Robert Hitchcock, M.D., FACEP, is T-System’s vice president and CMIO, leading the company efforts for solving regulatory issues and identifying trends. He is a nationally recognized meaningful use expert and active member of the HIMSS Physician Committee and other HIMSS subcommittees advocating usability and responding to regulatory issues.
Dr. Hitchcock also is a practicing ED physician and an Emergency Department Practice Management Association (EDPMA) board member. In 2001, he earned recognition for excellence in teaching from internal medicine residents, and in the early 2000s, he trained basic and advanced life-support EMS providers. His goal is to advance system adoption and usability to improve the quality and efficiency of ED delivery.
Here, he provides perspective about developments of meaningful use Stage 2 and Stage, how meaningful use is impacting vendors and practices, how they feel — or should feel — about it, and what Stage 3 means for everyone in the industry.
How do you see the market responding to meaningful use? How are physicians moving forward, or beyond, it?
The market’s overall response to meaningful use is generally clear: they’re pushing back, particularly on Stage 2. Vendors aren’t ready, so there are not as many certified products out there. Physicians and hospitals are both calling for delays. By some estimates, as many as 50 to 70 percent of physicians who were successful in Stage 1 will not be successful in Stage 2.
To give some perspective, the Eisenhower interstate system was authorized and construction began in 1956. Phase 1 was completed in 1992. It took 35 years to build roads in this country, a decidedly low-tech undertaking. With meaningful use, we’re attempting to take a relatively un-automated industry and automate it beyond what was ever considered possible in six years. Everyone is pushing back because it’s simply too much, too fast.
Printing is like electricity – when it works, no one really notices it. They only notice it when it’s not working.
Think about it. Quality communication is a cornerstone of delivering excellent patient care. Almost every department in a healthcare organization relies on their printers to provide instructions and information that are vital to a patient’s health. So, when the printing environment is offline or ineffective, it has a real impact on how healthcare is controlled and delivered.
At Cancer Treatment Centers of America (CTCA), our motto is to deliver “care that never quits,” meaning we place our patients and their caregivers first and foremost in every action and decision that we make. As such, we rely on our technology systems to be seamless, secure and reliable so that we can deliver on our motto.
The Importance of Printing
When a patient arrives at any one of our six treatment centers, he or she receives a personalized booklet providing details regarding his or her treatment schedule. Over the course of a stay, patients will receive additional documents such as prescriptions, post-surgery instructions, discharge summaries and insurance information, just to name a few. Administrative departments also generate and print reports, spreadsheets and presentations that are essential to hospital business functions.
All in all, approximately 90 percent of CTCA’s 5,000 employees rely on printers, printing roughly 30 million pages annually. That means, on average, our employees print more than 82,000 pages per day across the network.
Once again, HIMSS is asking for perspective about the value of Health IT. The organization asked members of the social media and blogging community to respond to this very question last year for its second year celebrating National Health IT Week. It’s doing so again in preparation of #HIMSS14.
As I pointed out last year, even though it seems like a simple question, there still don’t appear to be any simple answers. There remains different answers depending on who you ask. So, again, instead of offering my lone opinion, I’ve asked a variety of folks to respond to the question, “What is the value of health IT,” based on their insight and experience serving the space.
The value of health IT lies in its ability to address three of the major, although competing, forces of change in healthcare. The need to standardize care, personalize care, and reduce costs requires the synthesis of vast amounts of data as well as dramatic changes to workflow and process. I can conceive of no way to go about pursuing these changes without technology. The old adage “you cannot improve what you cannot measure” tells us that improving health care requires us to leverage our data, turning it into knowledge and to then build the new workflows that will change the way we deliver care.
Health IT is the means for providing the best possible data at the point of care. It addresses the who, what, when and where of a patient’s care, which helps healthcare providers enhance the patient experience and deliver high-quality of care to improve health and well-being, preserve privacy and ensure security. Health IT facilitates innovation and overcomes interoperability challenges that gives providers transparency for the patient pathway to improve quality of care and minimize clinical and financial costs by eliminating duplicate patient records, incomplete medical histories, incorrect medications, clinical errors, billing mistakes, and avoidable readmissions, as well as correcting the overuse, underuse, and misuse of beneficial care. Adopting health IT is the one strategy healthcare organizations can take to enter a golden age of patient care.
Guest post by Ed Simcox, healthcare business leader, Logicalis US.
Healthcare is undergoing a significant transformation today, and so is healthcare IT. As a result, healthcare providers and their IT departments need to brace themselves for change – which is happening faster than they might realize – in five business-critical areas: healthcare IT infrastructure, mobility and BYOD, business continuity and disaster recovery, storage and vendor-neutral archives, and patient portals and mobile applications.
