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Patients Favor Tracking, Sharing Health Data

Posted on February 3, 2016 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.

To date, I’d argue, clinicians have been divided as to how useful medical statistics are when they come straight from the patient. In fact, some physicians just don’t see the benefit of amateur readings. (For example, when I brought my own cardiologist three months of dutifully-logged blood pressure and pulse readings, she told me not to bother.)

Research suggests that my experience isn’t unique. One study, released mid-last year by market research firm MedPanel, found that only 15% of physicians were recommending wearables or health apps to patients as tools for growing healthier.

But a new study has found that patients side with health-tracking fans. According to a new study released by the Society for Participatory Medicine, 84% of respondents felt that sharing self-tracking stats such as blood glucose, blood pressure, heart rate and physical activity with their clinician would help them better manage their health. And 77% of respondents said that such stats were equally important to both themselves and their healthcare professional.

And growing numbers of healthcare professionals are getting on board. A separate study released last year by Research Now found that 86% of 500 medical professionals said mHealth apps gave them a clearer understanding of a patient’s medical condition, and 76% percent felt that apps were helping patients manage chronic illnesses.

Patients surveyed by the SPM, meanwhile, seemed downright enthusiastic about health trackers and mobile health:

* 76% of adults surveyed would use a clinically-accurate and easy-to-use personal monitoring device
* 57% of respondents would like to both use such a device and share the data generated with a professional
* 81% would be more likely to use a consumer health monitoring device if their healthcare professional recommended such a device

Realistically, medical pros aren’t likely to make robust use of patient-generated data unless that data can be integrated into a patient’s chart quickly and efficiently. Some brave clinicians may actually attempt to skim and mentally integrate data from a health app or wearable, but few have the time, others doubt the data’s accuracy and yet another subgroup simply finds the process too awkward to endure.

The bottom line, ultimately, seems to be that patient-generated data won’t find much favor until hospitals and medical practices roll out technologies like Apple’s HealthKit, which pull the data directly into an EMR and present it in a clinician-friendly manner. And some medical pros won’t even be satisfied with a good presentation; they’ll only take the data seriously if it was served up by an FDA-approved device.

Still, I personally love the idea of participatory medicine, and am happy to learn that health trackers and apps might help us get closer to this approach. As I see it, there’s no downside to having the patient and the clinician understand each other better.

#HIMSS16: Some Questions I Plan To Ask

Posted on February 1, 2016 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.

As most readers know, health IT’s biggest annual event is just around the corner, and the interwebz are heating up with discussions about what #HIMSS16 will bring. The show, which will take place in Las Vegas from February 29 to March 4, offers a ludicrously rich opportunity to learn about new HIT developments — and to mingle with more than 40,000 of the industry’s best and brightest (You may want to check out the session Healthcare Scene is taking part in and the New Media Meetup).

While you can learn virtually anything healthcare IT related at HIMSS, it helps to have an idea of what you want to take away from the big event. In that spirit, I’d like to offer some questions that I plan to ask, as follows:

