Guest post by Tom Bizzaro, RPh, vice president of health policy, FDB.
National Health IT Week has come and gone. The industry is focused on how far IT has come and how far it needs to go in healthcare. As most organizations have now adopted electronic records, one of the big themes this week has been EHR interoperability — getting these systems to work together.
Earlier this year, the Office of the National Coordinator for Health IT (ONC) published a 10-year vision to achieve an interoperable health IT infrastructure. The ONC publication is meant to move the industry toward the much coveted interoperability that will enable healthcare organizations to seamlessly share patient information. The simple fact that the federal government has issued this call to action and the industry is embracing it is a good sign for the future of healthcare. We will finally be able to share vital patient information that helps us improve care for individuals and populations, while cutting some of the unnecessary costs out of the system.
While the report is encouraging, this is a very real industry where change only comes after considerable effort. To help move toward the interoperable nirvana quicker – or at least make the journey more palatable — we need to:
In another display of beauty, the folks at CDW Healthcare recently released the following infographic describing the rise of the digital patient, a new specifies of mankind. As CDW notes, thanks to innovative mobile technology and the prevalence of broadband networks, patients are investing in their own healthcare more than ever before. Interest in their health and the ability to self diagnose ultimately may be the key to long-term patient engagement, but of course that’s a sticky wicket of its own.
“From searching for a physician online to tracking fitness activities via wearable technology to accessing their personal health records through a portal — patients are embracing mHealth and technologies that will help improve their well-being. In fact, the number of adults using smartphones to monitor their health grew to 75 million in 2012 — a number expected to more than triple by the end of 2014,” CDW writes on its blog.
According to the graphic, patients are “better informed” before they enter their physician’s office, are looking to social media for their health research and are embracing mobile devices as a way to connect with their caregivers. Additionally, the vast majority of patients want access to their medical records online. The graphic also suggests that patients are becoming more aware and attracted to portals, though I’m still skeptical that this is a widespread phenomenon.
Consumers also are getting more interested in wearable health tech, however, and are tracking their outcomes, especially using their smartphones; 112 million devices are expected to be in use by 2018.
Finally, security of the information and its exchange is of the highest importance to consumers , as if is for all of us, but it’s worth pointing out because even with all of the development and patient involvement in their care, they are still concerned about the safety of their information.
Take a look at the following graphic to see if there’s anything surprising here.
On Sept. 4, 2014, the Centers for Medicare and Medicaid Services (“CMS”) published a final rule that, effective Oct. 1, 2014, implements changes to the Medicare and Medicaid Electronic Health Record Incentive Program in light of industry-wide difficulties in transitioning to EHR technology certified to the 2014 Edition EHR certification criteria (“2014 Edition CEHRT”) during calendar year 2014 for eligible professionals and fiscal year 2014 for eligible hospitals and critical access hospitals. CMS makes no changes to the existing 2014 reporting periods or the requirement in future reporting periods to report for a full year.[1] This final rule also extends Stage 2 for an additional year for those providers first demonstrating meaningful use in 2011 or 2012. Instead of starting Stage 3 in 2016, those providers will now start Stage 3 in 2017. The timeframe for Stage 3 implementation by providers that first demonstrated meaningful use after 2012 is unchanged by this final rule.
Kevin Alonso
Prior to these changes, providers were required to use 2014 Edition CEHRT to demonstrate either Stage 1 or Stage 2 meaningful use in 2014. The shortened 2014 attestation periods implemented in the 2012 final rule were aimed at helping providers make the transition from 2011 Edition CEHRT to 2014 Edition CEHRT, but delays affecting the availability of, and the ability of providers to implement, 2014 Edition CEHRT meant that many providers still might be unable to demonstrate meaningful use, despite their best efforts.
To provide some additional flexibility, CMS will now provide three alternatives routes to demonstrate meaningful use in 2014 for providers facing such difficulties: (1) using 2011 Edition CEHRT only, (2) using a combination of 2011 and 2014 Edition CEHRT, or (3) using 2014 Edition CEHRT for Stage 1 objectives and measures in 2014 for providers scheduled to begin Stage 2. These alternatives will also provide some flexibility in the objectives and measures that providers must meet to demonstrate meaningful use, as summarized in the chart below.[2]
Congresswoman Renee Ellmers (R-NC-02) released the following statement after introducing H.R. 5481 – The Flexibility in Health IT Reporting (Flex-IT) Act of 2014:
“Healthcare providers have faced enormous obstacles while working to meet numerous federal requirements over the past decade. Obamacare has caused many serious problems throughout this industry, yet there are other requirements hampering the industry’s ability to function while threatening their ability to provide excellent, focused care.
“The meaningful use program has many important provisions that seek to usher our healthcare providers into the digital age. But instead of working with doctors and hospitals, HHS is imposing rigid mandates that will cause unbearable financial burdens on the men and women who provide care to millions of Americans. Dealing with these inflexible mandates is causing doctors, nurses, and their staff to focus more on avoiding financial penalties and less on their patients.
Congressman Jim Matheson
“The Health IT Reporting Act will provide the flexibility providers need while ensuring that the goal of upgrading their technologies is still being managed. I’m excited to introduce this important bill and look forward to it quickly moving on to a vote.”
Congresswoman Renee Ellmers introduced H.R. 5481 – the Flexibility in Health IT Reporting Act of 2014. The legislation would allow healthcare providers to receive the flexibility they need to successfully comply with meaningful use program.