With pressure mounting to meet new regulatory requirements and ICD-10 deadlines, as well as the increased demands being placed on IT departments for interactive communications among patients, providers, and payers, healthcare CIOs need a set of “best practices” to help them navigate this IT transformation and arrive at the data-driven, value-based future of healthcare from where they stand today.
We call this IT transformation a “journey” because it isn’t something that happens overnight. This is a multi-stage process requiring significant evaluation of not only IT systems, but also of what the future workflows and business processes will be and how healthcare providers, patients and payers can all seamlessly share time-critical data. It’s a journey that is taking healthcare IT to the new levels of IT sophistication needed to support a substantial business change from volume to value, and there are five important milestones that every healthcare IT department is going to have to tackle along the way.
HIT Infrastructure — Of all the technical capabilities healthcare IT professionals are being asked to master today, the key is an ability to rapidly adapt to change. As a more technology-oriented generation of doctors and tech-savvy patients take their place in healthcare’s future, IT is going to be drawn increasingly into the actual delivery of health services. As a result, healthcare IT professionals won’t be spending the bulk of their time caring for their IT infrastructures. The good news is that if the IT infrastructure is transformed from today’s siloed systems into a virtualized, automated IT-as-a-Service resource, then the IT department will be able to focus its efforts directly on using technology to help doctors and nurses care for their patients and allowing patients to electronically manage their own care and wellness.
Bobby Grajewski is president of Edison Nation Medical, a healthcare product and medical device incubator and online community for people that are passionate about healthcare innovation. Prior to joining Edison Nation Medical, Grajewski, a serial entrepreneur, co-founded two online companies (Heritage Handcrafted and eCollector) and spent five years in venture capital and private equity both in the middle market (J.H. Whitney Capital Partners & Kamylon Capital) and at larger LBO firms (Permira Advisers) investing in companies across numerous industries.
Grajewski holds a MBA from The Wharton School at the University of Pennsylvania, a MPA from Harvard Kennedy School, and a BA from Harvard University.
Here he discusses Edison Nation Medical, its importance, who it serves and how it came to be.
What is ENM? How did it begin and who are your partners? Please provide a little about the history, present and future goals.
Edison Nation Medical is a medical device incubator and online community for people passionate about making a difference in healthcare. We provide a clear pathway for anyone—physicians, nurses, technicians, entrepreneurs, university tech transfer officers, small companies, and even patients and caregivers—to submit their medical product innovations for in-depth review and potential commercialization. Our business model is based on trust—trust between a person with a great healthcare invention and a company that gives a thorough and expert read to determine the value of the innovation. If an innovation has value, we find it, unlock it and get it to market in order to improve care, lower cost and increase access for the patient.
Edison Nation Medical was founded in 2012 as part of a collaboration between the prolific consumer product developer Edison Nation, and Carolinas HealthCare System, one of the nation’s leading public healthcare systems. Both valued innovation in healthcare, and desired to create a model whereby open innovation in healthcare could exist, outside the traditional pathways, that would foster new ideas to improve care and increase efficiencies in the healthcare ecosystem.
In a change of pace, and in the spirit of patient engagement, the following graphic from Primacy speaks to the importance, and the need to engage patients online to educate them and bring them to a practice’s door.
According to Primacy, an award-winning agency known for creating digital experiences with impact: “Investing money in your hospital’s website can drive traffic online and to your door.”
Primacy analyzed the traffic and paid search activity of five hospitals during 2012 to see if any patterns emerged. It turns out some did. Take a look at the infographic below to see which clicks matter the most.
Dr. Mary Jo Gorman established Advanced ICU in 2005 as a solution to the growing ICU crisis across the country — ICU care accounts for a large portion (40 percent) of hospital costs. With only 1.5 ICU physicians per hospital, there is already a shortage in care; which will continue to magnify as Baby Boomers age (those 65+ use the ICU 3 times more than those under 65).
Advanced ICU aims to deliver a solution to this critical issue by working alongside hospital staff to provide 24/7, remote patient monitoring in ICUs across the U.S. The company manages more tele-ICU programs than any other organization in the country, and combines physician-led teams with telemedicine technology to improve the operational, clinical and financial performance of ICUs. For example, after an average of one year of services, Advanced ICU clients see a 40 percent decrease in mortality, and patients spend 25 percent less time in the ICU.
You started out as a medical doctor in the field. What drove you to leave your practice and start your own business? How has your perspective changed since launching the company?
As I practiced in the hospital ? both as an intensivist in the ICU and as a hospitalist — I saw firsthand the importance of having a well-staffed and well-run ICU. In addition, I have been responsible for recruiting physicians and experienced the recruiting challenges that ICUs face. I was aware of some of the technology solutions that were being developed and saw how we could combine our knowledgeable medical team with technology to bring our special expertise to hospitals in need. Now, as I look back, I realize that through the Advanced ICU Care team, I have been able to help more people than I ever could have in private practice. Every week at our staff meetings we highlight a clinical success story, and every month when I look at our clinical outcomes, I know that my training is having a positive impact and helping improve ICU patient care. Since Advanced ICU Care was founded, we have cared for nearly 100,000 patients.
The market for electronic health and health records (EHRs) is set to experience rapid growth over the coming years, with EMR peer group value estimated to climb from approximately $10.6 billion in 2012 to $17 billion by 2017, at a Compound Annual Growth Rate (CAGR) of 9.8 percent, according to research and consulting firm GlobalData.
The company’s new report estimates that McKesson had the largest healthcare information technology software and services revenue in 2012, with $3,300 million, placing it as the EHR market leader. McKesson is followed by Cerner and Allscripts, which achieved revenues of $2,666 million and $1,477 million, respectively.
According to GlobalData, this rapid EHR market growth is because of incentives offered under the American Relief and Recovery Act of 2009, which delivers opportunities for providers to transform unstructured, paper-based data into electronic digitized information that can be shared across the entire care industry.
In 2013, healthcare industry stakeholders, including associations, EHR vendors, practitioners and providers, raised significant concerns relating to the implementation timing of meaningful use Stage 2 and 3 criteria, including problems with interoperability, usability and regulatory failure to assess “value added” by implementation of meaningful use criteria to date. On December 6, 2013, federal officials announced that Centers for Medicare and Medicaid Services (“CMS”) were proposing a new timeline for the implementation of meaningful use stage criteria for the Medicare and Medicaid Electronic Health Record (“EHR”) incentive programs. The Office of the National Coordinator for Health Information Technology (“ONC”) further proposed a more regular approach for the update of ONC’s certification regulations.
Under the revised timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 for those providers had completed at least two years in Stage 2. The goal of the proposed changes is twofold; to allow CMS and ONC to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health information exchange requirements in Stage 2, as well as evaluate data from Stage 1 and Stage 2 compliance, to date, to create and form policy decisions for Stage 3.
CMS expects to release proposed rulemaking for Stage 3 in the fall of 2014, which may further define this proposed new timeline. Stage 3 final rules would follow in the first half of 2015.
Despite CMS’s positive response to stakeholders concerns relating to the timeline for implementation of Stage 2 and Stage 3 meaningful use criteria, significant reservations continue to be enunciated, on a monthly basis, by providers at both Health information technology (“HIT”) policy committee and work group meetings. Providers continue to urge rule makers to institute consensus standards that could be adopted broadly across the healthcare industry to ensure both usability and interoperability.
In early 2013, former national coordinate Farzad Mostashar chastised electronic health record vendors for improper behavior in the marketing and sales of systems that continued to frustrate interoperability goals. This frustration with EHR vendors continues to be enunciated in HIT policy committee and work group meetings as recently as January of 2014.
Dr. David Lischner started Valant Medical Solutions in 2005, a web-based EHR and practice management solution designed specifically for the mental healthcare practitioner. Because he went to school to practice medicine and not administer paperwork, he set about creating a tool that would not only afford him more time free from his practice, but also provide a secure record keeping solution that is integrated with a clinical support tool – allowing him to be a better doctor to his patients. Simply put, he and the team have developed a SaaS tool that intuitively enforces measurement based care.
Despite expert literature highlighting the potential importance of evidence-based-care in psychiatric practice, most doctors simply do not employ these measures. As we know, those physicians who don’t start showing off their patient outcomes to insurers are going to be weeded out by both the federal EHR incentive program and the Affordable Care Act. Valant provides this market, along with the early adopter forward thinkers with both useable solutions to age old problems and readied answers to future concerns — of which there are many within this industry, and this specialty particularly.
The following are his thoughts about EHRs, building a software business and why he chose to start Valant Medical Solutions.
As a practicing psychiatrist with a successful group practice, why did you venture into the EHR space and develop your own software?
I loved seeing patients. I loved being in private practice. But I wanted to have an impact on a larger scale. And, I also discovered that I loved starting and growing businesses.
I didn’t like the solutions that were out there to help me manage my practice. They were either focused on primary care and other specialties or too narrowly on just one type of mental health care provider or practice. I also saw that web-based software was beginning to transform business processes in other industries and thought that this must be possible in healthcare, and specifically in behavioral health care. Finally, and this was a more distant motivation, I wanted tools that made it easier or even fun to practice in an evidence based fashion.