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Patient Generated Data, Workflow and Usability Coming Into Focus for EHR Vendors

Posted on October 16, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

At the recent Medical Group Management Association annual conference (MGMA17), I made a point of visiting as many of the EHR vendors in the exhibit hall as I could so that I could ask them two questions:

  1. What are you working on right now, given that there is a bit of a lull between ONC requirements?
  2. How do EHRs and EHR vendors need to evolve over the next 5 years?

Below are some of the best responses I received.

Steve Dart, Senior Director of Product Management at AdvancedMD believes that both EHRs and EHR companies need to fundamentally change their paradigms in order to thrive over the next five years. “EHRs should facilitate the job that needs to get done rather than serve as a documentation repository,” says Dart. “What is that job? Helping patients live healthier lives while at the same helping physicians be happier at work. We really missed the boat during the Meaningful Use (MU) gold rush. We neither helped patients be healthier nor did we make physician lives easier. In fact, as an industry we generally made things more difficult for doctors.”

AdvancedMD is charting a new path forward, instead of just fixing their user interface (UI), they are rethinking their entire approach to their EHR. The company is taking full advantage of the lull in MU requirements by using the time to bring together designers, UI experts, physicians and office managers to design a brand new EHR. Dubbed the “connect the dots” strategy, AdvancedMD is centering their next generation on clinical and administrative workflows.

“When you think about it, healthcare is really just a journey of sequential workflows,” Dart explains. “A patient starts by experiencing symptoms, then moves to research physicians online, schedules an appointment, comes in for their visit, goes to get lab tests done, comes back to discuss the results and fills a prescription. What EHR companies have done is create whole bunch of point solutions for each one of these situations. What we haven’t done well is connect these all together with technology. We siloed everything. Instead what we need to realize is that each situation is actually a complex workflow and we journey from one workflow to another as patients. What we need now, and what AdvancedMD believes, is that we should build technology that enables these workflows – make them easier and more seamless for patients and physicians. Data collection, for example, should happen on devices that both doctors and patients already use and in a way that doesn’t detract from the visit.”

To illustrate that AdvancedMD is doing more than just giving their theory lip-service, Dart showed an early design prototype of an EHR interface that provides a longitudinal view of a practice. Instead of clicking down into one patient to order labs or renew prescriptions and then clicking down into the next patient to do the same, the new interface groups all lab orders together and all the prescriptions together. One click and the physician can see all that they need to do and clicks once to push the orders ahead. The new interface is highly intuitive and functional.

Juan Molina, VP of Strategy and Business Development at CareCloud also believes that EHRs need to radically change. “EHRs need to allow doctors and their staff to do their jobs better,” says Molina. “We have to stop asking doctors to be data entry clerks and documentation specialists. They need to go back to being 100% focused on the patient and providing care. As an industry we have focused too much on checking the box. We need to move beyond that through better use of technology – especially modern cloud-based architectures.”

Mollna is most excited about the potential of real-time analytics and Artificial Intelligence (AI) at the point of care. He feels that the promise of precision medicine and true personalized care will only be possible if “massive amounts of health data is crunched and context from that data delivered to the doctor at the time when they are seeing a patient.” CareCloud is using the freedom from compliance requirements to work on new partnerships for deep analytics, AI and patient experience (read about their partnership with First Data here).

It is refreshing to hear EHR companies talk about collaboration. Over the past several years it was frustrating to see vendors attempt to build everything themselves only to end up with inferior solutions to what was readily available in other industries from other vendors. Partnership and collaboration are a welcome shift in EHR strategy.

athenahealth is actively pursuing partnerships as part of their More Disruption Please (MDP) program. “We are constantly expanding and improving our cloud-based platform to align with our vision,” says Stephanie Zaremba, Director of Government and Regulatory Affairs at athenahealth. “We want to see a healthcare industry free from administrative burden, enabled to care for diverse and disparate populations, and one that ultimately lets doctors be doctors. We believe that the current paradigm of federal regulations hinders, rather than helps, our industry from making this vision a reality. The innovation we so desperately need can’t flourish in the confines of check-the-box requirements that do not grow and evolve with technological advances. But even if we’re stuck with the regulatory status quo, in the next five years, we hope that vendors will continue to embrace their collective potential, shifting from competitors to collaborators in an effort to create a more provider-friendly, patient-facing, and connective tech landscape that captures the full continuum of care.”

