Last year, 2015, was a year of buildup, anticipation, and finally some bold moves to propel healthcare technologies forward, specifically regarding interoperability of data. The Office of the National Coordination, under the auspices of the department of Health and Human Services, released the long-awaited and much-debated meaningful use Stage 3 requirements in October. All the players in the health tech space were awaiting the final verdict on how Application Programming Interface (API) technology was placed into the regulations, and the wait was worth it, regardless of which side of the fence you were on. Before we get into the predictions, though, a little background knowledge about these technologies, and their benefits, will be helpful.
An API is a programmatic method that allows for the exchange of data with an application. Modern APIs are typically web-based and usually take advantage of XML or JSON formats. If you are reading this article, you almost inevitably have used apps that exchange data using an API. For example, an application for your smartphone that collects data from your Facebook account will use an API to obtain this data. Weather apps on phones also utilize an API to collect data.
Next let’s take a look at the history of interoperability of healthcare data. HL7 2.x is a long standing method to exchange healthcare data in a transactional model. The system is based on TCP/IP principles and typically operates with Lower Layer Protocol (LLP) which allows for rapid communication of small delimited messages. The standard defines both the communications protocol and the message content format. No doubt about it, HL7 2.x is incredibly effective for transactional processing of data, but it has been limited in two key areas:
A pioneering developer of a successful HL7 interface engine once said: “Once you have developed one HL7 interface … you have developed one HL7 interface.” The standard exists, but there is nowhere near enough conformity to allow this to be plug-and-play. For example, a patient’s ethnicity is supposed to be in a specific location and there is a defined industry standard list of values (code set) to represent ethnicity. In reality, the ethnicity field is not always populated and if it is, it rarely follows the defined code set.
HL7 is an unsolicited push method, which means when a connection is made, messages simply flow from one system to another. If you are attempting to build a collection of cumulative data over time, this is a mostly sufficient method, but what you cannot do is ask a question and receive a response. Although some query/response methods have existed for years, their adoption has been very sparse in the industry.
2016: Year of the Healthcare API
If you are a physician with an electronic health record (EHR) system and you accept Medicare patients, you likely have gone through the process of becoming meaningful use (MU) certified, which means you have purchased an EHR software solution certified by the ONC. This EHR must follow guidelines of technical features, and physicians must ensure they utilize those features in some manner. In October 2015, the ONC released MU Stage 3 criteria (optional requirement in 2017, mandatory in 2018) which includes this game changer: A patient has a right to their electronic health information via an API.
Guest post by Ben Weber, managing director, Greythorn.
This is the time of year when people are looking into their crystal ball, and telling all of us what they see happening in the next 12 months. Some of these predictions will be wild (aliens will cure cancer!) and some will be obvious (more health apps in 2016!). But how many will be helpful?
As I gaze into my own crystal ball, I have to admit I’m also peeking at my email (I like to multi-task). I can’t really say if it’s inspired by the swirling lights of the magic orb on my desk, or if it’s because of the inquiries from clients, messages from my management team and RFPs from various hospital systems … but I also have a prediction for the New Year: 2016 will be the year of migration for Epic and Cerner consultants.
The United States healthcare industry has made great progress in EHR implementation—to the point where implementation is no longer the primary conversation we’re having. Now we’re discussing interoperability, if we’re using ICD-10 codes correctly, how and if we should integrate the data collected from wearable fitness technology, and more. Those discussions—and the decisions made as a result—will continue to require human intelligence and power, but in 2016 there will be a decreased demand for consultants on these projects. Healthcare IT professionals who have grown accustomed to this kind of work will either have to settle into full-time employment—or turn their nomadic hearts north to Canada.
Our neighbors on the other side of the 49th parallel are ramping up their EHR implementations, which is good news for consultants interested in using their passports. Implementations in the US are slowing down, and while there is still work available, it is not as constant and may not command the same hourly rates as in years past. Meanwhile, several leading Canadian healthcare IT organizations have already warned of a looming talent shortage in their country (source), the effects of which are beginning to be felt.
Epic and Cerner specialists are particularly in demand, as there is a dearth of experienced talent. Out of the Canadian healthcare IT professionals who have worked with an EMR, 28 percent report familiarity with MEDITECH, 13 percent with Cerner, and 7 percent with McKesson. Only 4 percent have worked with Epic, according to the 2015 Canadian Healthcare HI & IT Market Report.