  • How do you plan to support the shift to value-based healthcare over the next 12 months? The move to value-based payment is inevitable now, be it via ACOs or Medicare incentive programs under the Medicare Access and CHIP Reauthorization Act. But succeeding with value-based payment is no easy task. And one of the biggest challenges is building a health IT infrastructure that supports data use to manage the cost of care. So how do health systems and practices plan to meet this technical challenge, and what vendor solutions are they considering? And how do key vendors — especially those providing widely-used EMRs — expect to help?
  • What factors are you considering when you upgrade your EMR? Signs increasingly suggest that this may be the year of the forklift upgrade for many hospitals and health systems. Those that have already invested in massiveware EMRs like Cerner and Epic may be set, but others are ripping out their existing systems (notably McKesson). While in previous years the obvious blue-chip choice was Epic, it seems that some health systems are going with other big-iron vendors based on factors like usability and lower long-term cost of ownership. So, given these trends, how are health systems’ HIT buying decisions shaping up this year, and why?
  • How much progress can we realistically expect to make with leveraging population health technology over the next 12 months? I’m sure that when I travel the exhibit hall at HIMSS16, vendor banners will be peppered with references to their population health tools. In the past, when I’ve asked concrete questions about how they could actually impact population health management, vendor reps got vague quickly. Health system leaders, for their part, generally admit that PHM is still more a goal than a concrete plan.  My question: Is there likely to be any measurable progress in leveraging population health tech this year? If so, what can be done, and how will it help?
  • How much impact will mobile health have on health organizations this year? Mobile health is at a fascinating moment in its evolution. Most health systems are experimenting with rolling out their own apps, and some are working to integrate those apps with their enterprise infrastructure. But to date, it seems that few (if any) mobile health efforts have made a real impact on key areas like management of chronic conditions, wellness promotion and clinical quality improvement. Will 2016 be the year mobile health begins to deliver large-scale, tangible health results? If so, what do vendors and health leaders see as the most promising mHealth models?

Of course, these questions reflect my interests and prejudices. What are some of the questions that you hope to answer when you go to Vegas?

Will New Group Steal Thunder From CommonWell Health Alliance?

Posted on January 26, 2016 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.

Back in March 0f 2013, six health IT vendors came together to announce the launch of the CommonWell Health Alliance. The group, which included Cerner, McKesson, Allscripts, athenahealth, Greenway Medical Technologies and RelayHealth, said they were forming the not-for-profit organization to foster national health data interoperability. (Being a cynical type, I immediately put it in a mental file tagged “The Group Epic Refused To Join,” but maybe that wasn’t fair since it looks like the other EHR vendors might have left Epic out on purpose.)

Looked at from some perspectives, the initiative has been a success. Over the past couple of years or so, CommonWell developed service specifications for interoperability and deployed a national network for health data sharing. The group has also attracted nearly three dozen HIT companies as members, with capabilities extending well beyond EMRs.

And according to recently-appointed executive director Jitin Asnaani, CommonWell is poised to have more than 5,000 provider sites using its services across the U.S. That will include more than 1,200 of Cerner’s provider sites. Also, Greenway Health and McKesson provider sites should be able to share health data with other CommonWell participants.

While all of this sounds promising, it’s not as though we’ve seen a great leap in interoperability for most providers. This is probably why new interoperability-focused initiatives have emerged. Just last week, five major HIT players announced that they would be the first to implement the Carequality Interoperability Framework.

The five vendors include, notably, Epic, along with athenahealth, eClinicalWorks, NextGen Healthcare and Surescripts. While the Carequality team might not be couching things this way, to me it seems likely that it intends to roll on past (if not over) the CommonWell effort.

Carequality is an initiative of The Sequoia Project, a DC-area non-profit. While it shares CommonWell’s general mission in fostering nationwide health information exchange, that’s where its similarities to CommonWell appear to end:

* Unlike CommonWell, which is almost entirely vendor-focused, Sequoia’s members also include the AMA, Kaiser Permanente, Minute Clinic, Walgreens and Surescripts.

* The Carequality Interoperability Framework includes not only technical specifications for achieving interoperability, but also legal and governance documents helping implementers set up data sharing in legally-appropriate ways between themselves and patients.

* The Framework is designed to allow providers, payers and other health organizations to integrate pre-existing connectivity efforts such as previously-implemented HIEs.

I don’t know whether the Carequality effort is complimentary to CommonWell or an attempt to eclipse it. It’s hard for me to tell whether the presence of a vendor on both membership lists (athenahealth) is an attempt to learn from both sides or a preparation for jumping ship. In other words, I’m not sure whether this is a “game changer,” as one health IT trade pub put it, or just more buzz around interoperability.

But if I were a betting woman, I’d stake hard, cold dollars that Carequality is destined to pick up the torch CommonWell lit. That being said, I do hope the two cooperate or even merge, as I’m sure the very smart people associated with these efforts can learn from each other. If they fight for mindshare, it’d be a major waste of time and talent.