The announcement of the partnership between Pulse Systems and InteliChart at MGMA17 is a prime example of this newfound collaborative spirit. For years Pulse offered a perfectly serviceable patient portal, yet they recognized that they would never pour as much time and effort into that area of their solution versus a company like InteliChart.

“We are pursuing an open-EHR strategy,” explains Charles Walls, President & CEO of Pulse Systems. “Although we provide a comprehensive solution, we recognize that clients may not want every component from our stack. They may want to keep a best-of-breed solution that they already have in place. Rather than force our clients to change, we are working to ensure we can integrate and play nice with others.”

Pulse arrived at this open approach by listening closely to clients and prospects. What they found was an under-current of a best-of-breed approach. Physician offices wanted to use different tools and applications from different vendors but the lack of integration and internal IT resources forced them to go with a single monolithic solution instead.

Through this listening exercise, Pulse also realized that it was more than an EHR vendor to its clients. Many of their clients are smaller practices which do not have ready access to technical support. Rather than deflect their client’s calls for help with mundane things like anti-virus updates, internet connection issues and printer failures, they leaned into it. They created a dedicated IT Field Support team that handles calls for routine IT issues and will even fly out to help a client if needed.

By proactively helping their clients in this manner, Pulse has found that they reduce EHR issues down the road and they engender tremendous loyalty. When you think about it Pulse is essentially applying a Population Health approach to their own clients – offering preventative maintenance to avoid more costly support calls in the future.

Most impressive is how Greenway Health is using this lull in compliance requirements. “Now that we are freed from working on ONC compliance work, we are putting focus on customer requested enhancements” says Mark Janiszewski, EVP of Product Managmeent & Corporate Development at Greenway. “Much to the delight of our customers, we can now apply resources to the enhancements that they have asked for, but that were lower in priority compared to what was needed to comply with regulations and the Meaningful Use program.”

Greenway is also using their “found time” to take a serious look at EHR usability. They recognize that there is tension between physicians and EHR makers caused by the endless clicking and confusing user interfaces. Greenway is hoping to relieve that tension by collaborating with clients to improve their system. According to Janiszewski, the company has planned a series of customer visits where a team of designers and engineers can observe how people interact with their system over a 2-3 day period.

The team has already identified several areas of improvement after observing how admin staff were copying down ID numbers from one screen onto post-it notes in order to key it in on a different screen to bypass a lengthy click-path. The team is hard at work to ensure data is transferred across the system more seamlessly.

Over the next five years, Janiszewski believes that EHR companies will have to embrace the concept of multiple care settings and multiple data sources: “EHRs will need to have a higher degree of interoperability as patients move between care settings – from acute care to rehab to home care or from acute care to elder care. EHRs will also need to solve for Patient Generated Data. We are all wearing fitness trackers and using apps to track our health. This data needs to be incorporated in a meaningful way into the EHR. “

The responses from MGMA17 demonstrates that companies are well aware of the negative feelings healthcare providers have towards EHRs. What is very encouraging is that fixing the user interface is only one of many different solutions being pursued by EHR companies. Rather than myopically focusing on the shiny object in front of them, companies like Greenway, Pulse, athenahealth, CareCloud and AdvancedMD are taking a step back and looking at healthcare with a broader perspective in order to identify opportunities for improvement. It will be interesting to circle back with them a year from now to see what progress has been made.

Increasingly, Physician Practices Paying Fees To Receive Electronic Payments

Posted on October 13, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Virtually no one would argue that health plan reimbursement levels are particularly high. Adding a fee if they want to get paid electronically seems like adding insult to injury, doesn’t it?

Unfortunately, one in six medical practices report being hit with these charges, according to research by the Medical Group Management Association. Its recent survey found that some practices are paying a meaningful percentage of total medical services payments to get paid via Electronic Funds Transfer (EFT).

Under rules created by the Affordable Care Act, designed to decrease healthcare administrative overhead, CMS created a standard for EFT transactions. Health plans have been required to offer EFT payments if providers request it since 2014.

Health plans’ payment policies seem to vary, however. A recent MGMA Stat poll, which generated responses from more than 900 medical practice leaders, found that while 50% of practices were not paying fees for receiving payments via EFT, others are absorbing big surcharges.

For one thing, health plans are increasingly offering practices a “virtual credit card” they can use to receive payments. While 32% of MGMA respondents said they weren’t sure whether they paid an electronic payments fee or not, other research suggests that many practices end up using virtual credit cards without knowing they would be charged 3-5% per payment received.

Meanwhile, 17% of respondents told MGMA they were definitely paying transaction fees, and of that group, almost 60% said that the health plans in question used a third-party payment vendor.

