One thing recently became increasingly important to Metro Imaging and Radiology, an independent radiology practice with five locations throughout St. Louis, Missouri: meeting meaningful use.
In 2012, Metro Imaging added an electronic health record after having used NextGen’s billing system for several years. Along with the EHR, the chain added the Anoto digital pen.
With more than 100,000 annual patient visits, the practice sought a viable solution to help streamline the intake process and reduce some practice inefficiencies, like scanning and filing paper patient forms.
“We knew it was going to be difficult to reach meaningful use, and we needed something that was going to be very efficient,” said Christine Keefe, chief financial officer at Metro Imaging. “We couldn’t have anything that slows us down too much.”
The Anoto pens seemed like the best solution. The pen stays charged for 10 hours and can hold 200 pages filled out top to bottom.
The practice was sold on the pen because of its ability to capture the information being entered onto paper forms, especially the patient intake forms. According to Keefe, the pens were only considered based on a recommendation from it NextGen representative, but since implementing it, they have completely done away with any manual scanning of patient forms.
On top of that, the clinic has completely gotten rid of paper (except for the patient in take forms used at the front of house) and it no longer keeps papers files.
The first week following implementation was the most difficult, she said, but since everything has settled back to normal and there have been no hiccups. The EHR was probably a more significant change than adding the pens. After all, the patients rarely notice there’s something different about the slightly larger ball points.
The pen captures the data entered into the fields of the paper forms by the patient through a small camera on the pen. It snaps 70 images per second as a patient enters the required data, storing until the pen is docked on a charging station, at which point it downloads all of the information contained into the practice’s EHR through a USB port.
“A great thing about the pen is that you can dock it, ignore it and by the time you’re done doing other things, everything is downloaded and you can use it again,” Keefe said.
An immediate benefit, other than reducing the amount of manual input required of clinical staff is that the forms that are used by the practice are customized and capture data in a structured manner.
Staff that previously focused on transcription, scanning and filing now have had their resources reallocated to claims and billing administration and patient relations. For example, staff has more time to follow up with patients and address any billing and claims issues that come up.
The practice currently uses 25 pens; five per practice. Each costs $385 and there is a $1,000 license fee. Additionally, the practice pays a regular maintenance fee. The pens can be used for hours without re-charging and can capture multiple people’s records without needing to be docked.
The pens are also Bluetooth-enabled and can transmit information wirelessly back to a healthcare setting, making them appropriate for home health workers and others that work outside the four walls of the practice.
They are the ideal technology too, since today more than 80 percent of physicians still rely on traditional pen and paper to capture patient information. Finally, digital pens offers a simple, alternative way to capture data and transfer it into an EHR, especially for physicians concerned about a computer or tablet PC getting in the way of their patient’s experience.
“We like the flexibility the pens have created for us,” said Keefe, “anything to cut down on work at the front desk.”
Metro doesn’t use them in the clinical setting yet, Keefe said, but there has been some interest in bringing them into the exam room. If things continue to go as smoothly as they have, that decision would be like hand meeting glove.
In light of recent reports that nearly 220,000 hospitals, office-based physicians and other eligible professionals have received more than $12 billion in federal incentive payments, I thought I’d highlight the top questions as featured on CMS.gov’s FAQ section.
But, a little perspective first. According to Modern Healthcare, to this point, 3,757 hospitals, or 75 percent of the 5,011 U.S. hospitals that are eligible to receive federal funds under the program, have received an EHR incentive payment.
Also, “215,500 physicians and other EPs, or 41 percent, of the 527,200 total physicians and other professionals deemed eligible to participate, have been paid. Some 85 percent of hospitals and 70 percent of physicians/EPs are registered under the programs, the CMS reports.”
So, back to the original story: CMS.gov’s Frequently Asked Questions and the answers. If you’re not aware of the resource, it serves a broad base audience with a smattering of questions and responses. For example, there a variety of topics including billing, e-health, data navigation, EHR incentive programs, well, you get the point.
