Guest post by Richard A. Royer, MBA, chief executive officer, Primaris.
It has been several years since Medicare began introducing payment changes aimed at driving the healthcare industry away from volume-based payments and toward value-based reimbursements. One of the main purposes of the payment system’s overhaul is to improve the quality of care that healthcare providers deliver to patients. Of course, the other main goal is to keep costs in check. In simple terms, the shift to value-based incentives rewards providers that deliver on cost, quality and patient outcome measures. What many providers have learned along the way is that technology plays an important role in the transition to value-based care, and meaningful use of electronic health records is necessary for success under value-based incentive programs.
Value-Based Payment Basics
For healthcare providers that are working to adapt to new payment models and are just beginning to make adjustments, understanding the basics of value-based care is the first step to success. Some of the key points healthcare providers need to recognize about value-based reimbursements are:
The value model rewards performance. That can mean a number of different things, for example, achieving high quality and patient satisfaction scores or making improvements to care over time. The point is, providers must focus on meeting certain standards for care and cost in order to be eligible to earn financial incentives and to avoid penalties.
Value-based care models are extremely data driven. Providers need to measure and report performance outcomes in order to assess their efforts internally, and also so they can earn reimbursements from external payers. As a result, healthcare providers need to continuously measure and analyze patient data, not just collect it.
Collaboration is an important success factor under value. Patients – particularly those with chronic health conditions – receive care from multiple providers as they move across the care continuum. To ensure that treatments, medications, and care plans are safe and effective, and that patient outcomes (which impact reimbursements) are the best they can be, providers need to communicate with each other and work to coordinate care. Value-based programs demand coordinated care.
Guest post by Michael Leonard, director of product management, healthcare, Commvault.
Once a year, the healthcare community gathers to discuss the hottest healthcare trends. This year, the event took place in Sin City, and the turnout was staggering. Topics of choice at the show ranged from EHR best practices to the rising need for telehealth services.
Now that I’ve had a chance to step back and digest, there are a few key moments that jumped out from the event. Here are my top two:
The HIMSS survey showed healthcare organizations are ready for telehealth.
During the show, HIMSS released a survey that had some exciting results around connected technology in the healthcare field. The results showed that 52 percent of hospitals are currently using three or more connected health technologies. Technologies being used by that group that stood out to me include mobile optimized patient portals (58 percent), remote patient monitoring (37 percent) and patient generated health data (32 percent). It’s fascinating to see these results, and important for healthcare and health IT professionals to know that the telehealth wave is here to stay.
The U.S. Department of Health and Human Services’ (HHS) made a key interoperability announcement.
At the show, the HHS Secretary Sylvia M. Burwell made a major announcement around interoperability that was backed by the majority of the top electronic health record (EHR) vendors and is supported by many of the leading providers. This news will enhance healthcare services and allow doctors and patients to make better informed decisions. It certainly has the potential to catapult the industry forward, allowing healthcare partners to increase accessibility by improving their clinical data management solutions.
As always, the conversation at HIMSS was engaging and educational and I left with some great takeaways and predictions for the future of health IT including:
Guest post by Jeff Kaplan, chief strategy officer, ZirMed.
The 40,000 healthcare and healthcare IT professionals who gathered at the Sands Expo in Vegas brought a different vibe for HIMSS 2016. The halls buzzed with activity and an overall optimism that belied any of the potential causes for uncertainty—politics, a down stock market, increases in uncompensated care, the movement toward fee-for-value, or the staggering shift in patient responsibility.
For those who attended HIMSS 2015 in Chicago, the difference was visible in vendor messaging and audible in conversations during the conference. Among all attendees the optimism seemed well founded, grounded in reality. We all see significant opportunity to drive improvement in healthcare for our generation and generations to come. That’s why we came to HIMSS – we’ve placed our bets.
In that spirit, let’s talk about where healthcare is doubling down, where it’s hit a perfect blackjack, and which trends pushed as providers look for the next deal.
Double Down – Data Interoperability
Out of the gate at HIMSS 2016, there was increased focus and emphasis on the importance of data interoperability and integration. From booth signage to the increase in dedicated vendors to industry veterans evangelizing on the topic, you couldn’t miss the tells from all players—everyone wants to show they have a strong hand when it comes to interoperability. Epic’s Judy Faulkner made a play that Epic wasn’t just the leader of the interoperability movement – they were in fact the originator (see her interview with Healthcare IT Newshere).
Of course, wander off into other parts of the exhibition hall and it wasn’t long before you heard the all-too-familiar complaints about closed-system platforms – that they limit innovation by outside companies and technologists who can build applications to add additional value. In the era of Salesforce.com and other open platform successes, many HIMSS attendees spoke of their hope that companies like Cerner and Epic will follow suit.
Blackjack – Data Analytics
Over the last year vendors heard providers loud and clear – healthcare providers need hard ROI on any new initiatives, especially as many have EHR/HCIS sunk costs in the tens of millions of dollars. They need a sure thing—and the changes evident at HIMSS 2016 reflected that shift. Buzzwords like “Big Data” thankfully went to the wayside and were replaced with meaningful discussion around data analytics and data warehousing. Providers know they’ve amassed a wealth of clinical and financial data—now they’re looking for ways to increase the quality of patient care while driving down costs.
With the yearly bluster and promise of HIMSS, I still find there have been few strides in solving interoperability. Many speakers will extol the next big thing in healthcare system connectivity and large EHR vendors will swear their size fits all and with the wave of video demo, interoperability is declared cured. Long live proprietary solutions, down with system integration and collaboration. Healthcare IT, reborn into the latest vendor initiative, costing billions of dollars and who knows how many thousands of lives.
Physicians’ satisfaction with electronic health record (EHR) systems has declined by nearly 30 percentage points over the last five years, according to a 2015 survey of 940 physicians conducted by the American Medical Association (AMA) and American EHR Partners. The survey found 34 percent of respondents said they were satisfied or very satisfied with their EHR systems, compared with 61 percent of respondents in a similar survey conducted five years ago.
Specifically, the survey found:
42 percent of respondents described their EHR system’s ability to improve efficiency as difficult or very difficult;
43 percent of respondents said they were still addressing productivity challenges related to their EHR system;
54 percent of respondents said their EHR system increased total operating costs; and
72 percent of respondents described their EHR system’s ability to decrease workload as difficult or very difficult.
Whether in the presidential election campaign or at HIMSS, outside of the convention center hype, our abilities are confined by real world facts. Widespread implementation of EHRs have been driven by physician and hospital incentives from the HITECH Act with the laudable goals of improving quality, reducing costs, and engaging patients in their healthcare decisions. All of these goals are dependent on readily available access to patient information.
Whether the access is required by a health professional or a computers’ algorithm generating alerts concerning data, potential adverse events, medication interactions or routine health screenings, healthcare systems have been designed to connect various health data stores. The design and connection of various databases can become the limiting factor for patient safety, efficiency and user experiences in EHR systems.
Healthcare, and the increasing amount of data being collected to manage the individual, as well as patient populations, is a complex and evolving specialty of medicine. The health information systems used to manage the flow of patient data adds additional complexity with no one system or implementation being the single best solution for any given physician or hospital. Even within the same EHR, implementation decisions impact how healthcare professional workflow and care delivery are restructured to meet the constraints and demands of these data systems.
Physicians and nurses have long uncovered the limitations and barriers EHRs have brought to the trenches of clinical care. Cumbersome interfaces, limited choices for data entry and implementation decisions have increased clinical workloads and added numerous additional warnings which can lead to alert fatigue. Concerns have also been raised for patient safety when critical patient information cannot be located in a timely fashion.
Solving these challenges and developing expansive solutions to improve healthcare delivery, quality and efficiency depends on accessing and connecting data that resides in numerous, often disconnected health data systems located within a single office or spanning across geographically distributed care locations including patients’ homes. With changes in reimbursement from a pay for procedure to a pay for performance model, an understanding of technical solutions and their implementation impacts quality, finances, engagement and patient satisfaction.
Guest post by Adam Hawkins, vice president client services, CynergisTek.
HIMSS 2016 is right around the corner, and I’m sure everyone is excited about the prospects of conferencing in Las Vegas. This location certainly has a lot going on to keep everyone busy, on and off the exhibit floor. There should be many new healthcare technology players to see and learn about, and it is always interesting to visit the innovation area. Hopefully, we’ll get to hear what folks like KLAS, HIMSS Analytics and other research organizations are working on in 2016 as well.
For instance, KLAS is continuing its work toward including security vendors as its own category, and has a new study underway to look at service providers in this space. That study won’t be completed in time for HIMSS, but they should be able to preview what they hope to accomplish with the study and what its report will include. I think it will be an important read for everyone in our industry.
Interoperability is a huge area of concentration in healthcare at the moment with the Office of the National Coordinator, Health & Human Services and HIMSS all very much involved in this discussion. There are sure to be several presentations on this and related topics. Hopefully we will hear how security and privacy will be addressed, as they are critical components of making many of our health initiatives successful and rely heavily on interoperability for success.
Guest post by Linda Lockwood, solutions director and service line owner, health solutions, CTG.
With HIMSS 2016 fast approaching, the hunt for the perfect Population Health tool will be underway. Whether you’re a HIMSS veteran or a first-time attendee, expect to be caught in a jungle of vendors, each promising the latest and greatest Population Health tools.
HIMSS seems to grow each year, and with so many vendors, solutions and offerings, and the buzz happening during the event, it can be a challenge to carefully evaluate Population Health tools to help inform a decision.
HIMSS can make you excited for the future of your organization, but can also be overwhelming with so many Population Health options to consider. These six tips can help you separate fact from fiction and select a tool that best meets the population health needs of your organization:
Identify organizational goals for population health and match your tool choice to those goals: It’s important to understand what your organizational goals are, as they will drive the selection of tools. If you have not entered into risk bearing agreements, but want to be prepared, perhaps you may want to start off with a tool that supports development of registries and profiles physician performance. You will also want to identify your high risk, high cost patients, and be sure you have the ability to track this performance over time. This information may be available from your financial systems, but you also will need to have the ability to drill down to the device, and supply level—as well as use of medications and supplies including blood products—to identify opportunities for improvement.
How does joining an ACO impact your decision? If you have plans to join an ACO, your needs may include the ability to perform Care Management and Care Coordination and Patient Engagement. You will want to be sure that there is interoperability between the hospital, physician offices and care managers as well as the payers. Reporting becomes critical with an ACO as certain metrics must be reported on a regular basis. As you evaluate tools, ask if they have pre-build reports that include some of the standard measures that a MSSP requires, as well as CMS.
Think about mergers and acquisitions: If you are in the process of a merger or acquiring physicians, you must ensure whatever tool you include has the ability to aggregate data from multiple EHRs and formulate a plan to support interoperability for sharing and exchanging key data. If you are self insured, your organization will have access to data about your population. If you are focusing on wellness and prevention, you will want tools to support patient engagement, health and wellness. Alternately, if have high risk patients, you require Population Health tools to support care coordination, outreach, pharmacy and lab adherence and wellness reminders.
Make data quality a priority: The ability to have accurate, reliable data is crucial with any Population Health or reporting tool. If a data governance system is in place, it’s important to understand what source data you will need to populate the tool. Be sure you know where key data is entered in the system and the common values for that data. In tandem with this, the organization should identify data stewards and business owners. Data governance must have organization-wide commitment, and business owners who are actively engaged.
Guest post by Drew Ivan, director of business technology, Orion Health.
With such an enormous cross-section of the healthcare industry in attendance, the HIMSS Conference and Exhibition represents a comprehensive snapshot of the state of the healthcare industry and a perfect trendspotting opportunity. Here’s a preview of what I expect will be this year’s conference highlights.
Care coordination and population health and process improvement, workflow and change management are tied for the most popular category, with 29 educational sessions focused on each.
Representing 22 percent of the total number of sessions, this is clearly a focus area for the year’s conference, and it’s easy to see why. Changes in healthcare payment models are now well underway, and they are impacting payer and provider operations where healthcare is delivered, managed and documented.
Providers and payers alike are seeking information about how best to operationalize business processes and provide high quality care under new payment models, but it may be even more interesting to visit the Exhibition Hall to see what innovations vendors are bringing to the market to meet these needs.
Another topic related to changes in healthcare delivery is clinical informatics and clinician engagement, which is all about how new technologies, such as big data and precision medicine, can impact care decisions. The ability to make data-driven clinical decisions is one of the many dividends of widely adopted electronic health records. This is likely to be an important area for many years to come.
With 100 million medical records hacked last year, privacy and security is a hot topic at this year’s conference. The number of educational sessions in this category nearly doubled from 13 last year to 25 this year.
While preventing unauthorized access to records is the top priority, security will be a simpler problem to solve than privacy. As more sources of clinical data go from paper to electronic systems and more types of users have legitimate access to patient data, the problem of providing appropriate, fine-grained access in accordance with patient preferences, clinical settings and laws that differ across jurisdictions becomes very difficult to untangle.
Privacy and security concerns will need to be addressed with a combination of open standards and vendor products that implement them. Technologies from other industries, like banking, are likely to start making their way into healthcare.
This year, health information exchange (HIE) and interoperability educational sessions are combined into a single category, reflecting the fact that interoperability within a single institution is, at this point, more or less a solved problem. The next frontier is to enable interoperability across institutions to support improved transitions of care.
HIEs have a role to play when it comes to moving data between organizations; however, many HIEs are struggling or disappearing because of sustainability challenges. This year’s conference will provide an opportunity to learn best practices from the most successful HIEs. It will also be interesting to see what strategies HIE vendors will pursue as their customer base consolidates. In the Orion Health booth alone, we will have executives from HIEs talking about these same issues.
Over the past few years, healthcare technology has seen many advances. We’ve achieved mass-market adoption of EHRs, many organizations are making meaningful progress on data aggregation and warehousing information from multiple diverse systems, and wearables and other sensors show much potential to unlock personal information about each patient. The pace of change in healthcare is quickening, with each new technology or initiative sending off a chain of reactions across the entire ecosystem, ultimately improving patient care.
