Every leader of a competing electronics health records vendor probably jumped for joy once they heard the news that Glen Tullman was ousted by Allscripts, the company that he made what it is. Or, maybe I’m wrong. Perhaps leaders of competitive companies would have liked to have kept him around because of what he did to the organization following the acquisition of Eclipsys.
The man, for the most part, has been considered a genius. Peers in the industry gave his performance praise, patted him on the back and showered him in adulation through the maneuvered takeover of the hospital health IT giant. At the time, in 2010, the move made by Allscripts was hailed as a magnificent effort.
It was the kind of move that was supposed to have turned the industry on its head. Many thought it would, and many eyed the effort with envy for such a move was powerful and assertive.
It did rock the industry. Competitors shook in slight fear with the announcement of the news, and many feared for their longevity. In this fact I am serious. I know. I was at a competitor. The whispers went something like this: “Will this new monster kill us all?”
Though all of we worked to secure our shores, many of us were fearful of the coming tide.
But, from the beginning, there was always a sense that Allscripts, and Tullman specifically, was positioned as too big to fail. Perhaps we should have seen a previous merger, the failed move to integrate Mysis, as a harbinger of things to come.
There was even a point in which I had dubbed him the king of health IT. I referred to him as such during internal meetings in my effort to create the queen of health IT, who was a president of another firm in which I worked.
There was a level of pomp and circumstance about everything he seemed to do through his promoted PR moves and image building to his constant appearances and associations with Washington’s power elite, including the president.
I can’t imagine Tullman saw this coming during his rise to the top. Just 18 months ago he was on top of the health IT world, seemingly unafraid of the world in which he lived, or so it seemed from my outside position.
Hindsight is 20/20, though, and it’s easy to question failed policy after decisions have been made.
When the recent takeover bids failed to take the Allscripts private, the company had but one choice and he and other leaders of the company had to go. It’s a common scenario in the world of politics, another world which Tullman is known to frequent. As things grew worse for the once mighty giant, everyone associated with the debacle had to go.
And, even in lands where great kings have ruled, even their glory days come to an end.
But, does it surprise me that he and others at the disheveled vendor are gone? Gone from the vendor that positioned itself as too big to fail? Gone from the vendor that asserted itself upon the market; that worked to take over a market in which its ambitions were bigger than its capabilities?
No, I’m not surprised.
In many ways Tullman died at the hand of his own sword.
And, as we’ve seen countless times and will see again, no company nor its mascot is too big to fail. No kingdom too vast to conquer, no land immune from the trials of the nations it builds.
And so, the king of health IT is no longer king, but neither is he a pauper. And, like most who have achieved his heights, it’s safe to say we probably haven’t seen the last of him.
I continue to be a fan of quality reporting from publications such as Physicians Practice, and I’ve cited their reports in several of my blog posts in the past. Today is no different. As regular reader here may know, I’ve spent a good bit of time on the subject of patient engagement, specifically how physicians and practice leaders can engage patients to improve their care outcomes and their health.
In the piece, Nelson discusses “meaningful use incentives, increased profitability or improved quality of care.” In exacting terms, she makes a call for patient portals and how it can get “patients engaged in their own care and satisfy just about any goal.”
Though I’m somewhat of a skeptic at the party for patient portals (I don’t think that in their current status they’ll actually lead the patient engagement charge), she offers six pretty interesting and solid tips for helping practices lighten their administrative loads.
Thanks, Rosemarie. It’s hard to argue these points:
Self-registration: “Invite and encourage patients to self-register on the portal. It will save your front-desk staff time, reduce costs, and patient data will be more complete and accurate. When patients call to schedule appointments use that time to introduce them to your patient portal, and explain that advance online registration will save them time on the day of their visit, because their paperwork will already be filled out. Advance registration on the portal provides your practice with three core requirements to meet meaningful use too.”
Collect patient data. “A tightly integrated or interfaced patient portal and EHR will deliver data back to the patient from their encounter. Push the patient’s medication list, medication allergies, problem list, and diagnostic test results from the EHR into the portal and patients almost naturally become more engaged in their healthcare.”