Here’s a short list of some questions and their answers:
How and when will incentive payments for the Medicare Electronic Health Record (EHR) Incentive Programs be made? For eligible professionals (EPs), incentive payments for the Medicare EHR Incentive Program will be made approximately eight to 12 weeks after an EP successfully attests that they have demonstrated meaningful use of certified EHR technology. However, EPs will not receive incentive payments within that timeframe if they have not yet met the threshold for allowed charges for covered professional services furnished by the EP during the year. Payments will be held until the EP meets the threshold in allowed charges for the calendar year ($24,000 in the EP’s first year) in order to maximize the amount of the EHR incentive payment they receive. Medicare EHR incentive payments are based on 75 percent of the estimated allowed charges for covered professional services furnished by the EP during the entire calendar year. If the EP has not met the threshold in allowed charges by the end of calendar year, CMS expects to issue an incentive payment for the EP in March of the following year (allowing two months after the end of the calendar year for all pending claims to be processed).
What is CMS? The Centers for Medicare & Medicaid Services (CMS) is a branch of the U.S. Department of Health and Human Services. CMS is the federal agency which administers Medicare, Medicaid, and the Children’s Health Insurance Program. Provides information for health professionals, regional governments, and consumers. Additional information regarding CMS and it’s programs is available at http://www.cms.hhs.gov/.
When eligible professionals work at more than one clinical site of practice, are they required to use data from all sites of practice to support their demonstration of meaningful use and the minimum patient volume thresholds for the Medicaid EHR Incentive Program? CMS considers these two separate, but related issues. Meaningful use: Any eligible professional demonstrating meaningful use must have at least 50% of their of their patient encounters during the EHR reporting period at a practice/location or practices/locations equipped with certified EHR technology capable of meeting all of the meaningful use objectives. Therefore, States should collect information on meaningful users’ practice locations in order to validate this requirement in an audit.
How do physicians join or leave a group? If both the physician and the group are already enrolled with the same carrier, the physician and the group together are required to complete a CMS 855R showing the date the physician joined the group and reassigned benefits to the group. If a physician leaves a group, the physician or the group should complete the CMS 855R, showing the date the physician left the group. When leaving the group, the CMS 855R does not need to be signed by both the physician and the group. If either the physician or the group have not enrolled with the carrier, they must first complete the appropriate CMS 855 for either an individual (CMS 855I) or group (CMS 855B) before the reassignment can be effective.
With the annual HIMSS conference once again over, now is as good as any time to look back and pontificate on what the experience brought. For this piece, I once again reached out the readers of this site for their insight for their perspective, who are, after all, those benefiting from the show and its sessions.
It should be noted that I asked for pros and cons of the show, and I received mostly positive feedback, which doesn’t surprise me. However, don’t take that to mean this is a positive puff piece. On the contrary, I am trying to offer a fair and balance response from attendees that HIMSS leadership can use to plan future conferences.
Obviously, as each of us has been told at one time or another, criticism – good or bad – helps us grow, change and expand. With that, I welcome your comments, positive or negative about the show. Perhaps as a collective, we can help lead our community forward in a manner that’s most beneficial to all it stakeholders.
Without further ado, here are the comments from our colleagues about their reactions to HIMSS13.
Peter Ransome, vice president sales and marketing, Westbrook Technologies, Inc.
Pros: HIMSS was once again a tremendously successful event. Westbrook came away with new resellers, customers and partners. We had a great opportunity to network, learn and meet other vendors. Our team found great value in the keynotes and educational sessions and especially Farzad Mostashari’s final day keynote. Today, healthcare reform is focused on meaningful outcomes and disease management. The next wave of reform will put more emphasis on the value of preventive medicine. There are still a lot of error-prone paper processes that negatively affect the quality of patient care — even in a healthcare organization that has implemented a leading EHR system. We’ve found that more technology doesn’t necessarily result in better care. With more than 1,000 EHR vendors competing for the same healthcare dollars, consolidation is inevitable. It will be interesting to see how HIMSS changes in 2014 and how the industry is affected by rapidly accelerating acquisition activity.
Cons: (Apparently, the show was so good, Ransome listed no cons.)
Bill Fera, MD, principle, healthcare advisory practice of Ernst & Young
Pros: HIMSS has become an extremely valuable venue for gaining real-world examples of how organizations are advancing strategies to better utilize data for the improvement of patient care. Having so many industry influencers in one forum really makes HIMSS stand out — what I take away from networking and informal conversations can be just as useful as what’s formally presented in the sessions.
Cons: The challenge with HIMSS is the sheer volume of everything. The overload of information can become a distraction if you don’t allocate your time in advance and stay focused on what you want to accomplish.
