. Buried under strata of paperwork—the paper feedback form. Once a hallmark of modern medicine, the paper feedback form is now a relic. Yet patient feedback itself lives on, transformed into red ninja stars—the kind you would see on Yelp—headed straight for your healthcare organization.
Patient feedback is yet another element of society that has been transformed by the Internet. Where feedback used to be written privately on pieces of paper, it is now being left as reviews for the world to read on the Internet. The change in patient feedback stems from three technological, social and financial trends. This article identifies these three trends and serves as a conversation starter for healthcare IT leaders to engage other departments in a strategy to leverage online reviews for growth in 2015, and beyond.
Trend 1 – Technological
In 1999, America fell in love with the online review. Within six months of its invention, 1,146,201 reviews had been created for sports teams, products, etc. Doctors largely flew under the radar until 2007 when the Centers for Medicare and Medicaid Services (CMS) began publishing a list of all US doctors. Now, 70+ websites like Yelp regularly copy the CMS’s list of doctors onto their websites for consumers to leave reviews. This is why online reviews show up on nearly every search for a doctor’s name, even when patients aren’t seeking reviews out specifically.
Trend 2 – Social
It seems counter-intuitive that patients would believe the words of a stranger on the Internet over a trusted friend. Yet, a 2011 survey by CONE Research survey revealed that 89 percent of consumers check online reviews before making expensive purchases—even after receiving a recommendation from a trusted friend. Also surprising was the number of people who would take the time to write reviews. According to an August 2014 interview with Jeremy Stoppelman, CEO of Yelp, “Skeptics initially scoffed at the idea that people would feed Yelp free reviews of local businesses.” Those skeptics were wrong. Yelp has accumulated 61+ million reviews.
What must be done before you walk out of the office for the last time before the stroke of midnight Jan. 1, 2015? It’s a simple question with many possible responses. Each healthcare organization, based on its needs and priorities likely has a fix what it needs to do, though, perhaps those things are not necessarily what it wants to do. Like people, the final couple weeks of the year are different for everyone and practices are no different.
So, if you’re making a list and checking it twice, here are a few suggestions that you might want to add to it to be well prepared for the new year, based on your practice’s business needs, of course.
Review the ONC Federal Health IT Strategic Plan
Chris Boone
At Health Data Consortium, we have three must-do items before we close the door to 2014. First, we urge the health IT community to review the recently released ONC Federal Health IT Strategic Plan 2015-2020. Public comments are open until February 6, but don’t let your response get lost in the start of the year flurry. Second, we are preparing for the arrival of the 114th Congress and the opportunity to share Health Data Consortium’s public policy platform for 2015. Our platform will have an emphasis on the key issues that affect data accessibility, data sharing and patient privacy – all critical to improving health outcomes and our healthcare system overall. Finally, on January 1 we’ll be only 150 days from Health Datapalooza 2015. We are kicking off the new year and the countdown to Health Datapalooza with keynote speakers and sessions confirmed on a daily basis. We’re already making the necessary preparations to gather the innovators who are igniting the open health data revolution. As 2014 comes to a close, we look forward to hit the ground running in 2015.
Ideally, turn off not only your lights, but everything — I mean every piece of digital technology and every way digital technology can connect to your organization. That is the only way to assure there are no accidents, glitches, failures or breaches. Here are some other things you can do:
• Fill every open position you can. Have positions and people identified and include backups. The only thing worse than not having a position to fill is having one to fill and leaving it open.
• Address mobility, medical devices and patient engagement, and not just from a security perspective — this is everyone who provides access, information or uses these devices or systems.
• Address the culture and have a plan to include every individual in the organization, if the technology touches them, from BYOD to analytics to privacy to cloud storage.
IT, regardless of the industry, is ultimately about people. In healthcare, it is also about the data itself, which represents your patients. It has to be there, it has to work, it has to be secure.
— David Finn, CISA, CISM, CRISC, is a member of ISACA’s Professional Influence and Advocacy Committee, and the Health Information Technology Officer for Symantec
I remember when the Health Insurance Portability and Accountability Act (HIPAA) passed. I was working for a leading practice management software vendor. Everyone was overwhelmed by what was involved. We developed a huge amount of education and information for our customers. Some people wondered if the healthcare industry could make such a major change.
Today, HIPAA is ubiquitous. Many practices take it for granted. They are not concerned about a breach because they believe they have done everything they need to do. In a recent study by MedData Group of physicians top practice management priorities for 2015, HIPAA didn’t even make the list.
“We instigated HIPPA when it came out, and it is in place and second nature to us,” said Joann Lister, a provider at a family medicine practice in Texas. “We have all worked at the hospital so we had plenty of training on the rules. Our physical space and computers are confidential. Our practice management and EHR software, Kareo, always goes back to login when we are done in a room so the next patient does not see anything. We have limited personnel so it is easier to know that everyone honors the HIPAA rules.”
The question is: Have practices gotten too complacent with HIPAA? With the latest changes to HIPAA in 2014, have they followed through on making changes and updates? The data and experience of industry experts and consultants suggests that there may be a problem with HIPAA compliance.
“The last analysis we did for a practice had 41 pages of regulations that required implementation,” recalled practice management consultant Rochelle Glassman, CEO of United Physician Services. “Most practices do not know what the complete requirements are. They believe that if they have the patients sign the privacy form that is all they need to do. This year there were updates that included the new HITECH Act and the HIPAA Omnibus rule. I can guarantee that many practices have not updated their HIPAA program to include the changes because they do not even know they exist.”
In the first real-world trial of the impact of patient-controlled access to electronic health records, almost half of the patients who participated withheld clinically sensitive information in their medical record from some or all of their health care providers.
Should patients control who can see specific information in their electronic medical records? How much control should they have? Can doctors and other clinicians provide safe, high-quality care when a patient’s preference may deny members of the medical team from seeing portions of the electronic medical record? What is the appropriate balance between individual privacy concerns and health care providers’ need for relevant data?
The Regenstrief Institute, Indiana University School of Medicine and Eskenazi Health (formerly Wishard Health Services) partnered to design and conduct the first real-world trial intended to help answer these and related questions. During the six-month trial, 105 patients in an Eskenazi Health primary care clinic were able to indicate preferences for which clinicians could access sensitive information, in their electronic medical records, such as information on sexually transmitted diseases, substance abuse or mental health, and designating what the clinicians could see.
Regenstrief informatics developers then created a system where those preferences guided what information doctors, nurses and other clinic staff could see. Patients were able to hide some or all of their data from some or all providers. Importantly, the healthcare providers were able to override patients’ preferences and view any hidden data, if they felt the patient’s healthcare required it, by hitting a “break the glass” button on their computer screens. When providers hit this button, the program recorded the time, the patient whose electronic chart was being viewed and the data displayed.
Twenty eight states, three territories and the District of Columbia will receive more than $665 million in Affordable Care Act funding to design and test healthcare payment and service delivery models that will try to improve healthcare quality and lower costs, Health and Human Services Secretary Sylvia M. Burwell announced.
Together with awards released in early 2013, more than half of states (34 states and three territories and the District of Columbia), representing nearly two-thirds of the population are participating in efforts to support comprehensive state-based innovation in health system transformation aimed at finding new and innovative ways to improve quality and lower costs.
The State Innovation Models initiative supports states in planning or implementing a customized, fully developed proposal capable of creating statewide health transformation to improve health care. Example initiatives include:
Improving primary care through patient centered medical homes, building upon current Accountable Care Organization models or integrating primary care and behavioral health services.
Providing technical assistance and data to healthcare providers and payers that are working to advance models of integrated, team-based care, or transition to value-based payment models.
Creating unified quality measure score cards that health care payers and providers can use to align quality improvement and value-based payment methodologies.
Expanding the adoption of health information technology to improve patient care.
Fostering partnerships among public, behavioral and primary healthcare providers.
Strengthening the healthcare workforce through educational programs, inter-professional training, primary care residencies and community health worker training.