Interoperability will be healthcare IT’s biggest trend in 2016 as the industry finally sees momentous forward movement.
In fact, interoperability is not a new trend. It has been an important mission (and a challenge) for healthcare administrators for decades, but the past couple of years have been game-changing:
First, the U.S. Department of Health and Human Services (HHS) wants interoperability to be a common feature in all EHRs by 2024 so that patient data can be shared across systems to provide better care at a lower cost. Since the 2009 passage of the Health Information Technology for Economic and Clinical Health Act (HITECH), a $30 billion initiative to accelerate EHR adoption, more than 433,000 professionals (95 percent of eligible hospitals and 60 percent of eligible professionals in Medicare and Medicaid programs) have received incentive payments.
Second, the HHS’s ambitious announcement that mandates moving 50 percent of Medicare payments from fee-for-service-based to value-based alternatives by 2018 puts care coordination and interoperability at center stage. This historic initiative is transformational for patient-centered care based on accountability and outcomes and is the first step toward achieving better health overall with lower cost.
Third, there’s been significant industry momentum with more than 40 organizations coming together to work on HL7 FHIR (Fast Healthcare Interoperability Resource), dubbed “Project Argonaut,” an industry-wide effort to create a modern API and data services sharing between the EHR and other healthcare IT systems based on Internet standards and architectural patterns. Project Argonaut began in December 2014 and has made impressive progress. And while still evolving, the recently released Stage 3 meaningful use rules have emphasized interoperability — more than 60 percent of the proposed measures require interoperability, up from 33 percent in Stage 2.
Guest post by Robert Williams, MBA/PMP, CEO, goPMO, Inc.
I continue to view 2016 as a shakeup year in healthcare IT. We’ve spent the last five plus years coming to grips with the new normal of meaningful use, HIPAA and EMR adoption, integrated with the desire to transform the healthcare business model from volume to value. After the billions of dollars spent on electronic health records and hospital/provider acquisitions we see our customers looking around and asking how have we really benefited and what is still left to accomplish.
All politics is local
Our healthcare providers are realizing their clinical applications, specifically EMR vendors, are not going to resolve interoperability by themselves. When the interoperability group, CommonWell formed in 2013 much of the market believed the combination of such significant players (Cerner, Allscripts, McKesson, Athenahealth and others) would utilize their strength to accelerate interoperability across systems. Almost three years late CommonWell only has a dozen pilot sites in operation.
Evolving HL7 standards and a whole generation of software applications are allowing individul hospitals to take the task of interoperability away from traditional clinical applications and creating connectivity themselves.
Black Book’s survey published last month, stated that three out of every four hospitals with more than 300 beds are outsourcing IT solutions. Hospitals have been traditionally understaffed to meet the onslaught of federal requirements. Can they evolve into product deployment organizations as well? Across all the expertise they need within the organization? Most are saying no and searching out specialty services organizations to supplement their existing expertise and staff.
Are you going to eat that?
Patient engagement is on fire right now at the federal level (thank you meaningful use Stage 3), in investment dollars and within the provider
community. But to truly manage hospital re-admissions and select chronic diseases (diabetes, obesity and congestive heart failure for example)
providers need data and trend analysis on daily consumer behavior. The rise of wearable technology and the ability to capture data/analyze data from them will be a major focus going forward. These technologies will likely help to make us healthier but with a bit of big brother side affect.
Guest post by Mohan Balachandran, co-founder and president, Catalyze.
As we look back upon 2015, we can reflect, review and based on that and other factors, make some predictions about what next year will bring us. John Halamka had an interesting post that reflect on the bigger challenges, such as ICD-10, the Accountable Care Act and its implications on data analytics, the HIPAA omnibus rule and its impact on cybersecurity and audits and the emergence of the Cloud as a viable option in healthcare. We can expect to see some of these trends continue and grow in 2016. So based on these key learnings from 2015, here are a few predictions for 2016.
