As we head into the new year, I’d like to thank you for helping me grow Electronic Heath Reporter through your readership, comments, dedication and support.
I also ask that you continue to join me in 2014 to assist me with what I enjoy doing most—providing news, insight, editorial and opinion to those in health technology. You inspire and encourage me to keep bringing you the latest developments.
I look forward to what next year will bring and how, with your continued support, the site will grow and expand. Hopefully this year I’ll get a chance to meet with you – I’ll be at HIMSS — and work with more of you to deliver engaging content.
If I have not had the chance to be introduced to you, please feel free to contact me with your questions, comments or suggestions you may have. I’m always open and ready to hear from you — day or night, and I encourage you to reach out.
On a final note, I’d like to thank SpiceWorks for advertising on the site this year. The organization has been great to work with and I am extremely grateful to them for taking a chance on this site. I encourage readers of this site to check them out at http://www.spiceworks.com/. They really are where IT goes to work!
That said, I wish you and your family a happy holiday season and a Merry Christmas, as well as a healthy, successful and eventful new year.
With another new year on the horizon, many are wondering what 2014 will bring. For those in health IT, the more important question might actually be wear – as in wearable devices. The popularity of wearables will continue to explode and the burgeoning trend will move from a mainstay primarily in Silicon Valley and other tech meccas to mainstream America.
Wearables on the rise
Just as smartphones have evolved from being the hot gadgets of the early adopter set into the must-have devices for teens, soccer moms and business people alike — after all, 55 percent of global phone sales in the last quarter were smartphones — so too will wearables proliferate in the year ahead. Indeed, ABI Research has predicted the wearables space is in for a huge growth spurt, estimating the global market for health and fitness wearables to reach 170 million devices by 2017 (2).
2014 will see evolutionary advancements in wearable devices: they’re going to get smaller, sleeker, and more beautiful; battery life will increase; syncing will go wireless for everyone; a huge new generation of devices will emerge both from existing players and new players, and an even larger number of applications based on the new chips phone manufactures are building directly into smartphones will emerge with user interfaces as varied as ice cream flavors. But, at the current rate of innovation, I’m really hoping to see more revolutionary changes in the year ahead as well. My favorite would be anything that cracks the laborious food and calorie tracking nightmare for consumers.
One of the quite enlightened (though likely also overwhelming) healthcare initiatives directed at making healthcare more transparent and understandable is the Medicare and Medicaid electronic health record (EHR) incentive program. This is an act that forces all healthcare providers servicing Medicare and Medicaid patients, and by extension pretty much every patient, to use or expand their EHR systems for a large set of requirements, including making their notes, prescriptions, test results, diagnostic images and additional information all available to their patients on a web-based portal. And, unlike many other regulations that have no enforcement, this act not only requires that providers make these services available to their patients, it also measures and compensates providers on what percentage of their patients actually use said services.
As we all know, however, leading a horse to water is not enough. One of the most important and critical factors that all providers are facing is how to make their patients actually use these portals. Studies already indicate that a large percentage of the public wants more complete access to their medical records and doctor’s instructions electronically, via the web. It also makes sense that access to more complete information regarding your health status increases the odds that you’ll do what is necessary to do to get better.
The good news: We have technology to make that available. Unfortunately, it’s not working as well as it should.
As you’ve likely heard, ONC has named has its next leader, city of New Orleans Health Commissioner and senior health policy advisor Karen DeSalvo, MD, MPH, MSc.
She takes the post January 13, 2014.
DeSalvo is a former professor of medicine and vice dean of community affairs and health policy for Tulane University in New Orleans, according to Modern Healthcare. She led the effort to establish a network of primary-care medical homes as part of the city’s post-Hurricane Katrina rebuilding process. She also served as president of the Louisiana Health Care Quality Forum.
She will take over the role currently held by Acting National Coordinator Jacob Reider, MD, who is filling in for the departed Dr. Farzad Mostashari.
Department of Health & Human Services Secretary Kathleen Sebelius’s announced the move to HHS staff today (text here courtesy of EHR Intelligence):
I would like to announce that Dr. Karen DeSalvo, who currently serves as the City of New Orleans Health Commissioner and Senior Health Policy Advisor to Mayor Mitch Landrieu, will be the next National Coordinator for Health Information Technology here at the Department.
Guest post by Jonathan A. Handler, MD, FACEP and chief medical information officer for M*Modal.
The U.S. Government officially recognizes that filling out paperwork is expensive. The most costly paperwork requires us to measure and report information – like our yearly income. If you have ever filled out a government form, you may have noticed that it provides an estimated cost to complete.
For example, the simplest “EZ” income tax form will cost each taxpayer an average of four hours and $40 (http://goo.gl/C6ra — page 41). This is a result of the Paperwork Reduction Act, which requires the government to reduce the paperwork burden on the public and publish the estimated cost of completing each form. However, the Paperwork Reduction Act may have a loophole, because it seems to be limited to government documents.
The government creates a tremendous documentation burden on healthcare providers that appears to fall outside the scope of the Act. In 2014, new government requirements will increase that workload dramatically even as reimbursement drops. Since we do not have consensus on how to address these changes without sacrificing patient care, I believe a key trend in 2014 will be “Managing the Cost of Measuring Care.”
Clinicians are already at the breaking point in the time they spend on documentation and care measurement. This year, regulations demand more than ever. The move to ICD-10 significantly increases the cost of choosing the right billing code because ICD-10 is more complex and about eight times bigger than ICD-9. Stage 2 of the government’s meaningful use program requires clinicians to record more patient information in structured form, to report clinical quality measures, to perform medication reconciliation, and much more. The Two-Midnight rule requires physicians to anticipate when an admitted patient will need to stay in the hospital longer than “two midnights” and justify that in writing.
