Electronic health records uptake in the U.S. has accelerated dramatically as a result of government initiatives and the considerable resources – both capital and time – healthcare providers have invested over the past five years. Electronic health records have become the heart of health IT, and U.S. clinicians use them on a daily basis.
Frost & Sullivan’s newest health IT analysis, “EHR Usability—CIOs Weigh in On What’s Needed to Improve Information Retrieval,” finds that as the market matures and the volume of EHR data proliferates, ensuring reliable information retrieval from EHRs at the point-of-care will become a priority for healthcare providers.
In spite of significant progress in EHR adoption, the road is paved with pitfalls for many providers. Frequently highlighted customer pain points include:
Slow and inaccurate information retrieval from EHRs, as well as difficulty in finding and reviewing data, both of which result in productivity losses for clinician end-users as well as potential risks to patient safety.
Inability to create targeted queries or easily access unstructured data such as clinician notes.
Time-consuming data entry tasks.
“U.S. regulatory authorities will take notice of the growing chorus of complaints about EHR usability, resulting in a push to devote more resources to solving this issue,” saidFrost & Sullivan Connected Health Principal Analyst Nancy Fabozzi. “Further, the high levels of end-user frustration with usability present strong business opportunities for pioneering technology vendors.”
In a blog post “written” by Dr. Karen DeSalvo (in which she refers to herself in the third person) on ONC’s Health IT Buzz blog, the national coordinator for health IT announced that she’s actually not leaving her leadership roll there to become Acting Assistant Secretary of Health even though on October 23 it was announced she was doing so.
Walking back that announcement, DeSalvo announced that she’ll be maintaining her leadership role at ONC while also serving serve as Acting Assistant Secretary of Health to battle Ebola. According to “her” blog post, she will continue to work on high-level policy issues at ONC, and ONC will follow the policy direction that she has set. “She will remain the chair of the Health IT Policy Committee; she will continue to lead on the development and finalization of the Interoperability Roadmap; and she will remain involved in meaningful use policymaking. She will also continue to co-chair the HHS cross-departmental work on delivery system reform. “
Lisa Lewis will keep DeSalvo’s seat warm in the interim, providing day-to-day leadership at ONC. Lewis served as Acting Principal Deputy National Coordinator before Dr. DeSalvo joined ONC.
In addition, as has been noted in a number of other publications, the ONC announcement likely comes as a result of concern over an exodus of leadership at the organization. The post goes on to pat a few ONC employees on the back for their leadership skills and work.
MGMA announced that Debra J. Wiggs, FACMPE, founder and chief executive officer (CEO), Trinity Management Solutions, Bellingham, Wash., will serve as Board chair of MGMA. Wiggs has provided executive leadership in medical group management roles for private, public and hospital-based organizations in both rural and metropolitan settings. She served as vice president of physician services, St. Joseph Regional Medical Center, Lewiston, Idaho, from 2011 to 2014.
Stephen A. Dickens, JD, FACMPE, senior consultant of organizational dynamics, State Volunteer Mutual Insurance Co., Brentwood, Tenn., will continue to serve as immediate past chair and member of the MGMA Executive Committee. Mickey Smith, FACMPE, FACHE, FHFMA, chief executive officer, Oak Hill Hospital, Brooksville, Fla., will serve as MGMA Board vice chair. Ronald W. Holder Jr., MHA, FACMPE, vice president, medical specialties – Central Texas, Baylor Scott & White Health, Temple, Texas, will serve as the finance and audit chair of the MGMA Board of Directors. Jerard Jensen, MGMA interim president and CEO, will also serve on the MGMA Board of Directors.
New members appointed to the MGMA Board of Directors include:
• Yvette T. Doran, FACMPE, corporate director, Physician Operations Division II, Community Health Systems Professional Services Corporation, Franklin, Tenn.
• Todd Grages, FACMPE, FACHE, president, Methodist Physicians Clinic, Omaha, Neb.
• William R. Hambsh, CPA, CMPE, chief executive officer, North Florida Women’s Care, Tallahassee
The Certification Commission for Health Information Technology (CCHIT) announced that it is winding down all operations beginning immediately. All customers and business colleagues have been notified, CCHIT staff is assisting in transitions, and all work will be ended by Nov. 14, 2014.
Founded in 2004, CCHIT provided certification services for health IT products and education for healthcare providers and IT developers. Five years prior to the passage of the HITECH Act which enabled today’s Office of the National Coordinator certification programs, CCHIT worked in public-private collaboration to pioneer the design, development and implementation of health IT testing and certification programs.