Cybersecurity will become even more important
In 2015, insurers and medical device manufacturers got a serious wake up call about the importance and cost of cybersecurity lapses. Healthcare data will increasingly be looked at as strategic data because we can always get a new credit card but since diagnoses cannot change, the possibilities of misuse are significant. Just as the financial industry has settled on PCI as the standard, expect the healthcare industry to get together to define and promote a standard and an associated certification. HITRUST appears to be the leader and recent announcements are likely to further cement it as the healthcare security standard. Given all that, one can safely expect spending on cybersecurity to increase.
IoT will get a dose of reality
The so-called Internet of Things has been undergoing a boom of late. However, the value from it, especially as applied to quantifiable improvement in patient outcomes or improved care has been lacking. Detractors point out that the quantified-self movement while valuable, self selects the healthiest population and doesn’t do much to address the needs of older populations suffering from multiple chronic diseases. Expect to see more targeted IoT solutions such as that offered by those like Propeller Health that focus on specific conditions, have clear value propositions, savings, and offer more than just a device. Expect some moves from Fitbit and others who have raised lots of recent cash in terms of new product announcements and possible acquisitions.
Electronic health records (EHRs) were supposed to transform the healthcare industry in the same way that digital technology has transformed the rest of our lives – organize and simplify. EHRs held the promise of easier access to patient health history, greater patient engagement, and improved clinical decision making and outcomes. And yet, despite the potential, electronic health records thus far have proven to be just another industry headache. Doctors contend with complicated and incompatible systems that stifle collaboration and enhanced patient care. Patients lack adequate access to their own records and methods to conveniently communicate with their care team.
While patients and doctors struggle, EHR system vendors benefit from the stagnant and uncompetitive market, charging exorbitant installation and maintenance fees, with no real incentive to innovate. It is a broken system, but it can be fixed, with the tech industry’s penchant for disruptive innovation. There is great opportunity for tech companies to develop fixes that will benefit customers and reignite development in digital healthcare.
Electronic medical records are currently locked away in walled gardens that inhibit vital information exchange between care team members and patients. These walls need to be broken down to allow for the collaboration that patients expect between their care team members. EHRs based on Software-as-a-Service (SaaS) platforms would allow vendors and medical providers to cut installation and maintenance costs, while offering genuine compatibility and simplicity. SaaS platforms are also cost efficient, with transaction-based business models that only require subscription and access fees. A SaaS health record system would be cost-effective, compatible, and ultimately serve the doctors and their patients.
Currently, one patient can have several associated identifiers from different physicians, hospitals and EHR vendors. Data is often duplicated and workflow becomes complicated for providers. An industry-wide standard could work, but there is no guarantee that a solution can be selected and implemented nationwide in a timely manner. An outside approach would offer much-needed perspective and an injection of fresh ideas into the conversation. Silicon Valley could assist by developing simpler, tech-based solutions, with industry stakeholders providing input. For instance, a master patient index, successfully driven by heuristic real-time matching algorithms, would offer similar functionality to the universal account log-ins offered by Facebook and Google and further simplify access to electronic health records.
EHRs should behave more like part of a “clinical network” that combines simplified workflows with stronger communications. Lab tests, referrals, pre-authorizations and results can be delivered instantly, retooling today’s overcomplicated systems with a more effective transactional eco-system. The network simplifies physicians’ day-to-day activities, and aggregates the collected data into an electronic health record. Tapping into the success of social and business platforms, such as Facebook Messenger and Slack, secure communication between patients and their complete care team, built around these universal health records, adds a layer of proactive care management that was previously unattainable.
As any holiday TV-loving baby boomer can attest, the island of misfit toys is not a happy place. In the 1964 stop-motion animated television show, “unwanted” were destined to live out their toy lives without the joy of playtime with the child they were built to please. Unfortunately, some EHR products share certain misfit qualities which can make their use more difficult for a busy provider.
So how do you know if you are using a misfit EHR? Here are a few signs:
There is little to no communication with others or outside entities, and you are stuck with the same, less than perfect software environment that is dysfunctional and aging fast.
No one calls to see how your EHR is doing and no one responds to your outcries for help.
Sound familiar? This is essentially your situation when you have committed to an outdated and under-supported EHR system for your practice. You are land-locked by an older system that is not cloud-based or does not leverage the many cloud resources for communication and interoperability.
So, your technology is old, the code base has been put on the shelf by the EHR vendor and no updates are coming. This is despite the rapid changes surrounding your practice and the healthcare industry in general.