Pros: HIMSS is well-organized and it had a great location this year in relations to access to airport and hotels. Additionally, education tracks were comprehensive and interesting, and there is a good assortment of attendees (institution and title).
Cons: At HIMSS, there’s not enough opportunity for partner networking. HIMSS should have a new/upcoming technology track (not just big vendors pitching products) and there should be better management of keynotes as managing overflow was challenging.
Christopher Ellis, director, Vree Health
Pros: There was clear industry movement toward technology integration and interoperability – this is a very positive step forward and something that was spoken to more than acted upon, until now. More consistently usable, structured data will open many avenues for leveraging data for better quality of care. Coming from this meeting, I am energized to see that many of the speakers emphasized that while technology is a great enabler, solutions must begin and end with the patient in mind. Providers and vendors that emphasize patient engagement, across varying levels of patient technology literacy, are positioning themselves well. The HIMSS conference was an excellent forum to survey different approaches to solving the same problems, including coordination of care, assessing health risk and patient engagement. Organizations that have a deep and long-standing heritage in healthcare clearly hit the mark on approaching these in ways that are reflective of provider operational flow.
Cons: Bring your walking shoes next year.
Thanks for all of your candid feedback, guys. I know HIMSS was considered a success this year, but there’s always room for improvement and growth, and it’s nice to be able to report such positive feedback for all in attendance.
If you have something to add, please leave a comment below. Thanks!
Guest post by Harry Jordan, vice president and general manager, healthcare for LexisNexis.
The most important question in identity management is not: “Who are you?” It’s “What do we need to know about you?” And nowhere is the answer to that question more critical than in healthcare, where inadequate systems and processes can not only threaten business integrity and success, but jeopardize lives, as well. Inevitably, it is time to shift the focus of the discussion of identity management away from authentication methodology and toward the broader healthcare context in which identity management is no longer a luxury, but a necessity.
Effective patient/member identity management springs from this fundamental question: “Given what we are trying to accomplish through this particular transaction, what do we need to know about this individual to insure safety, integrity and trust?” Or, more elaborately: “What do we need to know to prove this individual is who they say they are and that they are authorized to access the information being requested based on those identity credentials?”
The answer is determined by the intersection of multiple factors: your objectives; product and service characteristics; population demographics and attitudes; the nature, value and riskiness of the transaction being performed; the point in the process and relationship where it takes place; and organizational risk tolerance. Getting the answer right is critical to the sustainability of health care organizations and, more importantly, the safety of the individuals they serve.
Identity fraud is the fastest growing crime in the United States, affecting more than 11 million adults in 2010. Medical identity fraud is the fastest growing type of identity theft. The Ponemon Institute estimates the annual economic impact of medical identity theft to be nearly $31 billion.
Health care consumers will, and should, expect their data to be secure at all times in order to protect their financial and physical well-being. Health care stakeholders will demand solutions that ensure they are dealing with the right person, at the right time, for the right transaction, thereby minimizing risk and negative impact on their health care delivery decisions, the health of their patients and overall business performance.
As a recent Gartner report states, identity management is “increasingly recognized as delivering real-world business value,” and “identity management agility improves support for new business initiatives and contributes significantly to profitability.” Identity management is rapidly evolving to encompass emerging risks and application variability. There are tools you can put in place now to meet the increasing demands of identity management.
Point solutions and one-size-fits-all implementations are being supplanted by or absorbed into more comprehensive and flexible approaches. These solutions provide identity management coherency across processes and relationships, as well as identity management consistency across multiple channels and organizations.
At the same time, they enable organizations to efficiently implement a wide range of identity management tools that blend the right identity elements together with the appropriate view and assurance level for each transaction. Established organizations can layer new identity management capabilities onto existing systems in the form of services. Merely extending enterprise identity management solutions will not work.
Three key concepts are at the core of the most successful health care consumer identity management solutions. They are general principles shared by diverse business-specific implementations.
1. Identity management is as much about business as about security. Identity validation (or “resolution”), verification and authentication – commonly regarded as security functions – have far-reaching business ramifications. How you perform them can strongly shape your most direct and therefore vital interactions with patients, payers, providers and other healthcare stakeholders. Thus, while it is important, and sometimes mandatory, to follow industry standards, it is also critical to make sure that the way in which you implement identity management is tailored to your market, business plan and mission to maximize business goals and minimize organizational risk.