MGMA sees this as little short of highway robbery. “Some bad actors are fleecing physician groups by charging them to simply receive an electronic paycheck,” said Anders Gilberg, MGMA’s senior vice president for government affairs.

The MGMA is asking CMS to issue guidance preventing health plans and payment vendors from charging EFT-related fees. The group argues that such fees are counter to the goal of reducing healthcare administrative complexity, the stated purpose of requiring health plans to offer EFT payments.

Also, the American Hospital Association and NACHA, the electronic payments association, are asking CMS to set standards on when and how health plans can implement virtual cards, as well as making it easy for practices to move to EFT.

The imposition of fees is particularly unfair given that health plans benefit significantly from issuing EFT payments, the group says. For one thing, health insurers save millions of dollars by sending payments via EFT, MGMA notes. Not only that, sending payments via EFT allows health plans to automate the re-association of electronic payments with the Electronic Remittance Advice.

While it’s true that physician practices used to save time staff would’ve used to manually process and deposit paper checks, that doesn’t make the fees okay, the group argues. “Beyond the material administrative time savings for all sides, the time and resources that physician practices spend on billing and related tasks are better spent delivering healthcare to patients,” it said in a prepared statement.

In What Seems Like An Effort To Make Nice, eClinicalWorks Joins OpenNotes Initiative

Posted on October 12, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

eClinicalWorks has decided to try something new. The health IT vendor has announced that it will support the OpenNotes project, an initiative in which doctors share their notes with patients.

As most readers will know, it recently came to light that eClinicalWorks had gotten itself into some very hot water with the feds. eCW was forced to pay a $155 million settlement when the U.S. Department of Justice concluded that it had faked compliance with EMR certification standards.

Now, perhaps in an effort to make nice, eCW is making it possible for its customers to share visit notes using its patient portal. Actually, to be precise, the patient portal already had the ability to offer visit summaries to patients, but OpenNotes capabilities enhance these summaries with additional information.

OpenNotes, for its part, got its start in 2010, when Beth Israel Deaconess Medical Center, Geisinger Health System and Seattle’s Harborview Medical Center decided to study the effects of letting patients read their medical notes via a portal.

The study, the results of which were published in the Annals of Internal Medicine in 2012, concluded that patients approved of note-sharing wholeheartedly, felt more in control of their care and had an easier time with medication adherence. Also, while some doctors reported changing documentation during this process, the study also found that doctors saw no significant changes in workload.

Perhaps most telling, at the end of the process 99% of patients wanted OpenNotes to continue, and none of the participating doctors opted out. A movement had been launched.

Since then, a long list of organizations has come on board to drive implementation of open notes, including Kaiser Permanente Northwest, Providence Health System, Salem Health and Oregon Health and Science University. This year, OpenNotes announced that 16 million Americans now had access to their medical notes online.

Back in 2012, I asked readers whether OpenNotes would eventually influence EMR design. Today, I would suggest that the answer is both “yes” and “no.”

On the one hand, I have little doubt that the project helped to advance the notion that patients should have on-demand access to their healthcare information, and moreover, to use it in managing their care. While some doubted this approach would work, OpenNotes can now be said to have sold the idea that health data transparency is a good idea. While the initiative had its doubters at its outset, today patient record access is far better accepted.

On the other hand, eClinicalWorks is the first EMR vendor I’m aware of to explicitly announce its support for OpenNotes. While it’s hard to tell what this means, my guess is that its competitors don’t see a need to take a position on the matter. While vendors are certainly being forced to take patient-facing data access into account, we clearly have a long way to go.

Bridging the Gap between What Patients Want and What Practices Offer

Posted on October 11, 2017 I Written By

The following is a guest blog post by Jim Higgins, Founder & CEO at Solutionreach. You can follow him on twitter: @higgs77

With the growing pressure of increasingly complex healthcare regulations, malpractice litigation, and expectations of quality care, modern-day medical practices face an unprecedented set of challenges when it comes to running a successful practice.

Throw in marketing, billing, scheduling, appointment reminders, and all of the other day-to-day aspects of running a practice, and many practices are maxed out.

But while practices are busy juggling this growing number of expectations, patient satisfaction has been falling.

Today’s patients have become accustomed to a buyer-centered approach in nearly every industry. Likewise, they expect the same from their healthcare professionals. Unfortunately, many practices have been slow to adapt.

The Patient-Provider Relationship Study recently found that the average medical provider with a panel of 2,000 patients could lose around 700 patients in the next couple of years. A large number of these patients are leaving due to dissatisfaction with their experience at a practice.