You feel isolated, and when you call for support you get little to no relief, as the vendor has moved on to bigger and better customers. In the TV show, Santa promised to come back to save the misfits, just as your EHR vendor promised customized support, ongoing upgrades and improved efficiency. But the costs are prohibitive and your confidence in the vendor is low.
Maybe it is time to get off the island, and hitch a ride with a new vendor. If a new EHR is on your holiday list, here some criteria you should consider:
Leverage the power of the cloud to connect to labs, e-prescribing networks, HIEs and other data hubs such as the Commonwell Health Alliance. With a cloud-based EHR system these connections are built into the application, and any new features or connections to other entities become available to all users, no upgrades, no updates required to your infrastructure.
Don’t buy expensive hardware, servers and IT support staff to manage them. All you need to run a cloud-based EHR is a desktop web browser or mobile device.
Though many Medicare and private payer reimbursement programs that require practices to begin moving to value-based compensation already have set sail, most small practices are still treading water near the shore when it comes to this new wave of payment models.
While admirable in their care goals, these quality care-based reimbursement programs can pose some insurmountable challenges for small providers. In fact, they require a whole new way of providing care for some practices, as well as creating new documentation of integrated data analysis, development of care coordination with other providers, payer reporting applications, and often times new technologies that can support these new provisions.
What’s more, all this change also can be quite expensive for small practices and wreak havoc on current business practices.
Set the course
No doubt about it, though, the move to value-based care is on. According to the 2015 Physician Compensation Survey, conducted by Physicians Practice magazine, 63 percent of physician compensation is currently tied to productivity; 37 percent to value metrics and 29 percent to patient satisfaction scores.
The Centers for Medicare and Medicaid Services (CMS), however, has expressed its goals of having more providers participating in value-based plans each year, with a goal of 50 percent by 2018. And it has further incentivized physician participation by specifying increasing reductions in payments for non-participation that began in 2013.
So unless they want to start leaving money on the table, practices have no choice but to take the plunge into such new compensation programs.
Lift the Anchor
Before diving in and potentially draining money and resources to participate in such programs, physicians need to look around and assess their current situation to determine how the new reimbursement model might work in their practice. For example, they need to evaluate current technology, vendors, resources and physician support to determine what changes they need to make, as well as what internal infrastructure they can use.
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.”
Guest post by Robert S. Oscar, R.Ph. CEO and president, RxEOB.
Prior authorization exists to reduce drug costs, to manage appropriate brand medication prescribing, and to curb medication abuse. Despite its good intentions, this extra step to determine whether or not a drug is appropriate for a patient’s symptoms has gained a reputation of inconvenience for both physicians and consumers.
In a 2013 study by SUNY Upstate Medical University, it was revealed that U.S. primary care physicians and their office staff have experienced significant increases in time consumption as a result of prior authorization and its associated requirements. For consumers, hours can be wasted waiting to find out whether or not they are allowed a particular prescription under the conditions of their health plan.
Reducing this negative aspect of prior authorization is paramount for the betterment of overall health costs and medication adherence. By streamlining the time spent between medical record lookup and prescription delivery, healthcare organizations and consumers can begin to experience more efficient prior authorization. If efforts made toward better big data advancements, mobile health (mHealth) and health IT are prioritized, doctors can confirm drug eligibility faster to help their patients recover faster.
Below are five reductions that can come from implementing electronic prior authorization (e-PA):
Reduced Labor Costs: When a doctor pulls up a patient’s medical records he must sift through numerous data points to determine which drugs are approved and which drugs are going to require prior authorization. The hours spent processing this data is costly for healthcare staffing, but lost time can be reduced by moving the process online and implementing electronic methods. This can allow physician offices and PBMs the ability to review, submit and determine authorization almost immediately.
Reduced Consumer Delays: A consumer will typically experience the unattractive side of prior authorization at the pharmacy. If a doctor issues a prescription without knowing the patient’s medication history or pushes a popular name brand drug without suggesting a generic, the consumer will likely get sidelined with prior authorization processing at the point of sale. Having an e-PA process that can review and determine which drugs a patient is already approved for before they head to the pharmacy can reduce customer wait times and greatly increase consumer satisfaction.