2. “Know your health care consumer” is the point of balance for multiple – and possibly competing – objectives. “Know your healthcare consumer” is a phrase that traditionally has different meanings to health care consumer service than it does for security management Service people are concerned with raising healthcare consumer satisfaction by increasing access and ease. Security people are concerned with reducing risk by restricting access.
3. Ask for only what you need to know. Knowing more can, in fact, enable you to ask for less information. In identity management industry jargon, the objective is “friction reduction” through “data minimization.” Improve the health care consumer experience by not asking for information you don’t need.
Strong security can be, for the most part, invisible to the user. Analytics operating in the background can spot links between healthcare consumer data and suspicious entities or recognize suspicious patterns of verification failure.
Analytics can be integrated with business rules to adjust the security level and trigger appropriate treatments or approval of treatments. They can also be used to determine if the current transactional pattern of behavior is unusual. Reacting to healthcare consumer responses in real time – taking business rules for different product lines, channels and types of transactions, and an entity’s tolerance for risk – an identity management service can make dynamic decisions about when to invoke additional and/or stronger measures.
The number of identity-reliant transactions engaged in across the health care continuum is multiplying rapidly and becoming ever more critical to the success of individual health care organizations. When dealing with any situation involving the sharing of a patient’s personal health information it is essential these organizations ask themselves the fundamental question about the individual or entity with which they will be sharing the information: “What do we need to know about you?”
This question is the starting place for all other questions in identity management. The right answer is the key to making identity management an enabler of great services accessed with ease and delivered at a low coast and minimal risk of fraud.
Harry Jordan is Vice President and General Manager, Healthcare for the risk solutions business of LexisNexis. He directs the healthcare business, offering capabilities in health management, predictive claims fraud analytics and health information exchanges.
Another day, another study, but this one – about the EHR user’s satisfaction levels with their systems – seems to have some teeth. According to the survey, “EHR Satisfaction Diminishing,” which was administered by the adept AmericanEHR group, users of EHRs are becoming ever more disenfranchised with their EHRS.
According to the AmericanEHR, data was collected over a two-year period of time, from 2010 through 2012. After two years of use, and in some cases longer, practice leaders and caregivers who have time to figure out their electronic collection systems and who are past the test-drive phase say they are not happy with the technology.
I’ve made this case before, but this is one of the primary reasons I strongly recommend physicians not getting locked into extremely long-term contracts. For example, some vendors require seven years. That’s way too long. Stay away.
Nevertheless, this could just be a standard response to the technology as a whole, but let’s get to the results of the survey. For brevity’s sake, I’ve cut what I don’t find to be significant. Some of the results noted here are amazing and eye opening; you decide.
71 percent of respondents were in practices of 10 physicians or less;
The average length of time that survey respondents had been using their EHRs was more than three years at the time of the EHR satisfaction survey;
Satisfaction and usability ratings are dropping. This holds true regardless of practice size, specialty type and across multiple vendors;
Overall, EHR user satisfaction reveals a 12 percent drop in satisfied users from 2010 to 2012 and a corresponding increase in very dissatisfied users of 10 percent for the same period;
In 2012, 39 percent of clinicians would not recommend their EHR to a colleague (I’m not surprised by this, especially given my experience with vendors);
Average satisfaction level with the ability to improve patient care decreased from 2010 through 2012 for all specialty groups;
Satisfaction with ease of use dropped 13 percent between 2010 and 2012 and 37 percent reported increased dissatisfaction in 2012;
34 percent of users in 2012 were very dissatisfied with the ability to decrease workload compared to 19 percent in 2010.
Why is this happening (according to AmericanEHR)? The following hypotheses may explain some of these findings:
With Meaningful Use, users may have lost some of their workarounds or have new ones that they have to do e.g. clinical visit summary that now takes 10 clicks and as a result workflow may feel more cumbersome;
The difference between cognitive versus procedural specialists. If one asked the majority of physicians how they would rate the quality of care they provide, most would likely say very good to excellent. Unless these physicians regularly use dashboards and reports they do not know whether they are doing better using an EHR. This is more challenging with procedural specialists such as a thoracic surgeon or orthopedic surgeon. It is not clear how the EHR helps with improving quality of care for proceduralists;
As we have further analyzed the data in related to satisfaction with the ability to improve patient care by duration of EHR use prior to completing the EHR satisfaction survey, there appears to be a strong correlation between length of use an EHR and ability to improve patient care especially in those who have been using an EHR for 5+ years. This could suggest that there is a minimum period of time that someone has to use an EHR before beginning to demonstrate improvements in patient care;
Dissatisfaction may also be a result of being asked to do something with an EHR that previously was not required (prior to Meaningful Use);
There continues to be an inability to complete certain tasks electronically despite having an EHR. For example, ACOs that require a paper form to be completed for registration of each patient in a pay-for-performance program, resulting in increased workload and decreased productivity/satisfaction.
