The long awaited road to true healthcare IT system interoperability is being implemented at Good Samaritan in Indiana, enabling the 232-bed community healthcare facility to better deliver on its commitment to delivering exceptional patient care. The system will also enable the hospital to substantially increase their practice’s revenue while containing healthcare system integration costs.
“We strive to be the first choice for healthcare in the communities that we serve and to be the regional center of excellence for health and wellness,” said Rob McLin, president and CEO of Good Samaritan. “We are proud to be the first hospital in the country to implement this great integrated health record system that will allow us to provide a much higher level of continuity of care for our patients, as they are our top priority.”
The integration is being made possible with Zoeticx’s Patient-Clarity interoperability platform that will integrate WellTrackONE’s Annual Wellness Visit (AWV) patient reports with Indiana’s Health Information Exchange (IHIE) and the hospital’s Allscripts EHR. IHIE is the largest HIE in the US, serving 30,000 physicians in 90 hospitals serving six million patients in 17 states.
Revenue Generator for the Hospital
WellTrackONE and Zoeticx will enable patient’s AWV data to flow from the application to Allscripts EHR and the IHIE system. With Zoeticx’s Patient-Clarity platform and WellTrackONE’s software, the healthcare IT integration passes on increased revenue from the Centers of Medicare & Medicaid Services (CMS) and decreased IT costs for medical facilities.
Medicare pays medical facilities $164.84 for each initial patient visit under the AWV program and $116.16 for each additional yearly visit. With the AWV integration in place, the hospital is now able to meet CMS’s stringent requirements for patient reimbursements.
It is estimated that the Good Samaritan will be able to generate $500 to $1,200 per AWV patient from follow up appointments for additional testing and referrals for approximately 80 percent of the Medicare patients that are flagged by the AWV for testing, imaging and specialty referrals within the hospital.
This subscriber number is expected to trend upwards into 2050 and will create billions in new healthcare revenue through the US as the population ages. The hospital is not charged any costs for the system until it is reimbursed by CMS.
Overcoming Healthcare System Limitations
The hospital began offering Medicare’s AWV’s a few years ago, but had to develop its own tracking protocols, which impacted its budget and staff resources. The system it had created also operated poorly, allowing hospital staff to only view about 10 percent to 15 percent of patient data.
Good Samaritan medical teams were also constrained by interoperability, having to enter new illness findings and other medical info manually and fax PDFs to other facilities where they would have to again be entered into a different system. The hospital also had all of the data contained in WellTrackONE and Allscripts’ system, but no way to integrate the two, let alone achieve that integration with IHIE. Providers were also spending valuable patient face time trying to find specific patient data buried in the EHR system.
“Our systems were working fine, independently of each other,” said Traci French, director of business development and revenue integrity. “But we could not achieve true interoperability between the two systems. The best we could do was basically reshuffling PDF documents. The next challenge was to integrate that data with the exchange. We needed to get data to providers where they needed it, when they needed it.”
Reports state that only 39 percent of physicians share data using a health information exchange (HIE). There is even a lower number of only 14 percent who electronically share data with ambulatory care providers or hospitals outside their organization. While these numbers may seem astounding to some with Stage 2 fast approaching — the reason is clear. Because even though providers want to share health information electronically they are hindered by EHRs that can’t communicate with one another, lack information-exchange infrastructure, and the high expense of setting up electronic interfaces and health information exchanges.
Below are the top reasons why EHR sharing remains low for adoption:
Lack of Interoperability. The majority of providers and physicians have acknowledged lack of EHR interoperability and exchange infrastructure as major barriers to health information exchange. They have also identified the cost of creating and maintaining interfaces and exchanges as a major barrier.
Lack of Advanced Technology. Over the last few years, various HIE systems have been developed, but many have failed for technological and organizational reasons. High-level issues must be addressed to implement an HIE successfully, including disparate EHR and HIS systems. Most previous HIE research focused on high-level issues and evaluating impact on healthcare delivery, ROI, Syndromic Surveillance, etc.
Lack of Security and Streamlining. Quantitative measures are crucial to the long-term sustainability of HIEs. Interoperability of patient data doesn’t effectively address concerns on privacy, productivity, workflow and costs. Streamlining HIE access through integration with electronic health records to minimize workflow interruption, and keeping costs reasonably low for providers, may increase participation.
