More than 82 percent of physician group practices responding to the MGMA Physician Practice Assessment: Medicare Quality Reporting Programs* research reported they actively engage in internal processes to improve clinical quality for the patients they serve. Despite this focus, practices were heavily critical of Medicare’s physician quality reporting programs and their impact on patients and practices. More than 83 percent of physician practices stated they did not believe current Medicare physician quality reporting programs enhanced their physicians’ ability to provide high-quality patient care.
In addition to the lack of effectiveness, physician practices reported significant challenges in complying with Medicare quality reporting requirements. More than 70 percent rated Medicare’s quality reporting requirements as “very” or “extremely” complex. In addition, a significant majority of respondents indicated these programs negatively affected practice efficiency, support staff time, and clinician morale.
Next year, 2015, will be a critical year for medical group practices participating under three main Medicare Part B physician quality reporting programs.* It will be the first year all three programs penalize physicians for reporting unsuccessfully, and penalties will continue to grow in future years. When added up, unsuccessful reporting in 2015 will subject physicians and other eligible providers to Medicare payment penalties as high as 11 percent, levied in future years.
Health IT pain points seem to be lingering long despite the never ending promises and hope eternal new technology innovation seems to offer. Every sector has its prickles, no doubt, and much is left to overcome in healthcare, but given the complexity and the copious amount of change and development here, it’s of little surprise that pain is being felt.
What may be surprising, though, is that like patient engagement, there seems to be a different type of pain, and severity of pain, depending on who you ask.
With that, for greater clarity, I decided to ask some of health IT industry insiders what they’re pain points were and why. Their responses follow:
Dr. Trishan Panch
Dr. Trishan Panch, chief medical officer, Wellframe
One of the biggest pain points for hospitals is that we’ve come across a health system’s inability to scale care management resources. They are effective in improving outcomes when patients are engaged, but because of limitations around existing models (i.e. human interaction via phone or in-person) only a small proportion of the patient population can be engaged. That’s why organizations are turning to technology solutions to scale care management resources to reach more people.
One of the biggest pain points for physicians today is the lack of interconnectivity between different IT systems. Participation in the meaningful use program has helped create some common standards for communication but, for a variety of reasons, these have not yet lead to widespread, effective clinical data sharing. Few physicians can operate in the ecosystem of a single electronic medical record, since they often work in systems that are different, from practice, various hospitals and other places of care.
Interoperability is a pain point in healthcare IT, particularly when it comes to transitions in senior care. Connecting the care delivery ecosystem to provide safer transitions of care is critical to long-term 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 individual will be available when he arrives at his new destination. However, this is not always the case. Healthcare providers, both long-term and acute, must invest in an infrastructure that supports seamless transitions of care; interoperability plays a vital role. Connecting healthcare providers across the care continuum will allow for better health outcomes, help reduce unnecessary hospital re-admissions, as well as keep healthcare costs down.
There are various statistics about the negative impact paperwork has upon providing healthcare. The AHA has estimated it adds at least 30 minutes to every hour of patient care provided. A main pain point continues to be the ability for IT to implement efficient EHR systems. At the core of any EHR system are its image capture capabilities. It must be simple to use throughout the workflow process. This includes image capture, editing, saving and sharing. The capture, or scanning, must be speedy. Editing features must be clear in how to use. This minimizes learning curves at the start. It also optimizes the speed of processing documents during the life of its use. Easy saving to local or network locations should also enable simple and secure sharing too. When one, some or all of these areas stall, it can cripple the realization of benefits from digital document management.
As has been much reported, national coordinator for health IT, Karen DeSalvo, M.D., is leaving the office effective immediately to become acting assistant secretary for health in the Department of Health and Human Services. The announcement was made Oct. 26, 2014, by HHS Secretary Sylvia Burwell.
Burwell requested that DeSalvo to make the move in an effort to help battle and lead to containment of the Ebola crisis. DeSalvo will serve as acting assistant secretary until the Senate confirms an assistant secretary. There is no pending individual nominated for the permanent position.
Lisa Lewis, the ONC’s chief operating officer, now will serve as the acting national coordinator at ONC.
According to Modern Healthcare: HHS Secretary Sylvia Mathews Burwell, in a notice to her staff, welcomed DeSalvo, saying, “As the acting assistant secretary for health, Karen’s experience as a practicing physician, a senior member of the HHS team, and as a nationally recognized leader in public health, will be invaluable to the department and me.”
“She will bring her knowledge and real-world experience to bear on some of the most important issues confronting our department, especially our Ebola response efforts,” Burwell said.
DeSalvo was appointed in December 2013 and started in mid-January 2014. She took over after the departure of former national coordinator Dr. Farzad Mostashari who stepped down in October 2013.
To date, she’s the shortest serving ONC national coordinator, if she’s leaving the position permanently, which has not been verified.
Guest post by Martin Edwards, MS, CHC, CHPC, compliance officer, Dell Healthcare.
Patient portals offer an unprecedented opportunity to engage consumers, provide a customized care experience and potentially change behavior. Yet they also introduce new security concerns for both patients and providers.
A question we often hear from healthcare providers regarding security is: How much protection against negligence does meeting the HIPAA requirements really provide? That question is particularly germane to patient portals, which create an additional entry point and more risk to the security of protected health information (PHI). The laws and regulations in these cases can be confusing.
Fortunately for providers, “safe harbor” is offered in those cases where the provider can prove that they have properly encrypted all devices that contain PHI. Under the HIPAA security rule, as long as PHI is encrypted according to National Institute for Standards and Technology (NIST) guidelines, it is no longer considered “unsecured” and providers are effectively exempt from improper disclosure being considered a “breach.” Thus, the HIPAA breach notification rule doesn’t apply, and, by extension, the provider can avoid potential fines from the Office for Civil Rights (OCR). Since most breaches of PHI reported to the U.S. Department of Health and Human Services (HHS) to date have related to the theft or loss of unencrypted mobile devices, encrypting the data is a primary defense against data loss and against the consequences of improper disclosure.
While patient portals add risk, they also confer many benefits to healthcare organizations, including enhanced patient-provider communication and empowerment of patients. Some studies have found that portals can also enable better outcomes for patients. These benefits are behind the HIPAA privacy rule’s “right of access,” which allows individuals to examine and obtain a copy of their PHI. Meaningful use requirements also require eligible professionals to exchange secure emails with at least 5 percent of their unique patients. Since portals are an ideal way to meet this requirement, organizations seeking to comply with Stage 2 criteria have an incentive to adopt them.
Twenty percent of American adults already own a wearable technology device and the adoption rate – on par with tablets in 2012 – is quickly expected to rise, according to PwC’s Consumer Intelligence Series – TheWearable Future report – an extensive U.S. research project that surveyed 1,000 consumers, wearable technology influencers and business executives, as well as monitored social media chatter, to explore the technology’s impact on society and business. In the last three decades, PwC has examined how technological innovation plays an increasingly prominent role in helping brands set themselves apart in their respective industries and how wearable technology can offer brands an opportunity to establish themselves, particularly in the entertainment, media and communications (EMC), health, retail and technology industries. In conjunction with The Wearable Future report, PwC’s Health Research Institute (HRI) launched a separate report, Health wearables: Early days, further examining consumers’ attitudes and behaviors toward health wearable technology.
While fitness bands, smart watches and other wearables are already established in the market, many of them have under-delivered on expectations. Consider that 33 percent of surveyed consumers who purchased a wearable technology device more than a year ago now say they no longer use the device at all or use it infrequently. Price, privacy, security, and the lack of “actionable” and inconsistent information from such devices are among consumers’ main apprehensions with the bourgeoning category. In fact, 82 percent of respondents were worried that wearable technology would invade their privacy and 86 percent expressed concern that wearables would make them more vulnerable to security breaches.
That said, 53 percent of millennials and 54 percent of early adopters say they are excited about the future of wearable tech. Among the top three potential benefits:
Improved safety: Ninety percent of consumers expressed that the ability for parents to keep children safe via wearable technology is important.
Healthier living: More than 80 percent of consumers listed eating healthier, exercising smarter and accessing more convenient medical care as important benefits of wearable technology.
Simplicity and ease of use: Eighty-three of respondents cited simplification and improved ease of technology as a key benefit of wearable technology.
And for wearable technology to be most valuable to the consumer, it needs to embrace Internet of Things opportunities; transform big data into super data that not only culls, but also interprets information to deliver insights; and take a human-centered design approach, creating a simplified user experience and an easier means to achieve goals.
“Businesses must evolve their existing mobile-first strategy to now include the wearable revolution and deliver perceived value to the consumer in an experiential manner,” said Deborah Bothun, PwC’s U.S. advisory entertainment, media & communications leader. “Relevance is the baseline, but then there is a consumer list of requirements to enable interaction with the brand in a mobile and wearable environment.”
