The following is an announcement from CMS about potential modifications to the meaningful use program, announced Apr. 10, 2015:
On April 10, 2015, the Centers for Medicare & Medicaid Services issued a new proposed rule for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs to align Stage 1 and Stage 2 objectives and measures with the long-term proposals for Stage 3, to build progress toward program milestones, to reduce complexity, and to simplify providers’ reporting. These modifications would allow providers to focus more closely on the advanced use of certified EHR technology to support health information exchange and quality improvement.
The proposed rule is just one part of a larger effort across HHS to deliver better care, spend health dollars more wisely, and have healthier people and communities by working in three core areas: improving the way providers are paid, improving the way care is delivered, and improving the way information is shared to support transparency for consumers, health care providers, and researchers and to strengthen decision-making.
The proposed rule is a critical step forward in helping to support the long-term goals of delivery system reform; especially those goals of a nationwide interoperable learning health system and patient-centered care. CMS is also simplifying the structure and reducing the reporting requirements for providers participating in the program by removing measures which have become duplicative, redundant, and reached wide-spread adoption (i.e., are “topped out”). This will allow providers to refocus on the advanced use objectives and measures. These advanced measures are at the core of health IT supported health care which drives toward improving the way electronic health information is shared among providers and with their patients, enhancing the ability to measure quality and set improvement goals, and ultimately improving the way health care is delivered and experienced.
Dr. Sol Lizerbram has been co-founder and chairman of the board of HealthFusion since its inception in 1998. HealthFusion develops web-based, cloud computing software for physicians, hospitals and medical billing services. HealthFusion’s fully integrated solution includes MediTouch EHR and MediTouch PM. Dr. Lizerbram was a co-founder of a national physician practice management company, and served as chairman of its board of Directors from 1986 through July 1998. Dr. Lizerbram has been in the healthcare industry for more than 35 years, received a degree in pharmacy in 1970 from Long Island University, School of Pharmacy, and was licensed as a registered pharmacist in the states of New York and Pennsylvania. He obtained a medical degree from the Philadelphia College of Osteopathic Medicine in 1977.
He is board certified in family practice and is licensed as an osteopathic physician and surgeon in the states of Pennsylvania and California. Dr. Lizerbram was recognized by NASDAQ/Ernst & Young as the 1996 Entrepreneur of the Year in the healthcare industry. He was a trustee of the US Olympic Committee and is active as a committee member in the Jewish National Fund. Dr. Lizerbram was appointed by the California Insurance Commissioner to the Governing Committee of the Workers’ Compensation Insurance Rating Bureau, and appointed by the California Governor as a Commissioner to the Health Policy and Data Advisory Commission.
Here, he discusses HealthFusion, the technology he helps develop and how it’s being used by physicians, the future of health IT, interoperability and the rise of consumerism and the cloud, the survival of EHR companies.
Tell me more about yourself and your background. Why healthcare?
I was a pharmacist prior to attending medical school in Philadelphia. After completion of my medical training I moved to San Diego, where I practiced as a board certified family physician. After several years in practice, I was appointed as the medical director of Prudential PruCare in San Diego. Soon after, I began to see the need for software that would assist doctors in improving the health of our population.
In 1998 I helped to found HealthFusion with Dr. Seth Flam, our CEO and a fellow family physician, to make the practice of medicine simpler for physicians and their staff by finding novel methods of utilizing the Internet.
Our job is to create the software tools used by physicians to further the health of their patients. We are honored that each day thousands of providers use our healthcare software to help make someone’s life a little better.
I come from a family with a strong healthcare orientation; my brother and six cousins are all physicians. As a result, I had an interest in helping people with their healthcare needs and found it very interesting.
What do you see as the sector’s biggest issues and, technologically, how can we solve them?
One of the biggest issues in healthcare right now is interoperability, the ability to seamlessly exchange patient data between physicians, hospitals, diagnostics centers, etc. This communication has been a challenge in healthcare because it needs to be accomplished between disparate systems, but it’s vital to garnering full value from digital healthcare information for patients, and for improving population health.
I’m glad to say that we are already accomplishing this with HealthFusion’s MediTouch; as an example, we provide data exchange successfully between Miami Children’s Hospital systems and MediTouch in the community doctors’ offices.