Lack of Affordability and Productivity. The cost and loss of productivity are major barriers to HIE adoption. While there are many compliant products on the market, not all of them provide cost savings and lead to efficiency or increased productivity.
The purpose of EHR and HIE is to make patient specific information available at the point of care to improve the delivery and quality of care. Interoperability of patient data no doubt has many advantages, including improved care coordination, elimination of paperwork, reduction in duplicate tests and reduction of medical errors. It is imperative to develop a long-term plan for standards and interoperability that will support competing public and private-sector Interoperability efforts. We should also encourage clear regulation on compliance with federal privacy and security laws. There should also be national benchmarking to share best practices and lessons learned. There should be significant cooperation among primary-care providers, medical specialists, long term care providers and hospitals to outline common information sharing needs promoting a value-based care.
Lindy Benton, CEO of MEA|NEA, has worked in the healthcare information technology for more than 20 years. Before joining MEA|NEA, Lindy served as divisional executive at Sage Healthcare, managing 1,400 employees, and prior to that she worked at Cerner for 15 years. MEA|NEA has nearly 20 years’ experience in providing revenue cycle enhancement solutions for payers and providers, as well as managing the secure exchange of health information, providing critical functionality to payers, medical and dental providers and other agents. Its solutions facilitate secure electronic requests for medical records and documentation to connected network providers for payment integrity, risk adjustment, audit tracking, performance/quality measures, claim attachments and more. Similarly, its technology enables providers to gain productivity via the electronic capture, storage and submissions of healthcare documentation – and to more effectively manage their revenue cycle and reduce claim denials.
Here she speaks about MEA|NEA, electronic attachments and secure health information exchange, how MEA|NEA serves healthcare and some of the most pressing issues facing healthcare’s leaders today.
Tell me more about yourself and your role at MEA|NEA.
I have worked in the healthcare information technology for more than 20 years. I am currently the CEO of MEA|NEA, a provider of electronic attachment and health information exchange solution.
Who uses the company’s products, and how are they enhancing their health systems and practices?
We have three major client sets. One is providers. They represent the point of origin for most medical records. One is payers or managed care organizations. They are often the requestors of medical record information about the members enrolled in one of their health plans. And the third we call partners who are those organizations who sit in-between the originators of medical record information and the requestors of medical record information. The enhancements you ask about are intuitive and real. We enhance the exchange of medical record protected health information – or phi – by making it 100 percent electronic, trackable and auditable.
In what ways is MEA|NEA evolving and where are you seeing the most change, the most rapidly?
With the increased focus on outcomes in healthcare in America, we are seeing an increase in the demand for medical record reviews. We see this increasingly being driven by the federal government, but the commercial sector is also participating. There are companies whose sole purpose is to audit the care being provided to patient populations and the reimbursement of charges related to that care. “Payment integrity” is commonly referenced in the industry today, and that wasn’t the case until recently. We are leading in process efficiencies to support these changes.
Tell me more about your involvement with CMS. How have the company and its strategy changed since the adoption of electronic claims submission through Medicare?
In January 2012 we began delivering medical records to Medicare contractors as one of a few organizations certified by CMS to do so. Today there are 23 certified organizations and we are the largest serving the acute-care hospitals of the nation. We are the 2nd largest overall. Since 2012 we have been selected by four organizations who are listed on the www.cms.gov website as their technology partner. We have a strong relationship with key leaders inside of CMS and we plan to continue to invest there. With 15 percent of US healthcare being tied to Medicare, this is a key component of our future in the medical marketplace.
Guest post by Judy Chan, president, HealthPro Consulting.
Burgeoning EHR implementations nationwide attributable to the meaningful use incentive program have created a surge in HIO and electronic health information exchange (eHIE).
Having health information available for electronic exchange is generally accepted as beneficial to patients, providers and payers. Providers can access patient information from other providers when they need it where they need it. Providers are able to avoid duplicating lab tests, scans and x-rays that save the payers dollars. Additionally, patients don’t need to remember what treatments were administered or drugs prescribed and can avoid unnecessary exposure to radiation.
In emergency situations, the benefits of having a patient’s health information available to emergency room staff are obvious. Patients who have experienced referrals in the course of diagnosis and treatment also readily see the advantage of not having to hand-carry all of their medical records from one doctor’s office to the next. The electronic exchange of health information among providers eliminates faxes, paper work and phone calls.