I see three trends driving the industry toward change:
Analytics will help predict population heath management
One of the persistent industry challenges is the “datafication” of healthcare. We’re amassing more and more data now than ever before. And new sources (like wearable devices) and new health factors (like DNA) will contribute even more. This data explosion is putting increased pressure on healthcare organizations to effectively make this data useful by delivering efficiency gains, improve quality of care and reduce overall healthcare costs.
Navigating this digitized healthcare environment will require increasingly sophisticated tools to help handle the influx of data and make the overload of healthcare information useful. In 2016, the industry will begin to take concrete steps to transition to a world where every clinician will see a snapshot of each of their patients to help them synthesize the critical clinical information they need to make a care decision. Moreover, hyper-complex algorithms will allow providers not only to know their patients, but to accurately predict their healthcare trajectories. By giving providers insights into how each patient is trending, clinicians will be able to make better-informed, precise decisions in real-time.
Consolidation leads to new healthcare models, improved outcomes
New models for effective population health management continue to drive change across healthcare systems. These models incentivize stakeholders to optimize costs, identify organizational efficiencies and improve decision-making processes to deliver better care at a lower cost through an emphasis on care coordination and collaboration.
As president and COO of a leading electronic health record (EHR) and practice management (PM) provider, part of my job is to be in constant communication with providers about health IT. They tell me and my team what works for them and what doesn’t work; what brings joy to their practice and what keeps them up at night. All this insight helps polish my crystal ball, making it clear what we can expect to see in 2016:
EHR system will pivot from regulatory compliance to physician productivity. EHRs are generally blamed for fueling the professional dissatisfaction of physician. A few software vendors are looking at the problem-oriented medical record (POMR), a more intuitive approach that works similarly to the way a doctor thinks. It organizes clinical records and practice workflows around specific patient problems, making it faster and more satisfying for physicians to use.
The problem list not only delivers a “table of contents” to clinically relevant issues, but also gives a provider a longitudinal view of a patient’s healthcare over time. This intuitive method of information organization makes it easier for provider and patient to set the agenda at the start of the exam. During the exam, the POMR supports the nonlinear nature of a patient encounter.
The POMR also helps reduce cognitive overload, which can lead to medical mistakes such as misdiagnosis and other potentially life-threatening errors. Providers can see “bits” of data like lab results associated with a specific problem, thus easing the number of mental connections required to make sound medical decisions.
Chronic care management (CCM) will grow quickly because it makes sense for both patients and providers. Our healthcare system is changing to address the needs of an aging population with chronic illnesses like hypertension, diabetes, heart disease, and more. To promote the effective care coordination and management of patients with multiple chronic illnesses, the Centers for Medicare and Medicaid Services (CMS) introduced CPT code 99490. This code reimburses providers for remote, inter-visit outreach, such as telephone conversations, medication reconciliation, and coordination among caregivers.
The reimbursement for CCM services is an average of $42 per month for Medicare beneficiaries. New levels of technology integration will enable clinicians to complete CCM reporting of remote care from inside their EHR system.
Guest post by Scott Jordan, co-founder and chief innovation officer, Central Logic
Gone are the days when IT department gurus ran lengthy reports, sifting through numbers and analyzing data until the wee hours of the morning, all in the quest of fancy profit center reports to impress the C-Suite. Especially in hospital settings where lives are on the line, data in 2016 must be delivered in real time, and even more importantly, must be relevant, connected, and able to be understood, interpreted and acted upon immediately by a myriad of users.
Data That’s Right
Today, having the right data intelligence that is actionable is paramount. It’s no longer enough for analytics to only interpret information from the past to make the right predictions and decisions. With the changing healthcare landscape, it’s increasingly important that data intelligence must also be relevant and the tools agile enough to provide an accurate assessment of current events and reliably point to process and behavior changes for improved outcomes … in real time.
All tall order for any IT solution, much less one in healthcare where robust security parameters, patient satisfaction concerns and HIPAA regulations are just the tip of the iceberg a health system must consider.
Data That’s Connected
The good news is data technology tools now exist that offer interoperability features – from inside and outside a hospital’s four walls – this allows providers to exchange and process electronic health information easily, quickly, intuitively and accurately, with reliably replicable solutions.
When users can see the full complement of a patient’s health record, they can more accurately improve care coordination and save lives. Specifically, connected patient records can:
avoid duplication of diagnostic procedures,
properly evaluate test results and treatment outcomes, regardless of where care was delivered,
share basic patient data during referrals and get information after specialist visits,
view medications, regardless of where prescribed, avoiding drug interactions, medication abuse, etc., and
view allergy and pre-existing condition information, especially valuable to Emergency Department transfers.