Amazing Charts, a provider of electronic health records and practice management solutions, issued its healthcare predictions for 2015. Some interesting predictions here I thought you might find worthwhile. Concierge medicine, which I’ve said for some time is going to have a lasting impact, especially in the era of the Affordable Care Act, made the list.
Patient engagement, and consumerism of healthcare– somewhat of a slam dunk — appears here, too. I believe we’ve get some clarification on what that movement means this year. Amazing Charts agrees.
Also, wearables (oh, wearables, will you become more than a fad?) makes this list, and telehealth is here, too; I think we’ve finally reached the saturation point of telemedicine. This year should show strong results that I hope will validate its role at the point of care. We’ll finally get to see if payers get the message.
Here’s the full list of healthcare predictions for 2015 from Amazing Charts:
Membership Medicine Comes on Strong: The patient membership approach to medicine will grow in all forms, including value-based Direct Primary Care (DPC), high-end concierge medicine and primary care services contracted directly by employers. Market-driven medicine, fueled by changes occurring in healthcare today, such as inexpensive health plans with very high deductibles, will continue to encourage consumers to explore more cost-effective alternatives for primary care.
Patients Help Define the Experience: The patient, in partnership with the provider, will help define the care experience going forward. This trend will be powered by technologies that enhance face-to-face interaction in the exam room. One example is the projection of an EHR onto a large display screen to facilitate information sharing between provider and patient. This in turn will help reduce errors and misdiagnosis, as well as motivate patients to take a renewed interest in their own healthcare and treatment options.
EHRs Get Personalized: The EHR market will further mature and become customizable for individual patient needs and treatment plans. Intuitive data analytics will play a critical role here, helping clinicians measure, assess and manage their specific patient populations to better define specific gaps in clinical care and introduce the latest evidenced-based treatment procedures or diagnostic techniques.
To better understand the fundamentals of predictive analytics — and why it has the potential to transform healthcare — it can be helpful to use Netflix as an illustrative example.
Let’s say, for example, you’re sitting around the house one rainy October Saturday and decide to view a few movies using Netflix’s streaming service. First you watched Field of Dreams then you decided, hey, this rain isn’t letting up any time soon, and that dog doesn’t want to go out in it any more than I do. So, after a brief backyard sojourn during which you and the dog confirmed that 38 degrees and rainy is in fact unpleasant — you reconvened your Netflixing and ended up watching Bull Durham, as well. Further, let us also assume that you enjoyed both movies and watched them all the way through.
As the credits rolled on Bull Durham, the critical question for Netflix was the same it always is: What would you enjoy watching next — specifically, what should Netflix recommend? Based upon the day’s viewing you may have a soft spot for baseball movies. Though it could just as easily be the case that you’re Kevin Costner’s biggest fan and the fact that you queued up two of his baseball movies was pure coincidence.
Given the uncertainty orbiting these pieces of information, maybe the best prediction would be Dances with Wolves, starring Kevin Costner. Or maybe the right pick would be Moneyball, the story of how the Oakland A’s leveraged data-driven, evidence-based sabermetrics to remain competitive against much more highly capitalized MLB teams. But what if neither Kevin Costner nor baseball is the most important correlation—what if the best predictor of whether you’ll like a film is simply whether it’s a sports movie from the late 80s?
As with all forms of predictive analytics, the question of what to recommend multiplies in complexity as overlapping variables (often in the form of unstructured data) are added and subsequently considered within algorithmic equations that power, in this case, Netflix’s recommendation engine. Further complicating the matter, it’s likely that you’re not the only person to have watched both of these films in close proximity and there are likely to be numerous “motivations” for such viewings across the population. It becomes apparent rather quickly the inherent challenge of something that seems, on the surface, as straightforward as a recommendation engine.
In healthcare we face these same kinds of challenges, just in a different form. The questions we ask are which gaps in care create the greatest risk for the patient, or which specific combinations of gaps in care correlate with readmissions—so that clinical outreach coordinators and other staff can prioritize whom to contact right away. We ask which types of claims are most likely to be under-coded or missing charges—so that organizations can make best use of finite resources like staff time and ensure the greatest positive impact on overall financial performance.