On August 29th, the HHS published a short-sighted final rule, maintaining a provision that requires providers to perform a full-year EHR reporting period in 2015. According to Ellmers, “The Flex-IT Act will allow providers to report their health IT upgrades in 2015 through a 90-day reporting period as opposed to a full year. This shortened reporting period would be an important first step in addressing the many challenges faced by doctors, hospitals and other medical providers due to the inflexible mandates of the meaningful use program.”
HIMSS released the following infographic that summarizes the findings of 25 years of health IT from its annual leadership surveys. It’s a pretty good depiction of how health IT has changed in the last quarter century. Looking back on the past twenty five years in healthcare, something are fairly interesting. For example, physicians in 1993 said they would not adopt their use in healthcare until they became easier to use. The sentiment still remains, to a certain degree, especially in regard to systems like electronic health records.
Another interesting factoid, is that in 1994, 14 percent predicted that digital patient information would be shared nationwide in one to three years.
Finally, the number of health IT priorities that has changed in the course of the last 25 years is either alarming or inspiring, based on the level of change in the space and how quickly things continue to change. However, the number of changes and their frequency remind me of a dog on a trail stalking down one scent after another without a real sense of purpose – Y2K, HIPAA, patient safety, reducing medical errors, financial survival, meaningful use, etc.
U.S. patients are likely to face growing challenges in access to care if shifting patterns in medical practice configurations and physician workforce trends continue. This is one of the key findings of a major new survey of 20,000 physicians commissioned by The Physicians Foundation, a nonprofit organization that seeks to advance the work of practicing physicians and help facilitate the delivery of healthcare to patients
According to the research, titled “2014 Survey of America’s Physicians: Practice Patterns and Perspectives,” 81 percent of physicians describe themselves as either over-extended or at full capacity, while only 19 percent indicate they have time to see more patients. Forty-four percent of physicians surveyed plan to take steps that would reduce patient access to their services, including cutting back on patients seen, retiring, working part-time, closing their practice to new patients or seeking non-clinical jobs, leading to the potential loss of tens of thousands of full-time-equivalents (FTEs). As the ranks of Medicare and Medicaid patients increase – in 2011, more than 75 million baby boomers began turning 65 and qualifying for Medicare – and millions of new patients are insured through the Affordable Care Act, patient access to care could pose significant health delivery and policy challenges.
“America’s physician workforce is undergoing significant changes,” said Walker Ray, M.D., vice president of The Physicians Foundation and chair of its Research Committee. “Physicians are younger, more are working in employed practice settings and more are leaving private practice. This new guard of physicians report having less capacity to take on additional patients. These trends carry significant implications for patient access to care. With more physicians retiring and an increasing number of doctors, particularly younger physicians, planning to switch in whole or in part to concierge medicine, we could see a limiting effect on physician supply and, ultimately, on the ability of the U.S. healthcare system to properly care for millions of new patients.”
In honor of National Health IT Week Sept. 15-19, 2014, American Sentinel University offers tips to health IT professionals for gaining a competitive edge in the healthcare marketplace.
A recent study by HIMSS shows demand for qualified health IT professionals are at an all-time high and a candidate’s skill set is the differentiating factor when filling a position. The skill most desired is that of an IT professional that has clinical workflow and terminology experience. American Sentinel offers specialization in healthcare, giving students a competitive advantage in the clinical IT environment.
“Technology and healthcare are two ever-changing industries. When the two collide it creates dynamic and exciting challenges for health IT professionals,” says Blair Smith, Ph.D., dean of Informatics-Management-Technology programs at American Sentinel University. “Electronic Medical Record (EMR) implementation has become the focal point and while it offers tremendous capabilities, it also creates a multitude of challenges for today’s IT professionals. Those with in-demand skills will find themselves far more marketable.”
At the top of the list of challenges includes data management, application management, BYOD, patient privacy, HIPAA compliance, business intelligence and analytics and risk management.
The HIMSS study found that a higher percentage of respondents said that their organizations were interested in either training current employees or hiring recent graduates to fill needed positions, but 85 percent of respondents said their organizations faced barriers meeting their health IT needs. The majority cited a lack of qualified talent and 40 percent of those surveyed said they have open positions for which they cannot find qualified talent.
Guest post by Rhonda Collins, MSN, RN, chief nursing officer of Vocera.
Studies show that cell phones can carry more bacteria than a toilet seat. This is a disturbing topic for anyone, but should be duly noted by those of us in healthcare. With hospital cell phone policies changing, it’s crucial that we focus on infection control as a priority for any mobile communication device in the hospital. A Spyglass Consulting Group survey revealed that regardless of a hospital’s device policy, staff nurses are using personal smartphones to support clinical communications and workflow. In addition, a whopping 51 percent of hospitals plan to invest in or evaluate their smartphone solutions over the next 18 months.
This movement toward a more mobile healthcare workforce is an exciting change that will allow clinicians to become more connected to both patients and colleagues. While this change will make a sizeable impact on the way that hospitals operate, devices that are surrounded by the sickest patients are of greater concern as they can transfer bacteria both to and from the patient. This poses potential harm to everyone in the environment.
The Centers for Disease Control and Prevention (CDC) found that one out of every 25 hospital patients contracts a healthcare-associated infection (HAI). This means that about 722,000 patients face hospital acquired infections annually. The most common HAI that hospitals are seeing today include pneumonia (22 percent), surgical site infections (22 percent), gastrointestinal infections (17 percent), urinary tract infections (13 percent) and bloodstream infections (10 percent), all urgent and uncomfortable situations that pose a major threat to patient safety.