“We are concluding our operations with pride in what has been accomplished”, said Alisa Ray, CCHIT executive director in a statement. “For the past decade CCHIT has been the leader in certification services, supported by our loyal volunteers, the contribution of our boards of trustees and commissioners, and our dedicated staff. We have worked effectively in the private and public sectors to advance our mission of accelerating the adoption of robust, interoperable health information technology. We have served hundreds of health IT developers and provided valuable education to our healthcare provider stakeholders.”
“Though CCHIT attained self-sustainability as a private independent certification body and continued to thrive as an authorized ONC testing and certification body, the slowing of the pace of ONC 2014 Edition certification and the unreliable timing of future federal health IT program requirements made program and business planning for new services uncertain. CCHIT’s trustees decided that, in the current environment, operations should be carefully brought to a close”, said Ray.
As a 503 c(3) nonprofit organization, CCHIT’s trustees decided to donate its remaining assets, primarily its intellectual property, to the HIMSS Foundation.
HIMSS Analytics releases its latest Essentials Brief. The 2014 Patient Portal Study is the first in the HIMSS Analytics series of Essentials Briefs to focus on patient engagement.
In addition to voice of customer (VOC) insight from healthcare IT executives across the country, the 2014 Patient Portal Study incorporates data from the HIMSS Analytics Database to provide a comprehensive view of the market as it pertains to this technology. Topics in the brief include market utilization, vendor market share and trajectory, as well as the relationship between meaningful use Stage 2 and patient engagement.
“Patient engagement is more than just today’s hot topic – it is foundational to the future of healthcare,” said HIMSS Analytics Research Director, Brendan FitzGerald. “The patient portal study is the first in our series of Briefs dedicated to patient engagement, and we wanted to go beyond the statistics and delve into the executive mindset.”
Key findings of the study:
• Show patient portals typically come from the EHR vendor currently used by the organization
• Indicate room for improvement, as IT executives did not display a high level of passion for their organization’s current solution
• Highlight cultural issues within organizations as a major challenge to overall patient engagement initiatives
HIMSS Analytics Essentials Briefs are complimentary for hospitals and health systems, and are available for a fee to all other interested parties. To request a copy, please email consulting@himssanalytics.org from your employer’s email domain.
HIMSS Analytics collects, analyzes and distributes essential health IT data related to products, costs, metrics, trends and purchase decisions, delivering it to healthcare delivery organizations, IT companies, governmental entities, financial, pharmaceutical and consulting companies.
Organizations deemed “better-performing medical practices” by the MGMA Performance and Practices of Successful Medical Groups: 2014 Report Based on 2013 Data excelled in four performance-management categories: profitability and cost management; productivity, capacity and staffing; accounts receivable and collections; and patient satisfaction. The practices designated as better performers in these areas were culled from 2,518 respondents to the MGMA 2014 Cost Survey.
Profitability and cost management
In this category, better-performing multispecialty practices reported a lower total operating cost as a percent of total medical revenue than other groups (55.91 percent compared to 70.42 percent).
“Medical practices that actively monitor their operating costs and use benchmarking data and tools to assess their performance are positioned for long-term success and sustainability,” said Todd Evenson, MGMA vice president of data solutions and consulting services.
Accounts receivable and collections
Medical groups designated as better performing reported collecting receivables more quickly than their peers. Better-performing multispecialty practices indicated that only 8.05 percent of their total accounts receivable (A/R) was in the 120-plus day category.
Evenson asserts that “this metric is a strong indicator of healthy financial management, and better-performing medical practices have the right procedures and processes in place to do this efficiently.”
Productivity, capacity and staffing
Better-performing medical practices in this area implemented operational efficiencies to ensure strong provider productivity, including employing non-physician providers such as physician assistants, nurse practitioners and certified nurse anesthetists, as well as ensuring efficient patient flow throughout the practice. For instance, better-performing multispecialty practices indicated that they leverage work from clinical support staff at a higher ratio, a reported 6.33 clinical support staff per full-time-equivalent (FTE) physician versus 4.31 in other groups.
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.
MGMA announced that Debra J. Wiggs, 
HIMSS Analytics releases its latest Essentials Brief. The 2014 Patient Portal Study is the first in the HIMSS Analytics series of Essentials Briefs to focus on patient engagement.