I recently had the opportunity to attend PointClickCare’s annual user summit held in Orlando. Though the senior care market is not one I’ve spent a great deal of time covering, senior and long-term care are deeply interesting to me. There are several reasons for this interest: Seniors are becoming the largest population segment in the US and that has serious ramifications ranging from politics to economics, and because I’m interested in alternative care models. And, in some way, senior care effects all of us.
There are a number of differences between senior care and ambulatory or in patient, but the technology needs are still overwhelming and great. Senior care facilities across the US face tight budgets, extremely high levels of employee turnover and technology challenges, but the care they provide is still important, as is how the information they collect on behalf of their patients is similar to other sectors.
According to Mike Wessinger, CEO and co-founder, “PointClickCare’s goal is to enrich the lives of care providers through technology that will help them better care for their residents in ways that are effective and efficient.”
PointClickCare’s primary reason for being is to deliver electronic health record and practice management solutions, but the company has an eye on mobile delivery, where both Mike and brother David Wessingner, CTO and co-founder, feel the future of health IT lies.
Mobile is king for its ability to deliver health data quickly and where needed, as well as to alleviate stress and confusion of overwhelmed healthcare employees.
Hospitals, too, are overwhelmed. Data flowing in from various systems often goes unnoticed or unpackaged, a particular troubling problem for the senior population. When there’s a patient transferring in from a senior home to a hospital for emergency care, a health record of some kind may accompany them. A fully loaded paper chart may only be shuffled through and details lost.
The report includes a web-based interactive innovation scorecard to assess medtech companies based on leading innovation practices. Only 14 percent of medtech executives say that they formally manage innovation activities, which is essential to creating new services and business models.
Just 17 percent of med tech executives believe their companies are innovation pioneers. The PwC’s Health Research Institute report outlines how medtech companies need to expand their approaches to innovation outside traditional R&D to remain competitive.
“Historically, medtech innovation has relied on incremental improvement,” said Christopher Wasden, managing director and global healthcare innovation leader, PwC. “But ‘innovation’ needs redefining for an environment that rewards value – measured in affordable patient outcomes and customer satisfaction – over volume. True innovators learn from failure – fast, frequent, frugal failure. Medtech leaders need to change their business models, their corporate DNA, to embrace lean innovation beyond their core operations.”
HIMSS is one of the most exciting events on the health IT calendar. An annual parade of the pomp and circumstance, the mighty and the meek; the somewhat great equalizer for everyone in attendance (perhaps not measured by booth size but by mere participation).
HIMSS is the place to be seen as it holds a certain stature, like being invited to the hottest party in town or attending an industry’s red-carpet event. As such, there’s a level of elitism for those that make the journey as all that enter the grounds can claim that they’ve reached a certain stature in their careers.
There are the parties and toasts, educational and informational, evangelists and doomsdayers walking the same halls, shaking the same hands, seeking the same solutions and securing similar aspirations. As if a city of its own, HIMSS thrives upon its own economies and its communities, its own crooks and its own saints; it is the world in which we live, and great things tend to happen here, despite the few inevitable hiccups that happen along the way.
From the sessions to the show floor, the whole thing is a carnival. Like in the real world, everyone in attendance has their tribe and the land in which they’ve staked is the land in which they occupy.
I’ve done my time in the booth; standing at the edges of the territorial carpet, scanning the horizon, taking in the tourists and judging the competition for their various faults — from the poorly dressed sales folks to the vendors vying for supremacy from the land of the largest booth.
Sometimes, we cross the isle, make nice and say hello to a neighboring tribe. Others times we invade, stealing chachkis, and water and the occasional free massage.
We smile and make nice, and for a minute we’re friends, but then we remember that we come from the other side of the isle so we slither back to our tents and to our carnival barker duties. After all, it’s the show they love — the folks walking by – who window shop their way through the maze of capitalists.
We’re their entertainment, in our pressed shirts, standing in our corner smiling. We make passersby pass the time between sessions, but we understand our role. Even though we’re there to show some product and educate some minds, it’s a time for us all to come together and to celebrate the best that is healthcare, its technology and all its related parts.
For a few short days, we’re united and (somewhat) sincere with each other. Like a high school graduation party where everyone can come together even after years of disagreement or opposing views and think grand things about the future even though we know the roads we’ll travel will take us down very different paths.