Much of the growing dissatisfaction from patients is in relation to practices not offering the services and technology that they have come to expect. Experts warn that the medical field lags behind every other industry in the adoption of new technology. This inevitably leads to a gap between what patients expect from their medical practice and what practices actually offer.

Perform a thorough gap assessment

According to the study, 60 percent of patients are not completely satisfied with practice logistics such as appointment scheduling, reminders, and communication. In fact, logistics is the area in which patients have the greatest overall dissatisfaction with their practice.

It is important that practices both understand what patients want the most and then complete an assessment to determine areas that need improvement.

The Patient-Provider Relationship Study found that patients want many additional touchpoints, including:

  • Text appointment reminders
  • Appointment alerts by email
  • Appointment alerts by text
  • Being able to text message back and forth with the practice
  • Allowing patients to initiate text messages to the practice

Unfortunately, a large number of practices do not offer these services. The following chart highlights how many practices offer each of these services, compared to a goal of 100 percent implementation.

With the majority of patients expressing dissatisfaction with the logistics offered by their medical practice, it is clear that changes need to be made. This requires the implementation of new, or more robust, technology.

Implement technology without distress

Practices want to be more efficient and provide an improved patient experience, but the fear of making the wrong choices around new technology can hold them back. Each of the aforementioned services have the potential to either improve processes and efficiency or make them more difficult. The outcome depends on the practice’s ability to carefully assess each piece of technology before moving forward.

There are steps you can take to eliminate some of the risk when choosing a new technology. One of the most important things you can do is to ask right questions before and during the selection process. Consider the following:

  1. Who will be impacted by this change?
  2. How will the technology affect your current workflow?
  3. Is the technology compatible with your current systems?
  4. Will the technology meet current and future compliance requirements?
  5. What will the implementation process include?
  6. How have other offices felt about the technology?
  7. What type of on-going customer service and training does the company offer?

When it comes to achieving high levels of patient satisfaction, it is critical that practices bridge the gap between what patients want and what is currently being offered. After performing a gap assessment and carefully vetting available technology, practices will be able to move forward in a way that will reduce the load on employees, create meaningful improvements in the practice, and boost the bottom line.

Solutionreach is a proud sponsor of Healthcare Scene. As the leading provider of patient relationship management solutions, Solutionreach is dedicated to helping practices improve the patient experience while saving time for providers and staff. Learn more about the Patient-Provider relationship survey here.

MGMA17 Day 2 – The Future of Patient Engagement Looks Bright

Posted on October 10, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Day 2 at MGMA17 started very early for exhibitors when the doors to the exhibit hall opened sharply at 6:30am Pacific Time. It was clear that MGMA organizers were catering to the early-rising-east-coast contingent of attendees. Thankfully there was a warm breakfast with plenty of caffeine options available.

The early exhibit hours provided a unique opportunity to slowly browse the floor and read booth signage fully without being blocked by fellow attendees walking in the aisles…and in some cases without being blocked by company representatives in the booth itself.

As I walked around the exhibits I began to notice that the words “Patient Engagement” appeared frequently. EHR companies, revenue cycle management companies, call center providers and even HR consultants had this nebulous term emblazoned on their booth properties. I thought it would be interesting to ask a few of these companies how they interpreted patient engagement and how they saw it evolving over the next three years.

Josh Weiner, Chief Operating Officer at SolutionReach, was quick to say “Patient Engagement is more than having a portal on your EHR”. He believed that the key to engaging patients was communicating with them in an easy, convenient manner. “For SolutionReach, this means texting. Everyone knows how to text and it’s just so simple to use. A few years ago texting patients was just one-way. Doctors would send a text to a patient and that would be it. More recently companies like SolutionReach introduced the ability for healthcare providers to conduct one-to-one conversations with patients via text. We call it SR Conversations and we have over 4,000 clients using it.”

In the future, Weiner predicted that providers and patients would continue to use SMS texting as the primary means of patient engagement. The key difference is that instead of just sending text messages back and forth we would be sending mini-text-applications back and forth. He cited the example of the latest iOS upgrade which now featured the ability to send a map, a Starbucks gift card and other such applications within an SMS message. He foresaw a day when we will have the ability to send a prescription, a lab test, a referral and an appointment schedule to a patient via SMS.

At BinaryFountain, a company that makes a platform that consolidate patient feedback from multiple social media sources as well as from HCAHPS surveys and allows providers to publish positive comments made in those medium as online reviews, they define patient engagement through the lens of reputation management. Engaged patients mean they are more likely to provide a positive comment and if they provide a positive comment, they are more likely to rate the doctor/practice/hospital highly. That, in turn, leads to a better reputation which attracts patients who are more likely to be engaged in their care. In the future, the company believes that quantitative measures for patient engagement will be developed and that these measures will be used in a similar way that the 5-star rating system is used today.

West Communications is a provider of telephony solutions to a broad range of industries. In healthcare, West offers a number of patient communication tools that engage patients via phone, email, and text. They define patient engagement as the degree to which a patient is active in and adherent to their care plan. They saw a bright future for patient engagement – especially as technologies from other industries are adapted to healthcare. The West team, for example, has been working on adding AI-based intelligent IVR capabilities to their healthcare IVR solutions so that inbound calls from patients can be automatically triaged quickly based on needs.

At Stericycle Communication Solutions, Sarah Bennight, Healthcare Strategist, defined patient engagement as getting patients to be active throughout their care journey. “Patient engagement creates trust between patients and providers. It’s more than just pushing information out to patients, it’s true two-way conversations that are relevant to where the patients are in that moment. It means providing patients with useful calls to action – clicking on a button to book their next appointment, download information or connect with the right clinician.”

Bennight sees a patient engagement future that includes new forms of communication through platforms like Snapchat and iMessage. “The younger generation communicates in different ways. They’ve gone beyond voice, text, and email. Healthcare will need to adapt to these new forms of communication. We may even need to develop a healthcare nomenclature for communicating information via emoji’s and giphies.”

Finally, Varun Hippalgaonkar, Senior Vice President of Growth at HealthGrid suggested that patient engagement is the sum total of all the interactions that a patient has with their healthcare providers including face-to-face visits, phone calls, text messages, telemedicine, and emails. The key for Hippalgaonkar was not to try and engage patients across all channels, but rather to zero in on the communication modalities that each individual patient preferred.

“HealthGrid is striving to be the single communication platform for all pre-, day of and post- visit patient interactions. Our platform will provide a consistent patient experience in the communication channel or channels that patients prefer to use. We mine our own interaction data to determine the best way to interact with patients. For example, the analysis of past interactions may reveal that John Smith responds better during weekday mornings via text message and seems to prefer phone calls at night. When a hospital or a practice has the information they want to share with John, they simply put the content in our system and we handle how it will be delivered to him based on his known response patterns.”

Down the road, Hippalgaonkar saw patients interacting with AI-powered chat bots that were so sophisticated that patients would feel they were interacting with a person. These bots would work across the different communication channels providing a consistent experience no matter what modality the patient elected to use.

Hippalgaonkar summed up by saying: “In the end it’s all about motivating patients to make changes to their health or put another way, to engage in their health. We can only achieve this if we communicate with patients in a way that compels them to take action. As an industry, we need to build technologies and processes that takes things down to the individual patient level. We need to use AI, machine learning, personalization and deliver meaningful information to patients so that they are compelled to make a change.”

From these conversations, it was clear that patient engagement meant different things to different people. Yet everyone agreed healthcare needed more engagement and more involvement from patients in order to deliver on the promise of better health at lower cost. Motivating patients to become more involved is not going to be easy, but if the MGMA17 exhibit hall is representative of HealthIT overall, the future is certainly bright for patient engagement.

Full Disclosure: Solution Reach and Stericycle Communication Solutions are both sponsors of Healthcare Scene.

Optimizing Your EHR for MIPS and Other Quality Payment Programs – MACRA Monday

Posted on October 9, 2017 I Written By

The following is a guest blog post by Meena Ande currently acts as Director of Implementation for Advantum Health. This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program (QPP) and related topics.

As quality reporting requirements ramp up under value-based payment programs like MIPS, healthcare organizations are busy retrofitting their EHRs to make way for new measures. In some settings, not much has changed by way of tech utilization since initial EHR investments were made. Many outpatient settings still lack the internal expertise needed to optimize their implementations.

The truth is many EHRs have the functionality providers need for quality reporting, but many providers don’t know that due to limited exposure to the system. Couple that stunted tech knowledge with the well documented lack of familiarity with MACRA and the recent rise of the service model in healthcare is no surprise. Many practice administrators are relying on their EHR vendor or engaging outside experts to help lead the charge on system reconfiguration to meet Quality Payment Program demands.

There are several EMR capabilities providers can take advantage of to support QPP reporting efforts. Here are a few tips to keep in mind as you customize your EHR for MIPS and other value-based models.

Don’t boil the ocean when selecting CQMs.

Most EHRs give the option of tracking more than what is required for quality reporting. Initially, track applicable measures that exceed reporting requirements. After three to four weeks you’ll know which are your strong areas. Pick the best of the litter and proceed.

Providers can be overwhelmed by too many measures, particularly in multi-specialty practice settings. While it can be difficult to find overlap in measures between specialties, taking advantage of shared metrics whenever possible can reduce reporting burdens. Sit down as early as possible and develop an EHR configuration that works for your practice’s various clinicians.

Case in Point:

A gastroenterologist and a cardiologist may work in the same multi-specialty organization and on the same EHR, but the clinical quality measures they care about differ. There is no reason to give the gastroenterologist access to the cardiology problem list in the EHR. Specialty views improve ease-of-use and support more complete documentation.

Most EHRs offer role-based and specialty-based customization. Administrators can enable or disable EHR features related to some quality measures at the practice level and sometimes at the individual provider level. Clinical quality measures are based on details about the patient, but what is captured at each point of care should be tailored to the specific provider role.

Consider the roles impacted by different CQMs.

Keep the role of the person who may be responsible for different quality measures and Advancing Care Information workflows in mind when selecting and carving out space for CQMs in your EHR. Select measures that spread reporting work across multiple roles to relieve clinicians of unnecessary burdens.         

Case in Point:

The insurance eligibility verification required under Meaningful Use is managed by the front office. Front-office staff members should be made aware of the processes they need to complete before a patient checks in, and where to document that task in the EHR.

Control what is included in MIPS denominators.

Like Meaningful Use, patient encounter volume is important under MIPS. The size of the patient pool under any given quality measure directly impacts your adherence percentage. While most primary care encounters do meet patient visit requirements under MACRA, that is not always the case in specialty settings. Clinicians can exercise some control in determining what is included in patient denominators when reporting under MIPS.

Case in point:

Some primary care visits can be omitted. Let’s say a two-physician practice sees 50 patients a day. Only 15 of those patients might be seen by a physician. The rest of the patients may be there for a simple procedure like a blood pressure screening, stress test, or echocardiogram, where quality reporting elements are not verified. Such visits should be excluded.

Evaluate your reporting paths.

MIPS offers both EHR-based and registry-based reporting paths. Most specialties can submit CQM data via their EHR while others will have to rely on paid registry reporting. Additional reporting options might include submitting through associations that member clinicians are affiliated with, or through registries created by large hospital affiliates to help related providers.

Another hurdle for clinicians is deciding whether to submit data as a group or independently. Groups interested in participating in MIPS via the CMS web interface or administering the CAHPS for MIPS survey had until June 30, 2017, to register. Beyond that, clinicians have until the March 31, 2018, MIPS submission deadline to decide whether to report independently or as a group.

Case in point:

Big groups with different levels of EHR proficiency among providers may be better suited reporting at an individual level. Individual reporting takes more time for attestation, but the advantage is that higher-performing clinicians can avoid a penalty if the group doesn’t collectively meet reporting criteria.

Each month, sample 10 percent of EHR CQM data, including instances where criteria have been met and where it has not. Catch outliers with trouble following through on processes and extend targeted training to the team members bringing numbers down.

Conclusion

Optimizing the EHR and other tech resources providers have in place can be a huge MIPS enablement factor. Up-front customization work helps providers meet reporting requirements and save time over the long run. EHR optimization also enables future value-based care initiatives and lays the groundwork for population health management programs. Gains made in EHR use benefit the life of the practice through increased efficiency and, at the end of the day, better patient care.

About Meena Ande
Meena Ande currently acts as Director of Implementation for Advantum Health where she manages Implementation of services along with EHR optimization, with emphasis on workflow management for value-based reporting.

Usability, Interoperability are Political Questions: We Need an EHR Users Group

Posted on October 6, 2017 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Over the years, writers on blogs such as this and EMRandHIPAA have vented their frustration with lousy EHR usability and interoperability problems. Usability has shown no real progress unless you count all the studies showing that its shortcomings cost both time and money, drives users nuts, and endangers patient lives.

The last administration’s usability approach confused motion with progress with a slew of roadmaps, meetings and committees. It’s policies kowtowed to vendors. The current regime has gone them one better with a sort of faith based approach. They believe they can improve usability as long it doesn’t involve screens or workflow. Interoperability has seen progress, mostly bottom up, but there is still no national solution. Patient matching requires equal parts data, technique and clairvoyance.

I think the solution to these chronic problems isn’t technical, but political. That is, vendors and ONC need to have their feet put to the fire. Otherwise, in another year or five or ten we’ll be going over the same ground again and again with the same results. That is, interop will move ever so slowly and usability will fade even more from sight – if that’s possible.

So, who could bring about this change? The one group that has no organized voice: users. Administrators, hospitals, practioners, nurses and vendors have their lobbyists and associations. Not to mention telemed, app and device makers. EHR users, however, cut across each of these groups without being particularly influential in any. Some groups raise these issues; however, it’s in their context, not for users in general. This means no one speaks for common, day in day out, EHR users. They’re never at the table. They have no voice. That’s not to say there aren’t any EHR user groups. There are scads, but vendors run almost all of them.

What’s needed is a national association that represents EHR users’ interests. Until they organize and earn a place along vendors, etc., these issues won’t move. Creating a group won’t be easy. Users are widely dispersed and play many different roles. Then there is money. Users can’t afford to pony up the way vendors can. An EHR user group or association could take many forms and I don’t pretend to know which will work best. All I can do is say this:

EHR Users Unite! You Have Nothing to Lose, But Your Frustrations!

Health System Sues Cerner Over Billing-Related Losses

Posted on October 5, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

If I asked you what issues cause the biggest conflicts between EMR vendors and their clients, you might guess that clinical data management disputes or customer service issues topped the list. But actually, in my experience the most common problems health systems encounter in their EMR rollouts are billing-related.

For example, Dana-Farber Cancer Institute just announced a $44.2 million operating loss for the third quarter of fiscal 2017. The Boston-based hospital attributes at least part of its losses to billing issues associated with its Epic system. Leaders at Dana-Farber said that these billing issues had cost the hospital roughly $25 million since it rolled out Epic in May 2015, according to Becker’s Hospital CFO Report.

Another instance comes from Healthcare IT News, which reports that Cerner is being sued by a health system accusing the vendor of selling it faulty billing software.

The suit, by Wisconsin-based Agnesian Healthcare, accuses Cerner of fraud and breach of warranty, and asserts that issues with Cerner’s revenue cycle software led to losses of more than $16 million. The hospital system contends that these problems have damaged its reputation and generated $200,000 a month in damages. (Cerner disputes these allegations, of course.)

According to HIN, the hospital system went live with Cerner’s RCM software in 2015, for which it paid $300,000. Agnesian’s suit says that problems with the Cerner package began shortly after rollout, generating widespread errors in its patient billing statements.

According to the health system, its billing process was so compromised that it had to send out statements by hand. (Yes, I can feel you cringing from here.) Given the delays inherent in relying on manual processes, Agnesian ended up with a huge backlog of unprocessed statements, some of which it deemed uncollectible and wrote off.

When the health system alerted Cerner about its concerns, the vendor got involved, and in 2016 it told Agnesian that problems have been addressed.  Nonetheless, this year the health system found “major additional coding errors” which led to another round of lost revenue, Agnesian says.

And brace yourself for more cringing: according to the suit, the Cerner RCM software had been writing off reimbursable charges without informing the health system. If you’re an RCM leader or CFO, this is the stuff of nightmares.

Ultimately, Cerner agreed that the RCM solution needed to be rebuilt given the depth of the coding errors found in the software, but that didn’t happen, the suit says. In a final indignity, the personnel tasked with rebuilding the RCM solution left Cerner before completing the rebuild.

Given all the aforementioned mishegas, it will be many a month before billing processes normalize even if Cerner fixes its RCM software, the health system says. And of course, it’s likely to end up writing off more bills under the circumstances, which has got to be very painful by this point.

Agnesian’s suit asks the court to cancel the Cerner contract and award it direct, indirect and punitive damages. Cerner, meanwhile, seems to want to go into arbitration. We’ll see which side blinks first.

#SHSMD17 in 17 Tweets – Perspectives on Healthcare Marketing

Posted on October 4, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

The AHA’s Society for Healthcare Strategists and Marketing Development recently held its annual conference – SHSMD17 – in Orlando Florida. For three full days, 1,500 attendees shared ideas and traded insights on the latest trends healthcare marketing trends. The 60+ concurrent sessions covered a variety of topics including:

  • Developing online support groups for patients
  • Successful blog-driven content marketing
  • Media relationships
  • Communication and preparedness during a crisis
  • Chatbots
  • Consumerism

For daily summaries of SHSMD17, check out these Day 1, Day 2 and Day 3 blogs. As well see this blog on the release of SHSMD’s Bridging Worlds 2.0 report during the conference.

If I had to pick an overall theme for SHSMD17 it would have to be “perspective”. The four keynote speakers and many of the session presenters urged the audience to break out of our boxes in order to truly “see” healthcare from multiple viewpoints – including patients, clinicians and government. Only by putting ourselves into the shoes of healthcare’s various stakeholders can we create effective marketing campaigns and hospital programs.

During the conference, there was a lot of live-tweeting and there were many conversations happening via social media with people who were not in attendance. I thought it would be fun to highlight 17 tweets from SHSMD17.

Here goes.

Fun SHSMD17 Tweets

 

CareCloud + First Data Partnership a Hopeful Sign of Things to Come

Posted on October 3, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Earlier today, CareCloud and First Data (NYSE: FDC) announced they have partnered to create Breeze, a new patient experience management platform. Built on First Data’s Clover infrastructure, Breeze’s mobile, web and kiosk based applications provide consumer-style convenience to patients while helping practices streamline workflows. Through Breeze, CareCloud customers will be able to offer patients the ability to book appointments, fill out medical forms, check-in remotely and manage payments from their phones.

“We looked outside of healthcare for inspiration on what patients want” says Juan Molina, VP of Strategy and Business Development at CareCloud. “What we found was that consumer interactions have changed from in-person transactions to online experiences. We wanted to give patients the same experience in healthcare that they are used to from the rest of the world through apps like Uber, OpenTable and Amazon.”

At a Breeze-enabled CareCloud practice, the “happy path” patient interaction would be as follows:

  • Patient is invited to Breeze by their doctor’s office through a text with a specific link
  • Patient downloads the Breeze app to their phone through that link
  • Patient books an appointment through the app
  • Prior to the appointment date, patient is reminded by the app to fill in paperwork which could include: demographic information, consent forms and insurance data (photo of insurance cards can be uploaded)
  • On the day of the appointment, patient can check in remotely
  • After the appointment, patient can manage payments through the app (credit card on file, Apple Pay, Android Pay or other options made available by the practice)

By automating parts of the appointment booking, patient intake and payment workflows, Breeze reduces the workload on front-line staff.

“From the moment that the patient walks in, they are happier, and my staff no longer has to spend time dealing with packets of registration papers. Our front office can now focus on patient care and delivering the excellent level of service that they deserve,” says Barbara Arbide, a practice manager who is using Breeze in her allergy practice in Coral Gables, FL.

The CareCloud and First Data partnership is encouraging. For many years now, EHR vendors have tried to build their own walled gardens where customers and partner companies could play nicely together. Unfortunately, a lack of useful application interfaces (APIs) and a high cost of entry for potential partners, resulted in a barren courtyard with high walls (aka a prison) for customers rather than a thriving garden.

By partnering with First Data, CareCloud is showing that it is a company willing to break from traditional EHR vendor thinking. They have opted to play in someone else’s ecosystem in order to bring more functionality to their customers at a faster pace.

First Data’s Clover platform already has hundreds of useful business apps built for it including employee scheduling tools, customer loyalty apps, inventory management systems and survey programs. By basing Breeze on Clover, CareCloud’s customers have access to this rich library of apps.

“After just two days of using Breeze,” Molina told EMRandEHR.com, “A practice in southern Georgia went and downloaded a time-and-attendance app for their system from the Clover library. This replaced a cumbersome Excel spreadsheet that they had been using. This helped the practice become more efficient and sophisticated.”

Could CareCloud have developed a time-and-attendance app on their own? I’m sure they could have. Would it have been a wise investment of their time? Probably not. Would it have been delivered in two days? Absolutely not. Although in theory CareCloud is forgoing potential revenue, their partnership with First Data allows them to focus on what truly matters – improving the clinical and practice operations side of their own platform.

What’s next for Breeze? According to Molina: “Patient expectations are only going to climb higher and higher as more and more consumer apps bring more sophistication into their lives. We have to pay attention to what’s happening outside of healthcare – how people are booking tickets online, speaking to Alexa, tracking their fitness with wearables and getting food from uberEats. Patients don’t want to be transported back to the 1980s when they come to a physician office where you have to fill out forms on a clipboard. With Breeze we have a flexible platform that can continue to grow and expand. We will be able to build new patient-centric applications faster, that help our clients with more and more of their workflows.”

Hopefully this new partnership is a sign of things to come.