Patient’s perspective
What makes the exchange of health information frightening to patients?
1. Your health information is available to others who have a legitimate need.
2. Consent must be given by the patient to share their information
3. You must trust the distributor of your information
4. You should monitor your data on a regular basis and make corrections when necessary
5. Information could be accidentally released without your permission.
6. Your consent is electronically recorded by multiple systems.
Do these risks sound familiar? They should because they are not very different from the risks that credit rating agencies that have recorded your financial transactions for years.
Received the following study recently that is quite interesting; thought it worthy of sharing:
Emergency department physicians are less likely to admit patients to the hospital when they have readily available electronic access to those patients’ health records, Weill Cornell Medical College researchers have found.
Its study, published March 12 in Applied Clinical Informatics, illustrates the value of combining multiple providers’ digital patient charts into a single source for health care providers – particularly in an urgent setting like the emergency department. With information such as previous test results, prescriptions and other patient history immediately accessible, providers are able to treat patients more efficiently and effectively than when they lack that data.
“New York State has made significant investments in health information exchange,” said Dr. Joshua Vest, an assistant professor at Weill Cornell and the lead author on the study. “Our study shows that providing physicians, nurses and allied health care professionals such as physician assistants real-time access to community-wide, longitudinal health records does in fact benefit patients.”
With federal and New York State government backing, hospitals and medical practices across the state are investing millions of dollars to make health records sharable among physicians when they need the information. The digitized charts contain doctors’ notes from every patient visit; family medical history; immunization records; lab results; medication history; allergies; reminders for preventative care and more.
Guest by Michael Charest, vice president healthcare, insurance and financial Services, GMC Software Technology.
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.
The Brookdale University Hospital and Medical Center is one of New York’s most innovative hospitals on the forefront of health IT. As one of Brooklyn’s largest voluntary nonprofit teaching hospitals with 530 inpatient beds and a regional tertiary care center, Brookdale provides general and specialized inpatient care to hundreds of thousands of people every year. In addition, the medical center provides 24-hour emergency services, numerous outpatient programs, and long-term specialty care. Brookdale is one of Brooklyn’s largest, and most experienced full-service emergency departments and a regionally recognized Level I Trauma Center that receives more than 100,000 visits a year.
Brookdale University Hospital and Medical Center has come to rely on two main resources to seamlessly and securely access patient data and medical history.
Brooklyn Health Information Exchange (BHIX) is a Regional Health Information Organization (RHIO) devoted to developing, deploying, operating and promoting innovative uses of health information technology to facilitate patient-centric care in Brooklyn and surrounding areas. BHIX was established in 2007 as a community-driven collaboration between providers and payers interested in improving patient care across healthcare settings.
RHIOs, such as BHIX, maintain medical records that are continually updated by participating healthcare providers, who can then access the accumulated data with a patient’s consent.
As one of the largest and busiest full-service emergency departments in Brooklyn and a regionally recognized Level I Trauma Center with more than 100,000 visits a year, Brookdale University Hospital and Medical Center has a demonstrable need to instantly and securely access accurate patient data from a multitude of sources. In an emergency situation, access to critical patient data such as medical history, medication usage, and allergies can often make the difference between life and death.
HIMSS Analytics recently released a new report on the barriers, challenges and opportunities of healthcare information exchange (HIE). The report, sponsored by ASG, examines the current state of information exchange among U.S. hospitals and explores the opportunities for improving the collection and exchange of patient data.
Survey respondents – 157 senior hospital information technology (IT) executives – indicated that there are two major challenges in the collection and sharing of patient information despite high levels of HIE participation:
Healthcare facilities that are participating in some form of health information exchange organization (HIO) reported difficulties in exchanging patient information in robust, meaningful ways.
Additionally, respondents indicated sharing information outside of HIOs is constrained by budget limitations and staffing resources.
More than 70 percent of respondents reported that their organization was part of a HIO, meaning that they participate in HIE with other hospitals and health systems. Approximately half of those respondents also reported improved access to patient information. However, the benefit did not result in robust data sharing, as 49 percent of the respondents cited this as the primary challenge to sharing patient information.
Received the following study recently that is quite interesting; thought it worthy of sharing: