In a new report that’s been gaining quite a bit of attention in recent weeks, CMS faces several obstacles in overseeing the meaningful use incentive program.
Here’s what OIG found in its assessment:
“CMS faces obstacles to overseeing the Medicare EHR incentive program that leave the program vulnerable to paying incentives to professionals and hospitals that do not fully meet the meaningful use requirements,” the report states. “Currently, CMS has not implemented strong prepayment safeguards, and its ability to safeguard incentive payments post payment is also limited. The Office of the National Coordinator for Health Information Technology (ONC) requirements for EHR reports may contribute to CMS’s oversight obstacles.”
Essentially, OIG has concerns that the ONC is simply giving away money without verifying whether those who have attested actually completed the process properly. I think it’s a valid concern, though, given the number of hurdles physicians face and the degree in which their meaningful use systems must undergo to become certified, I think it’s probably a little far fetched that an overwhelming number of practices are going to bilk the system (though it could happen).
What follows are the recommendations for the administration of the meaningful use program, per OIG:
First, it is recommended that CMS:
Obtain and review supporting documentation from selected professionals and hospitals prior to payment to verify the accuracy of their self-reported information and
Issue guidance with specific examples of documentation that professionals and hospitals should maintain to support their compliance.
OIG wants CMS to conduct occasional spot audits prior to payment for them to receive their money. It won’t happen. After all of the work and time invested at the practice level, there is going to be too much push back to administer an audit cycle of this magnitude, and CMS doesn’t have the time nor resources to undertake it as an action item.
Frankly, this seems like a point made for the sake of making a point. This is big government we’re talking about. Everyone feels the need to participate in a conversation just to they look important while doing it. These may be some valid points, but OIG comes off a little out of touch in doing so.
Also, according to the report, CMS did not concur with OIG’s first recommendation, stating that “prepayment reviews would increase the burden on practitioners and hospitals and could delay incentive payments.”
Finally, OIG recommended that ONC:
Require that certified EHR technology be capable of producing reports for yes/no meaningful use measures where possible
Improve the certification process for EHR technology to ensure accurate EHR reports.
ONC concurred with both recommendations, which I think are beside the point.
Perhaps the most “intriguing” element of the report, though, is its actual title. Let’s take a look: Early Assessment Finds that CMS Faces Obstacles in Overseeing the Medicare EHR Incentive Program.
Is it me or can the title be any more vague? Seriously? CMS face obstacles? That’s a pretty bland statement given the scope of meaningful use, and (perhaps I’m reaching) that seems to diminish the validity of the entire report, which brings me back to my previous point: Is OIG inserting itself into a conversation in which, at this point, it really has very little to say?
Mobile device management is vitally important. Mobile devices are not going away and they continue to affect the professional setting, and managing the safety of mobile devices is important to organizations.
As a business leader with an enterprise to protect, one of the most important, and possibly easiest, steps to take is managing the safety of mobile devices. There is no way to avoid, or ignore, employee’s personal use of mobile devices in your “public” setting.
75 percent of mobile users believe it’s critical to their jobs to use a mobile device. Employees feel that using mobile devices makes their jobs easier, and they feel more productive. Employers also feel that allowing their employees to use the devices means their employees are always connected and always on.
85 percent of IT managers believe that the introduction of a mobile ecosystem has made the companies they manage more productive. With the exception of having to implement policies to monitor, protect and mange employee’s personal devices, mobile devices also help save companies money and create efficiencies.
Smartphones and laptops are the obvious front runner as the device most used in the workplace, but personal tablets are increasingly becoming more common in the professional setting.
According to CDW, 25 percent of mobile device users use tablets at work; 69 percent of tablet users use their own tablet at work.
The trend is expected to rise by 117 percent in the next two years. No surprise here. If you are surprised by this point then you might be wondering why this is so important.
Why? I’ll let Leiva-Gomez sum it up, as it does so aptly: “The CDW report concludes that 67 percent of IT managers aren’t even familiar with the concept of Mobile Device Management. Are you?”
MDM is much too important to ignore. Not taking an active role in its implementation or its management could put you and your practice’s health information in jeopardy. If swiped, stolen or ripped off, there’s also a pretty good chance you’ll face violations and fines for your HIPAA breeches.
If for no other reason, let this be a motivation for you. An ounce of prevention is worth a pound of cure, or so I’m told.
Is health IT a crystal ball? Nope; not yet. For all of its good, health IT still lacks in so many ways. Health IT may save the masses, but not necessarily the individual at this point. As it matures and grows, no doubt it will fill some voids, but as far as its current capabilities, the information collected in the form of electronic health records, for example, is still nothing more than a repository of information gathered from the past.
What we need are technologies that hint or predict health outcomes before they happen. I’m not talking about broad brush analysis, but individual predictions for each person with a record.
Who wouldn’t want their medical cases charted and entered into an EHR if it could help physicians determine which conditions were going to impact them down the road.
It’s not lost on me that on the current road map, if all healthcare data is aggregated, there’s a hope that a population’s data may provide insight into predicting what’s in store for the said population.
To cite IBM, “As digital records and information become the norm in healthcare, it enables the building of predictive analytic solutions. These predictive models, when interspersed with the day-to-day operations of healthcare providers and insurance companies, have the potential to lower cost and improve the overall health of the population. As predictive models become more pervasive, the need for a standard, which can be used by all the parties involved in the modeling process: from model building to operational deployment, is paramount.”
Even though current forms of data collection are merely meant to gather information to help establish standard approaches to most types of care in which the care system will use to treat the majority of patients (evidence-based care, essentially) as a way to reduce costs to the system (health insurance providers not excluded), there is little push for technologies that could actually help determine, at the individual level, what may affect us and how to treat it before it becomes chronic or life threatening.
Let’s be clear: I’m not talking about predicting the obvious. For example, in cases where years of overeating and lack of exercise are present, no one needs to predict what the outcome is likely to be. I’m referring to other types of conditions that are, for the most case, unavoidable: MS, cancer, Alhzeimer’s, and so on.
Whoever begins to develop these technologies is going to set the market and turn healthcare on its head. These people, or this person, will be considered genius and their effects on millions of lives great. It might be science fiction of me to think this will ever happen, but it gives me hope to think it could happen.
Until then, if such a day ever comes, we have to wait and hope for the best like a dear friend of mine who recently was diagnosed with brain cancer. Ironically, she has always been an advocate for healthful living, living an active lifestyle, working with a major organization dedicated to lobbying for and providing hope to those affected by cancer, and even championing healthcare technology as a means to improve patient health outcomes and our health as a society.
But given all of these efforts, despite the wise choices she’s made to live healthy and help others, there was little that could be done to predict that she too would be in this situation, where if predictive technologies existed she could have benefited.
Now, because there is not a predictive crystal ball, despite all the technological gains we’ve made, she, like everyone else, must react rather than act.
Sad to think that even after all the billions being spent in healthcare technology and with all of the apparent advances, as individuals, are we really better off?
There is little doubt that I’m addicted to health start ups.
Everything about their underdog stories implores me to want to know more about their stories: who they are, what they do, why they do it and what, ultimately, they can do to improve the healthcare landscape.
My excitement lies in discovering the passion behind the company and why its leaders work so hard to bring their vision to the market.
Meddik is one such new venture attempting to establish itself in healthcare, with a particular focus on the patient consumer. It offers a place where people can check out questions, stories and products, and share their experiences through a “personalized health network” comprised of people who have gone through similar health issues, diagnosis and conditions.
According to its site, “Meddik is the first of its kind to combine machine learning and user-submitted content for the betterment of health, leading to a more informed and empowered patient. Our mission is to tap into the power of the masses, discovering new insights and ultimately accelerating the pace of innovation.”
At its most basic, Meddik is a community where people with healthcare questions can get together, discuss topics and offer insight. It’s different than some other sites, like WebMD, in that it doesn’t just use algorithms to compile data through a robotic search for an individual’s query.
Users can search through a list of topics that are already posted to the site to see what others have already said, or they can begin their own discussion about their own topic. They can search by gender, condition or symptom, treatments or procedures.
The topics to choose from are almost overwhelming. Here are a few: eating gluten free, how to choose a psychologist, dealing with a parent’s depression, diagnoses with celiacs, and so and so forth.
But here are a few things that make the site seem so much more advanced than what’s available now.
First, of all the submissions on the site you can “boost” the information you find helpful. According to Meddik, doing so increases the chances that people who are going through the same or similar issues as you will find that submission.
Next, you can discuss and leave comments with thoughts or suggestions about a topic or condition.
Users can also mark an item “Not Helpful” if it is not helpful or not relevant to their condition based on their search. In addition, according to Meddik, the more submissions that exist, the better the system can draw meaningful conclusions that can lead to future health innovation, or so says Meddik.
And probably the reason for its being, and the reason for this post, simply comes down to this (the passion for the thing): “The power of Meddik increases at an exponential rate the more users that exist. Imagine how fast we could change health if the entire world worked together.”
Collaboration is kind of a tech-like way of saying, “Let’s play together because when we do, things will go well.”
Meddick seems like a great collaboration tool, especially for patient consumers. If the company can hang on and engage users, there’s a good chance that it could engage patients more in their overall care, which seems a pretty good place to take this experiment.
Those who conceived and brought meaningful use to life can apparently chalk up another victory, according to a new survey conducted by Accenture.
As told by For the Record, patients overwhelming want access not only to their medical records and personal health information through connected devices (mobile or otherwise), but they also want direct electronic access to their physicians.
By “access to their physicians,” I mean they want to interact with their caregivers through web portals and email. Actually, respondents of this survey (88 percent) said they want to receive email appointment reminders from their physicians, while 76 percent of survey takers said they want the option of email consultations directly with their physicians.
Enter the patient portal. Secure, web-based portals that, for most EHR systems, allow patients the opportunity to interact directly with their physicians, view lab results (in certain non-overly sensitive cases), schedule appointments and make payments, among other things. The same patient portals that are required ingredients of meaningful use certified EHR systems.
Despite the arguments over the benefits or lack thereof of meaningful use, the requirement that EHRs contain patient portals so patients and their caregivers can interact with each other seems to be giving the patients exactly what they want.
In the very least, at least according to the results of this survey, patients are more likely to engage with physicians and take greater ownership of their care if they are simply allowed to communicate with their doctors electronically.
And given the seemingly current lack of patient engagement that’s prevalent in our healthcare community, anything that sparks interest in patients should be considered a welcome sign to every healthcare professional. After all, patient engagement will continue to become more popular as consumers take greater ownership of their care as they discover that their healthcare providers are actually easier to access because of electronic health records and patient portals.
Unfortunately, however, the average patient doesn’t know whether his physician offers a practice portal or if the practice uses an EHR as fewer than half of the 1,100 survey participants in the Accenture study didn’t know whether they had access to such systems.
Despite this minor detail, there’s plenty in this survey to celebrate. Specifically, patients clearly want to access their health records electronically and they want to be able to connect with their physicians when they want or need through any connected device wherever they are in the world.
The other good news here, for practice professionals anyway, is that there is plenty of room for and an abundance of opportunity to educate patients about a practice’s internal technology systems. Patients clearly want to know more about the technology their physicians are using in their practices.
If you don’t currently have these systems in place, engaging patients is a great way to find out what they might like to see from you in the future and, if nothing else, the information gathered helps you build and develop your practice and tailor it to your customer’s needs.
In what appears to be an extension of yesterday’s post, today I want to examine some questions posed by Success EHS, which asks, “Should you replace your EHR?”
As you most likely know, most large enterprise ambulatory practices and hospital systems have well-established EHR systems in place. They are clearly recognized as among the early adopters of electronic health records, and, compared to their small counterparts, are also the most likely healthcare facilities to currently be in the market for an alternative EHR.
In the age of meaningful use, in a time where healthcare technology is also known as the electronic health record, the systems are being replaced with great frequency. The why and what fors are pretty simple to figure out if you’re familiar with the technology and the marketplace.
There are several prevailing reasons practices are jumping systems, though. They include (and I’m citing Success EHS here):
• Lack of strong vendor support
• Lagging product development
• Consolidation of disparate solutions
• Systems fail to live up to vendors claims
• EHR hinders efficiency and productivity
Given these hurdles – there may be others, of course – there are several questions practice administration must ask to determine whether it’s time to move.
Some of these questions include (feel free to grab a pen and paper and add to the list):
• Are issues able to be solved through remediation? No? Might be time to hit the road.
• Can the vendor’s technical improvements resolve any issues? If so, you need to ask that fixes be made in a reasonable timeframe. Obviously, telling said vendor that fixes need to be made “ASAP” won’t do; you must be reasonable. Consider negotiating a term of three to six months and get final terms in writing. Anything more than six months and it might be time to pack up and leave.
• Are you partially responsible for the EHR’s issues? If you’re partially or fully at fault for a botched EHR implementation or for poor usage, you owe it to yourself, your staff, your patients and, yes, to your vendor to work out a solution. If you’ve tried every solution and there’s no fix, you may be forced to move on. Some times it’s a matter of agreeing to disagree, let’s just agree on that.
• Do you have an opt-out clause? If so, you may wish to exercise it. If not, you’re going to pay, probably handsomely, to exit stage right.
• Are your current long-term goals going to be met using your current EHR? If not, you need to change your goals or change your system.
• Is your EHR negatively impacting practice efficiency? Success EMS says it best, “An EHR that hampers productivity now will only grow worse as the complexities of health reform initiatives increase in the future.”
If you decide it’s time to implement a new EHR system then it’s time to create an assessment plan. Assessments are designed to answer the “why” of implementing an EHR, and what is working and can be improved by installing one.
In taking a look around the HealthIT.gov site recently, I once again stumbled upon its series dedicated to offering practices insight into how to implement an EHR. A several part series, topics included cover what to look for when selecting a product, how to conduct training and, ultimately, how to reach meaningful use.
Given that nearly 50 percent of all practices currently have some sort of EHR, the process for setting up and implementing the systems are becoming more well known; however, having a clear plan and getting a little advice goes a long way.
So, without further ado, the following information is valuable and bears repeating, at least in part, even if you heard some of it before.
When starting an EHR implementation, a practice should assess its wants and needs. Keep in mind that no implementation is going to go completely smoothly (or at least as smoothly as imagined) so it helps to have a plan for what to expect and the plan should include room for error. Figure 10 to 15 percent in added time, resources and staff commitment over and above what you originally plan.
During the assessment, there will be some error and a few hurdles to jump. Don’t allow yourself to be told otherwise. If someone tries to tell you differently, that person does not have your best interest in mind.
If it’s a vendor, run. Do not purchase the product from the company because it’s only the beginning of what’s likely to be a long road of misinformation and false expectations. And no one appreciates being snowed, especially when you’re spending money on something.
Asking yourself questions
During the assessment phase, you also need to determine if you are even ready to implement a system, and if not, what more you need to accomplish. Assessments are designed to answer the “why” of implementing an EHR, and what is working and can be improved by installing one.
According to HealthIT.gov, “practice leadership and staff should consider the practice’s clinical goals, needs, financial and technical readiness as they transition.”
The site provides the following questions that practice leaders should consider during the process:
Are administrative processes organized, efficient and well documented?
Are clinical workflows efficient, clearly mapped out and understood by all staff?
Are data collection and reporting processes well established and documented?
Are staff members computer literate and comfortable with information technology?
Does the practice have access to high-speed Internet connectivity?
Does the practice have access to the financial capital required to purchase new or additional hardware?
Are there clinical priorities or needs that should be addressed?
Does the practice have specialty specific requirements?
What will the future look like?
Next up, it’s time to envision the future. Think about what you want to accomplish with an EHR, and write as part of your plan some things like: how are patients going to benefit, how can the care provided be better and how are providers’ lives going to change?
Finally, set some goals. According to HeathIT.gov, “goals and needs should be documented to help guide decision-making throughout the implementation process. And they may need to be re-assessed throughout the EHR implementation to ensure a smooth transition for the practice and all staff.”
Goals guide an EHR implementation, and are set once an assessment has been completed. As in life, goals provide an achievable end to an arduous task; the medal at the end of the race, if you will.
When developing goals for the implementation forgo conclusions like trying to determine what amount of savings will be created or how much of an increase in the number of patients or revenue will come into the practice. For now, these are intangible and often create a sense of failure if not immediately met after the EHR is “turned on.”
Keep the goals more process oriented and related to practice strategy and team building. For example, what goal do you have for the transition team? Do leaders emerge? Do advocates and coaches come to the forefront of the team that you had not expected? What practice visions are realized? Are you now more technologically savvy and able to attract better talent to the organization?
Perhaps you have business goals (other than the aforementioned money goals). Do you have a stronger business-planning process and clearer organization objectives now?
If physicians use healthcare technology so much less than practice administrators and others in the average practice with these implemented systems, why do they continue to receive so much of the marketing and pre-sales attention from vendors and others in HIT community?
All healthcare vendors take a similar approach with physicians as they jostle for a lane at the front of the race. They gear their public-facing collateral and educational materials to physicians knowing all the while that they also must woo practice administrators and support staff. Rarely, though, is there any effort put into publicly promoting healthcare technology systems to non-physicians nor is there much effort behind celebrating non-physician care givers and administrators as the industry’s leading users of HIT.
It should come as no surprise that non-physician practice employees, such as RNs and PAs, use the systems like electronic health records, much more than their physician counterparts, on average. But, for whatever reason, HIT messaging is all about the physician and continues to be tailored to these mascots and figureheads within practices and healthcare settings.
EHR Watch’s editor, Jeff Rowe, recently published a blog post about the amount of time physicians use healthcare technology as opposed to their in-practice colleagues like RNs and PAs.
In his succinct summation PAs and RNs spend more time online for professional purposes than physicians; during consultations, PAs and RNs leverage mobile applications more at the point of care than physicians; and, in his words, “PAs and RNs use pharma or biotech websites more frequently than physicians and are more interested in using pharma features on electronic health record systems (EHRs).”
If physicians spend most of their time seeing patients and administering care, there’s nothing shocking about this data. It’s a good thing; they need to be seeing patients, not playing around on their computers.
However, this information should validate what everyone in healthcare already knows: Physicians are not the only ones using healthcare technology, and more can be done to include healthcare’s other care providers (and leaders) in the conversation about the technology and how it affects business and patient care outcomes.
The data Rowe provides also should encourage practices to continue including non-physician team members in the selection process of new technology if they are not already doing so because, clearly, though physicians are experts in providing care, they are not always the experts in using a practice’s technology solutions.
Does healthcare technology actually interfere with patient care? Apparently so, according to a new study commissioned by athenahealth.
“Overburdened” physicians face pressures from continual government “intervention,” “increased use of and frustration with EHRs” and “administrative burdens.”
According to the study, physicians are disenfranchised.
Why? Well, according to athena’s study, there’s too much change. Perhaps that’s a bit of a blunt summation, but it seems to be the picture the study paints.
Nearly half the physicians interviewed for the study said electronic health records were not designed with the physician in mind while nearly two-thirds said the EHRs take away from their ability to engage with patients.
Some of this is obviously subjective opinion. Of course, there’s really no way to measure whether or not patients feel put off by their doctors entering data during the visit. On the contrary, there are plenty of reports to suggest that patients actually appreciate that doctors use an EHR during the visit.
However, from the eye of the beholder (physicians), they’re the ones sitting in the practice day after day getting a feel for the moods of their patients in the exam room once the keyboard comes out.
Sadly, the conclusion they have come to as a collective population is that EHRs are significantly reducing the quality of care patients receive. Again, this is filled with opinion, but if it’s the mood conveyed, that mood is bound to rub off on the patient population and will affect their perception of the technology, too.
These same physicians – more than 80 percent of physicians in the study – also feel the future of the independent practice is not viable, and more than two thirds feel the quality of care will greatly diminish over the next five years because of all these continuous distractions, including technology’s pervasiveness in the practice space.
This is stark “reality” for the profession from the mouths of its professionals.
Interestingly, in a completely unrelated study by recruiting firm Jackson Healthcare, more than a third of private practitioners say they will quit private practice within the next 10 years because of “declining reimbursement, capitation, and unprofitable practice; business complexities and hassles; overhead and cost of doing business too high.”
Where they’ll likely end up is obvious: in a hospital setting or in a hospital-owned practice. Why leave? They said they fear economic factors facing private practice (the first reason given) and they don’t want to practice in the age of reform (second response), which may be quite difficult given the current climate of healthcare.
What does all of this eye-opening information mean?
Well, it doesn’t bode well for those concerned about the ever increasing shortage of healthcare providers.
Perhaps more troublesome, though, is that no matter how much time is spent educating and informing certain segments of the healthcare population, there are always going to be many who remain unconvinced that technology produces practice efficiencies and helps lead to better care outcomes.
Patient engagement will continue to become more popular as consumers take greater ownership of their care and begin to discover that their health information should actually be easier to access because of electronic health records and patient portals. However, patients must have reason to engage for this trend to become less of a trickle and more of a flood.
Healthcare technology is meant to allow more access to, and increase the availability of, patient’s health information. At least that’s one of the desired outcomes of the push (meaningful use and federal incentives) to lure physicians to adapt the systems.
Sterling Lanier, CEO of Tonic Health, succinctly sums up lack of patient engagement in a recent editorial published by For the Record magazine.
In it, he states that healthcare, like government, is filled with vernacular and jargon – HIEs, EHRs, ACOs, HIT, et al. – and the more these terms continue to be used, the less likely patient consumers are going to interact and engage with the healthcare community, and to take ownership of their own care outcomes.
As Lanier notes, and as I have often thought, to bring patients into the conversation, they have to be treated like consumers and they must have a reason to “buy” into the system. In this case, consumers must “buy” the information given to them. If they buy and own it, they’ll want more of it, or so goes the prevailing thought.
But simply speaking in terms the natives will understand isn’t enough. Consumers need to better understand how the technology they encounter at the doctor’s office helps produce better care outcomes. They may need some education and certainly they need some engagement once the systems are in place and being used during the visit.
Though patients will interact with the EHR less frequently than other technology they encounter, such as the patient portal (which they can actually use and interact with on their own), that doesn’t mean the EHR should be ignored during the interaction or treated as a foreign concept. In most cases, let’s remember, healthcare is actually behind many other consumer markets so consumers are actually more versed in the use and capabilities of similar systems outside their doctor’s office. Besides, we’re like children with devices and must test drive things like smart phones, televisions and computers as we learn to use them; we like to get our hands on the technology to try it out to satisfy our child-like need to see with our hands.
Even though patients can’t “touch” their EHRs, we can watch the information we provide our doctors being entered into the system; we can speak with our caregivers as they toggle and tab; and we can engage clinicians as they review our profiles and medical records. As a patient of a doctor with an EHR, I ask questions about the system: what it does, who makes it, why it was chosen and if it layout closely resembles the clinics’ past paper charts. I feel better about the little details and doing so makes me feel as though my doctor is listening to me during the visit.
Asking me these questions engages me more in my healthcare, and more than likely, engages my doctor in my care and outcomes.