Dissatisfaction with inpatient electronic health record systems among nurses has escalated to an all time high of 92 percent, according to the Q3 2014 Black Book Loyalty survey results to be published later this month. Disruption in productivity and workflow has also negatively influenced job dissatisfaction according to nurses in 84 percent of US hospitals. Eighty-five percent of nurses state they are struggling with continually flawed EHR systems and 88 percent blame financial administrators and CIOs for selecting low performance systems based on EHR pricing, government incentives and cutting corners at the expense of quality of care.
Eighty-four percent of nursing administrators in not-for-profit hospitals, and 97 percent of nursing administrators in for-profit hospitals confirm that the impact on nurses’ workloads including the efficient flow of direct patient care duties were not considered highly enough in their administration’s final EHR selection decision.
Black Book polled nearly 14,000 licensed registered nurses from forty states, all utilizing implemented hospital EHRs over the last six months. Survey respondents also ranked the vendor performance of 19 inpatient EHR systems from a nursing satisfaction perspective.
“Although the inpatient EHR replacement frenzy has calmed temporarily, the frustration from nursing EHR users has increased exponentially,” said Doug Brown, managing partner of the survey firm Black Book Market Research. “The meaningful use financial incentives for hospitals have many IT departments scurrying to implement these EHR’s without consulting direct care nurses, according to the majority of those polled by Black Book.”
I’m a huge fan of infographics. I think they provide simple and very easy to understand explanations of often difficult to comprehend subjects, like health IT. The following health IT infographic shows the evolution of the electronic health record since 2009 when they really started to gain attention. One of the things I particularly like about this image is that it defines the difference between EMRs and EHRs, something that is often confused, which is a huge pet peeve of mine.
What’s somewhat interesting about the information here, too, is that large, teaching hospitals utilize EHRs more than other organizations. Ironically, in the past, it’s been reported and much discussed that teaching hospitals don’t actually spend much time teaching student how the use the electronic health records.
Also, the bigger the practice, the more likely they are to have an EHR. This suggests that size does matter.
There’s some other good info buried in the following piece. Take a look; I look forward to your feedback.
Joanne Rohde is the chief executive officer and co-founder of Axial Exchange. She brings 30 years of experience to her role and has grown companies using “disruptive business models.” Prior to Axial Exchange, she served as the COO and director of health IT strategy at Red Hat, as well as was the CIO of UBS Investment Banking IT. She’s passionate about healthcare because it’s personal; healthcare is a personal business and with the advent of patient engagement, healthcare is even more so personal than its ever been.
Here she discusses the reasoning for her venturing into to healthcare and Axial’s creation, the company’s mission, what “patient engagement” is to her, how “patient engagement” is changing healthcare and Axial’s solution set. Finally, she addresses what she feels are the most pressing issues facing the healthcare as a whole. Her perspectives are deeply insightful; the following is well worth the read.
Can you tell us about yourself and your background prior to starting Axial Exchange? Why healthcare?
I spent most of my career in finance and technology. If I had a personal tagline, it would be that I like to build disruptive businesses in old industries. I did this in finance, with a company called O’Connor and Associates, which brought derivatives and computers to the financial industry when derivatives were still used to hedge real transactions. Then at Red Hat, we brought the benefits of open source to the enterprise, revolutionizing the software industry. Healthcare is one of the most inefficient industries in our country, and it affects every one of us. It is ripe for disruption.
What was your motivation in starting Axial Exchange? Perhaps you can tell me more about your entrepreneurial spirit and journey. Do you have other plans for new business lines in the works presently?
I was COO of a rapidly growing global technology company, Red Hat, when I became ill. Over the course of two years I became too sick to walk up a flight of stairs. I was in constant pain, and couldn’t speak properly. It took two years and 10 doctors to properly diagnose me. As I went from doctor to doctor, it became clear that I was starting over with each doctor — they couldn’t share information, and that lack of information sharing made it difficult for them and for me. It was also apparent that when I would go into their offices, they’d take tests and check symptoms, but they were point-in-time analysis — if I had a bad situation a week prior, it wouldn’t be captured. It occurred to me that my story was in part every American’s story and the current system frustrated both doctors and patients alike.
We are just at the beginning of what we can do to improve the patient-doctor experience. The rapid advances of wearable devices is our current area of focus. We want patients to understand their own health patterns, and to securely share that key biometric information with their physicians so each appointment can be fact-based, not “recall” based. Our next area of focus is real-time case management. What if you could get in touch with a recently released cardiac patient precisely when they were at the most risk instead of waiting for a crisis that lands them back in the hospital? These kind of timely, specific interventions can be a reality with the integration of our application back to the care managers.