Healthcare organizations today are pursuing a wide range of health IT initiatives in the hopes of reducing costs, improving efficiencies and, most importantly, enhancing patient care. While a great deal of attention is being paid to high-profile health IT topics, such as electronic health records (EHRs) and health information exchange (HIE), there are basic aspects of the workflow at healthcare organizations that can also play a key role in driving healthcare efficiencies. One of these is the patient discharge experience.
How well patients are communicated with upon discharge is a leading threat to a healthcare organization’s top-line revenue, as well as an endangerment to the patient experience. With Medicare/Medicaid regulations now making it difficult to collect revenue for a patient’s second visit for the same problem within 30 days, special attention needs to be paid to how well healthcare organizations are preparing the patient when they walk out the hospital door—and at home following their release. Patients need to be able to understand their at-home instructions for post-visit care so they don’t have to return to the healthcare facility for more treatment or instructions, which will negatively impact the hospital’s revenue and the patient experience.
Creating a more effective discharge experience for patients requires providing clear, easy to read discharge instructions. Accomplishing this is not always a simple task given that the instructions typically are compiled from a large set of data feeds, gathered from multiple treating physicians and need to be provided in a language that the patient can understand. Health IT can play a critical role in overcoming these hurdles.
Similarly, healthcare organizations will benefit from considering the archival system in place. It is important to have an archival process that will enable the organization to prove that discharge instructions were complete and comprehensive. This will avoid the potential for losing Medicare/Medicaid reimbursements in the event of an audit. Not having the ability to easily retrieve all relevant records exposes the healthcare organization to avoidable revenue loss.
Guest post by Brian White, founder of Competitive Solutions.
Should every physician practice adopt electronic health records? Maybe not. When evaluating the transition to an EHR system, it is critical to consider the long-term efficiency of the practice. Simply put, EHR adoption will not yield operational improvements for every practice.
While many practices using EHRs increase the overall throughput of the business and enhance profitability, others struggle with adoption of the new technology – slowing operations and creating significant financial losses. Many practices repeatedly change vendors or abandon the EHR entirely after significant investment. Making the right decision for your individual practice and navigating the pitfalls of EHR implementation can be difficult and time-consuming. Maximize your potential for success by undertaking a strategic evaluation that includes the following considerations.
If your practice has not adopted EHR, is now the time to do so?
1. What are the operational benefits/detriments of adoption?
a. Will EHR allow the practice to see more patients? Or, will it cause the practice to see fewer patients?
b. Will EHR require additional labor in the day-to-day function of treating patients? (In most cases, the answer to this question will be yes.)
c. Will EHR provide the ability to track trends in patient status, statistical data or ease of access that will be more efficient and/or clinically beneficial?
In the new healthcare ecosystem that is increasingly migrating to cyberspace, who can healthcare consumers rely on? Who in the healthcare service supply chain will prevail? Who will be the next Amazon or Yelp? Chances are it will be the organization that can deliver and mediate a centralized consumer experience – connecting healthcare consumers not only with care and treatment options, but also with pharmacists, labs, therapists, clinics, wellness coaches and other resources along the care chain.
More today than ever before as the care conundrum continues, fewer and fewer crave office visits, hospital stays or trying to reach physicians by phone. When we’re well, we see no reason to visit a physician. When we’re sick we increasingly wait until we’re sicker. And when we’re somewhere in between, we avoid calling because we know we’ll be put on hold. If there were a better way to consume healthcare, most of us would likely take it.
Interestingly, within this conundrum lies an opportunity for the myriad of healthcare players – from payers and providers at one end of the supply chain to wellness tacticians, retailers and mobile tool providers at the other end – to create a sustainable dialogue with healthcare consumers.
According to a recent survey conducted by Purdue Healthcare Advisors, a nonprofit healthcare consulting organization, hospital executives are reluctant to implement ACOs — 46 percent — and they have no plans to implement an Accountable Care Organization (ACO)-like model in the near future.
Conducted in October 2013 among 206 hospital executives at a director level and above, the survey also reveals that executives are struggling with finding solutions for lower reimbursements and increased costs, while still maintaining an acceptable level of quality care.
“This survey has identified a significant need for advocacy and education to support hospitals and help them survive the wave of changes brought on by the Affordable Care Act,” said Mary Anne Sloan, director of Purdue Healthcare Advisors. “Hospital executives are charged with enhancing patient care and managing margins with a shrinking workforce and diminishing patient volumes.”
Hospital executives find ACOs to be unstable and financially risky
Executives are waiting for ACO models that are more stable and mature to avoid having to reinvest funds to implement changes or updates, according to the survey. The executives who do not have plans to implement an ACO model in the future (46 percent) cited the following reasons:
According to a new report from AMN Healthcare, a healthcare staffing firm, 78 percent of hospital executives believe there is a shortage of physicians nationwide, 66 percent believe there is a shortage of nurses, and 50 percent believe there is a shortage of advanced practitioners. The survey also indicates that the vacancy rate for physicians at hospitals approaches 18 percent, while the vacancy rate for nurses is 17 percent, considerably higher than when AMN Healthcare conducted a similar survey in 2009.
“Change in healthcare is a continuous evolution, but the one constant is people,” said AMN president Susan Salka. “No matter what models of care are in place, it takes physicians, nurses and other clinicians to provide quality patient care, and the fact is we simply do not have enough of them.”
AMN Healthcare’s 2013 Clinical Workforce Survey asked hospital executives nationwide to comment on clinical staffing trends affecting their facilities. More than 70 percent rated the staffing of physicians, nurses, nurse practitioners and physician assistants as a high priority in 2013, compared to only 24 percent of hospital executives who rated staffing these professionals as a high priority in AMN Healthcare’s 2009 workforce survey.