Additional observations (which are amazingly insightful):
The speed of change in relation to the Meaningful Use program may be too much too fast for many practices who are unable to cope the demands and workload;
Different populations have different expectations. The pioneers and early adopters have a greater tolerance for the problems and challenges of implementing an EHR vs. those in the mid or late majority;
EHR systems clearly have usability issues which need to be addressed even with respect to basic functionality.
Recommendations (here’s the real gold):
Training is a significant deficiency. Training is required at all stages of adoption, both at time of implementation and as more advanced functionalities are required or integrated with EHRs. Almost 50 percent of respondents in a 2011 AmericanEHR report on the correlation of training duration with EHR usability and satisfaction reported receiving less than three days of training to use their EHRs or no training at all;
Dissatisfaction levels with basic EHR functionalities highlight the need to improve existing technologies rather than just focus on adding new features and capabilities;
Clinician workload within the practice must be re-balanced. Providers are working harder and face numerous additional challenges including the impact of payment reform and the need to comply with multiple incentive/penalty programs.
In closing, according to AmericanEHR: “If these issues are not recognized and addressed, the alternative is that clinicians will do the bare minimum in order to meet meaningful use requirements.”
In a recent conversation with Steve Ferguson, vice president of Hello Health, he described how the company is identifying new revenue sources for practices while working to engage patients. Even though the company’s business model is one that sets it apart and helps it rival other free EHRs, like Practice Fusion, I left the conversation with him wondering why more venodrs weren’t trying the same thing as Hello Health: trying something no one in the market is trying to see, if by change, a little innovation helps pump some life into the HIT market.
Along the same lines, myself and thousands of others in HIT have wondered why systems are not interoperable and, for the most part, operate in silos that are unable to communicate with competing systems.
Certainly, there’s a case to be made for vendors protecting their footprints, and for growing them. In doing so, they like to keep their secrets close; it’s the a business environment after all and despite the number of conversations taking place by their PR folks, improving patient health outcomes comes in only second (or third) to making money.
However, let’s move closer to my point. Given the recent rumors that Cerner and McKesson are working on a joint agreement to enable cross-vendor, national health information exchange, I’m wondering: Why don’t other vendors partner now and begin to build interoperable systems.
According to the rumors, the deal, if completed, could shift the entire interoperable landscape for hospitals, physicians and patients. It would position Cerner, which has more EHR users, and McKesson, which has a strong HIE product in RelayHealth with a loyal user base, to take on Epic Systems, a leading EHR vendor.
An announcement is expected at HIMSS13.
Here’s why this is important news: Interoperability mandates are coming. Like most things, it’s really just a matter of time. Systems will be forced to communicate with other, competing systems. They should already. It’s actually a bit shocking that given the levels of reporting required of care givers, the push for access to information through initiatives like Blue Button and patient’s access to information through mobile technology that there’s not more openness in the market.
The Cerner/McKesson news is incredibly refreshing and worth a look. Two major competitors may be realizing that by partnering they’ll be better able to take on each company’s biggest competitor: Epic.
Imagine connected systems exchanging data. The thought alone would be marketable across several sectors of the healthcare landscape and the move worthy of reams of coverage, which would lead to great brand awareness for each and the change to do what all EHR companies aim for: To create thought leaders; to stand out; to set the market on its heels.
If nothing else the partner vendors would stand ahead of the pack when future interoperability mandates are enacted and will be seen as experts in the exchange game. Tongue and cheek aside, the idea really is a good one and with no one currently doing it, it’s a great opportunity for a couple of HIT companies to actually move change forward and create an environment where information can be easily exchanged across practices, across specialties and across borders.
Then, perhaps, we’ll see a real commitment to improved patient health outcomes rather than them simply trying to improve bottom lines.