And when it’s all over and life settles down, after the tent cities are razed and we’re back in our offices, we’ll remember the time we had where we came together and we’ll long for those time once again.
“There’s always next year,” some of us will say to ourselves, but we know it will never last forever.
Despite the good times we had round the hotel bar, in the ballroom or conference center board room, we realize that even the best of times must end and, ultimately, we pretend to know “it” (read: interoperability) could never work in the “real” world so we settle for and embrace the short-term relationships we’ve made knowing “we’re just not right for each other.”
Truth is, in the end, when the show is over, we’ll simply return to our silos and shut the door. Lights out, and once again we’ll be alone.
I’m not unique in that during this time of year I love to take a look at predictions made by some of the industry’s “best” and see if their predictions make sense, are surprising in a good way or if they are surprising in a stupid way.
With that in mind, I came across an interesting piece in Canadian Manufacturing of all places that features several intriguing predictions by analyst firm Gartner that I think are worth a look here as they have peripheral relation to healthcare.
So, here we go. Gartner’s top IT predictions include:
By 2015, big data demand will reach 4.4 million jobs globally, but only one-third of those jobs will be filled. According to the report: “The demand for big data is growing, and enterprises will need to reassess their competencies and skills to respond to this opportunity. Jobs that are filled will result in real financial and competitive benefits for organizations. Note that enterprises need people with new skills—data management, analytics and business expertise and nontraditional skills necessary for extracting the value of big data, as well as artists and designers for data visualization.”
In a market like healthcare, where highly skilled jobs are often difficult to fill, we should understand this prediction to be very true and one not to take too lightly. Some of these job vacancies will be at health system that needs the data to meet federal reporting requirements. The individuals with these skills will have a great deal of clout as they eventually move into the job market.
Employee-owned devices will be compromised by malware at more than double the rate of corporate-owned devices. “Corporate networks will become more like college and university networks, which were the original “bring your own device” (BYOD) environments. Because colleges and universities lack control over students’ devices, they focus on protecting their networks by enforcing policies that govern network access. Gartner believes that enterprises will adopt a similar approach and will block or restrict access for those devices that are not compliant with corporate policies. Enterprises that adopt BYOD initiatives should establish clear policies that outline which employee-owned devices will be allowed and which will be banned.”
BYOD continues to rear its head so don’t be caught unawares. AS Gartner predicts, you must have a plan for mobile device management and personal device use in the workplace. Ignorance is not bliss, in this case, and since employees are currently using their own devices in the healthcare setting where very important personal information can be exposed, develop a policy, stick with it and let your employees know you have one in place. Circulate it!
By 2016, wearable smart electronics in shoes, tattoos and accessories will emerge as a $10-billion industry. “The majority of revenue from wearable smart electronics over the next four years will come from athletic shoes and fitness tracking, communications devices for the ear, and automatic insulin delivery for diabetics. CIOs must evaluate how the data from wearable electronics can be used to improve worker productivity, asset tracking and workflow.”
Healthcare will play a role in how wearable electronics and traceable devices are used to track the health of individuals, especially in outpatient and in-home care. The data from these devices will flow directly into your EHR and become part of the patient record. Physicians will be forced to learn the benefits of these devices and patients are going to need to accept it.
By 2014, market consolidation will displace up to 20 percent of the top 100 IT services providers. “The convergence of cloud, big data, mobility and social media, along with continued global economic uncertainty, will accelerate the restructuring of the $1 trillion IT services market. By 2015, low-cost cloud services will cannibalize up to 15 percent of top outsourcing players’ revenue, and more than 20 percent of large IT outsourcers not investing enough in industrialization and value-added services will disappear through merger and acquisition. CIOs should re-evaluate the providers and types of providers used for IT services, with particular interest in cloud-enabled providers supporting information, mobile and social strategies.”
The prediction smacks of the ongoing discussion about the EHR vendor market and how much longer it can contain the number of players. Certainly, we’re seeing deterioration of this segment now, though it has been expected to erode more quickly than it has. Expect there to be fewer EHR vendors in the next 12 months, and realize that no vendor is too big to fail (see Allscripts). Prepare early and do your due diligence before signing the dotted line.
I’d love to know your thoughts. Do you agree with these predictions and my assessments? What are yours?
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.