Report patient data. “There has always been a mystery surrounding that paper medical chart for patients. By delivering key components of their health information to them automatically, you can satisfy their curiosity and engage them in their own healthcare. As your nurse discharges the patient at the end of the office visit, use that discharge instruction time as an opportunity to introduce patients to the kind of information they will be able to find on the portal.”
Provide clinical summaries. “The integration/interface from the portal to the EHR allows for automation of data exchange after the patient visit. Clinical documentation is completed and made available to the patient without any action from your staff. In addition to further engaging patients in their own care, you’ll have achieved two more core requirements of meaningful use.”
Secure messaging. “Once you’ve got your patients using the portal to access information, you can begin to communicate with them via the secure online messaging function. Communicating online instead of on the telephone will streamline your practice operations significantly, even if all of your patients aren’t using the portal. Your staff can use the portal to deliver automatic reminders to patients regarding preventive care and/or follow-up care. No more manual logs or tickler files and no more mail merges to process. Developing HIPAA-compliant processes and standard messages frees up your staff to provide direct patient care.”
Provide patient education materials. “Secure messaging can also be used to direct each patient to educational information that is specific to their own individual needs and conditions. Your practice will achieve greater percentages of patients meeting quality measures and your patients will feel as well cared for as their pets. Three more requirements for meaningful use can be checked off, too.”
Though there no longer necessarily a “season” for trend and projection pieces, but given our place in the calendar year, it’s appropriate that analyst firm Gartner recently released its latest piece, “Healthcare IT Trends to Embrace/Health IT Trends to Avoid,” published recently on CIO.
The following tips are part of a larger article about big data that, other than being a bit of a clumsy read, is worth a look. One of Gartner’s top healthcare analysts, Vi Shaffer, opines about the current state of healthcare and how those in it can begin to embrace the changes ahead.
So, without further ado, here’s some of the things you should definitely do (according to Gartner, that is), if you’re seeking ROI. I’ve made some edits to the list in points not relevant to this blog.
Big data. Along with big data, you need to make sure you’re making a move to structured data collection. In its most simple terms, you need to make sure that all of the data being collected in the practice is being collected in the same fashion, and that all of the same data is being collected. Once your data gets “bigger,” you’ll be better able to work with and analyze it. According to Gartner, “This may take time to implement, but it will have a “transformational” benefit and organizations that implement all facets of big data by 2015 can expect to start to outperform their competitors by as much as 20 percent.”
E-visits. “This facet of telemedicine is catching on now that EHR systems and patient portals include secure messaging. Success comes with setting expectations and enforcing policies,” Gartner says.
Wireless health asset management. Putting RFID chips on anything that moves—equipment as well as patient wristbands—is an “increasingly routine component of cost and patient care quality management.” Since there’s a lot to monitor, CIOs must collaboration with clinical engineering or biomedical device departments.
According to Gartner, the following are four healthcare IT trends to avoid. For various reasons, I don’t agree with any of these reasons, do you?
Patient decision aids and personal health management tools. These appear largely in the form of interactive apps that educate patients or help them make care decisions, such as seeking treatment or undergoing surgery for a particular ailment. Though, Gartner says their effectiveness is questionable and adoption remains low, I’m not sure I’m convinced that they should be avoided. There is some value to these programs, especially if they help with patient engagement and education.
Personal health records. “The concept is attractive, as it gives patients ownership of their data, but poor usability and vendor disinterest have hindered adoption. Only with a government mandate, as is the case in Australia, does PHR adoption seem to catch on, Gartner says. Patient portals, which connect patients directly to their caregivers, are more popular.” Not only are they more popular, they are required through meaningful use and, if leveraged properly, can be quite effective in helping drive engagement and education.
The patient-centered medical home. “There’s been much discussion of making this a reality, especially in light of the accountable care organization model, but information exchange challenges and a reimbursement model unfavorable to insurers hinder adoption.” Again, not sure if I agree with Gartner. I don’t have any hard reasons why except that for some, they actually have proven successful. Check out this piece for more about a practice that clearly has leveraged the PCMH successfully.
Patient self-serve kiosks. “While these can streamline patient registration and payment collection, the ROI isn’t there, Gartner says. Most organizations are better off focusing on meaningful use or the conversion to the ICD-10 code set, which must be done by Oct. 1, 2014.” Again, for some organizations, these are simply good tools help streamline the patient intake process. They may not improve ROI, but they can get people into the practice more easily and to their physician without the cumbersome paper and pen approach.
Can a business model be beautiful? Yes, it can, according to Hello Health’s Steve Ferguson, vice president of marketing.
The business model, and the way things get done, at Hello Health are what set it apart from other electronic health records in the market place, Ferguson said.
Hello Health was built from the ground up and launched by the private company Myca in 2008. It made its meaningful use certified EHR available in 2011. The Hello Health system includes everything needed to run a small practice, the area of the ambulatory market in which the company focuses.
Originally designed for single doc practices, the system now scales up, with practices of as many as 10 physicians using it.
At its most basic, Hello Health is a web-based EHR and patient health record, and it’s free to for qualified physicians to use. A qualified practice is typically one with 1,500 active patients on its panel. Unlike Practice Fusion, another well-known free cloud-based electronic health record, it’s not powered by ads, but instead is a revenue source for practices as monthly access subscriptions can be sold to practices’ patients, allowing the patient to access the system’s patient portal, where their personal information is kept.
The patient subscription model allows patients to schedule appointments, view lab results, communicate with their physicians through the HIPAA-compliant portal and, in some cases, view their complete record including visit notes.
Those patients that don’t subscribe are still allowed limited access to the portal, but they can’t access all of the information available to them. Cost of monthly subscriptions range between $3 and $10, Ferguson said, but the average is closer to $5.
The annual revenue earned through patient subscriptions is $10,000 per practice, he said, with 30 percent of patients, on average, signing up in each of the practices Hello Health serves. In some cases, more than 50 percent of a practice’s patients have signed up for access to their health information.
Currently, the typical age of a Hello Health subscribing patient is 57 years old and has at least on chronic condition. The “indestructible” 30-something is less likely to subscribe to access to the portal, said Ferguson.
In some cases, patients are able to skip a practice visit or an in-office consult because of their prescription to Hello Health, Ferguson said, and practices are okay with it because they can still bill for the visit.
It’s a simple model, and with the number of portals currently available and the likelihood that access to them will increase alongside meaningful use stage 2, it’s a wonder why other vendors are not creating similar strategies.
“Companies are so in grained in the license model, and on paper it may seem easy to change, but it’s tough to change a business model,” Ferguson said.
Among another key difference between Hello Health and competitor systems is that it doesn’t charge for training and allows as much training as is needed so practice employees are comfortable using the system and are able to educate patients about the value of subscribing to the patient portal.
“Practices really have a partner in Hello Health,” he said. “We take extra time to implement and train employees so they can educate patients to use the systems and better understand the benefits of it.”
Ferguson said Hello Health is experiencing explosive growth, though, would not confirm the number of practices using the system nor the number of patient subscribers because the company is private. However, it is currently available in 27 states, with concentrations of users in New York, New Jersey, Texas, California, Georgia and Florida.
The value proposition to physicians is Hello Health’s business model and the fact that it is a revenue driver.
“Our differentiator is our business model,” Ferguson said. “Everyone tries to sell to the physicians, but most physicians are forced to push back because they can’t afford another bill.”
The fact that the system is free to implement and offers unlimited training is also a plus, he said.
According to the results of the 2nd Annual HIMSS Mobile Technology Survey, mobile technology is increasingly important to healthcare. Patients are obviously on board, but so are physicians and their employers.
Extensive adoption of almost every type of technology continues to take hold in the space, including smartphones, tablets, laptops and “movable workstations.”
An argument I remember hearing during my time in the vendor space is that if patients/consumers evolved into a mobile community, physicians would follow. Obviously, we’re seeing this prediction come true, but I can’t think of any reason why it wouldn’t be the case as it’s the type of technology that’s cheap, assessable, mobile and effective.
More so, according to the HIMSS study, “physicians are embracing new ways of collecting information and connecting with patients.” I do wonder, though, if physicians thought they’d be using their technology to connect with their patients as much as they have reported through the survey.
Surprisingly, (for me, at least) is the HIMSS reports that 93 percent of all physicians use mobile health technology in their day-to-day activities, and 80 percent use it to provide patient care.
A little less surprising is that nearly 25 percent have EHR systems that capture clinical information from mobile devices, and 36 percent allow patients to access information and health records using a mobile device.
The survey featured 180 individuals who “were directly responsible for some aspect of a healthcare organization’s mobile health policy shows that the number of mobile health programs in hospitals and individual practices increased.”
In my experience with this type of research, and as my former colleagues in research might point out, the sample size is statistically pretty small, though, and I’d like to see how the numbers would come out with an inflated sample size. I’d be surprised if 93 percent of physicians used so much mobile tech.
Finally, according to the survey, and I’m just reporting the facts here:
68 percent of participants reported that their organization already had a mobile technology plan in place
An additional 27 percent are currently developing theirs
Only 4 percent indicated that they had no plans to develop a mobile technology policy at the time.
Two thirds of participants report that they are in the process of developing a policy, expected to be completed in the next six months
25 percent anticipate completion of the policy within six months to a year
Two percent believe it will take more than two years to implement a program
In a new report that’s been gaining quite a bit of attention in recent weeks, CMS faces several obstacles in overseeing the meaningful use incentive program.
Here’s what OIG found in its assessment:
“CMS faces obstacles to overseeing the Medicare EHR incentive program that leave the program vulnerable to paying incentives to professionals and hospitals that do not fully meet the meaningful use requirements,” the report states. “Currently, CMS has not implemented strong prepayment safeguards, and its ability to safeguard incentive payments post payment is also limited. The Office of the National Coordinator for Health Information Technology (ONC) requirements for EHR reports may contribute to CMS’s oversight obstacles.”
Essentially, OIG has concerns that the ONC is simply giving away money without verifying whether those who have attested actually completed the process properly. I think it’s a valid concern, though, given the number of hurdles physicians face and the degree in which their meaningful use systems must undergo to become certified, I think it’s probably a little far fetched that an overwhelming number of practices are going to bilk the system (though it could happen).
What follows are the recommendations for the administration of the meaningful use program, per OIG:
First, it is recommended that CMS:
Obtain and review supporting documentation from selected professionals and hospitals prior to payment to verify the accuracy of their self-reported information and
Issue guidance with specific examples of documentation that professionals and hospitals should maintain to support their compliance.
OIG wants CMS to conduct occasional spot audits prior to payment for them to receive their money. It won’t happen. After all of the work and time invested at the practice level, there is going to be too much push back to administer an audit cycle of this magnitude, and CMS doesn’t have the time nor resources to undertake it as an action item.
Frankly, this seems like a point made for the sake of making a point. This is big government we’re talking about. Everyone feels the need to participate in a conversation just to they look important while doing it. These may be some valid points, but OIG comes off a little out of touch in doing so.
Also, according to the report, CMS did not concur with OIG’s first recommendation, stating that “prepayment reviews would increase the burden on practitioners and hospitals and could delay incentive payments.”
Finally, OIG recommended that ONC:
Require that certified EHR technology be capable of producing reports for yes/no meaningful use measures where possible
Improve the certification process for EHR technology to ensure accurate EHR reports.
ONC concurred with both recommendations, which I think are beside the point.
Perhaps the most “intriguing” element of the report, though, is its actual title. Let’s take a look: Early Assessment Finds that CMS Faces Obstacles in Overseeing the Medicare EHR Incentive Program.
Is it me or can the title be any more vague? Seriously? CMS face obstacles? That’s a pretty bland statement given the scope of meaningful use, and (perhaps I’m reaching) that seems to diminish the validity of the entire report, which brings me back to my previous point: Is OIG inserting itself into a conversation in which, at this point, it really has very little to say?