Meaningful Use Holdover Could Be Good News For Healthcare

Posted on January 25, 2016 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.

I know all of us are a flutter about the pending regulatory changes which will phase out Meaningful Use as we know it. And yes, without a doubt, the changes underway will have an impact that extends well beyond the HIT world. But while big shifts are underway in federal incentives programs, it’s worth noting that it could be a while before these changes actually fall into place.

As readers may know, the healthcare industry will be transitioning to working under value-based payment under the Medicare Access and CHIP Reauthorization Act, which passed last year. But as ONC’s Karen DeSalvo noted last week, the transition could take a while In fact, proposed draft regulations for MACRA rollout will be released this spring for public comment. When you toss in the time needed for those comments to be submitted, and for the feds to digest those comments and respond, my guess is that MACRA regs won’t go live until late this year at the earliest.

The truth is, this is probably a very good thing. While I don’t have to tell you folks that everyone and their cousin has a Meaningful Use gripe, the truth is that the industry has largely adapted to the MU mindset. Maybe Meaningful Use Stage 3 wouldn’t have provided a lot of jollies, but on the whole, arguably, most providers have come to terms with the level of process documentation required — and have bought their big-bucks EMRs, committing once and for all to the use of digital health records.

Value-based payment, on the other hand, is another thing entirely. From what I’ve read and researched to date, few health organizations have really sunk their teeth into VBP, though many are dabbling. When MACRA regs finally combine the Physician Quality Reporting System, the Value-based Payment Modifier and the Medicare EHR incentive program into a single entity, providers will face some serious new challenges.

Sure, on the surface the idea of providers being paid for the quality and efficiency they deliver sounds good. Rather than using a strict set of performance measures as proxies for quality, the new MACRA-based programs will focus on a mix of quality, resource use and clinical practice use measures, along with measuring meaningful use of certified EHR technology. Under these terms, health systems could conceivably enjoy both greater freedom and better payoffs.

However, given health systems’ experiences to date, particularly with ACOs, I’m skeptical that they’ll be able to pick up the ball and run with the new incentives off the bat. For example, health systems have been abandoning CMS’s value-based Pioneer ACO model at a brisk clip, after finding it financially unworkable. One recent case comes from Dartmouth-Hitchcock Medical Center, which dropped out of the program in October of last year after losing more than $3 million over the previous two years.

I’m not suggesting that health systems can afford to ignore VBP models, or that sticking to MU incentives as previously structured would make sense. But if the process of implementing MACRA gives the industry a chance to do more preparing for value-based payment, it’s probably a good thing.

Is Cerner Edging Up On Epic?

Posted on January 7, 2016 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.

At Verona, Wisc.-based Epic Systems, growth is a way of life. In fact, the EMR vendor now boasts a workforce of 9,400, which is estimated to be an increase of 1,400 staffers over the past year.

Not only that, Epic is confident enough to build cute. Its Campus 4, dubbed the “Wizards Academy Campus,” is designed to resemble the fictional Hogwarts school of Harry Potter fame — or if you’re academically-minded, England’s Oxford University. When completed this summer, Campus 4 will add 1,508 offices and 2,000 parking spaces to the Epic headquarters.

I could go on with details of the Disneyland Epic is making of its HQ, but you get the picture. Epic leaders are confident that they’re only going to expand their business, and they want to make sure the endless streams of young eggheads they recruit are impressed when they visit. My guess is that the Epic campus is being designed as a, well, campus speaks to the idea of seeing the company as a home. When I was 25, unique surroundings would have worked on me!

In any event, if I was running the place, I’d be pretty confident too. After all, if its own stats are correct, Epic software is either being used by or installed at 360 healthcare organizations in 10 countries. The EMR giant also reports that its platform manages records for 180 million Americans, or about 55 percent of the entire U.S. population. It also reported generating a not-so-shabby $1.8 billion in revenues for 2014.

But a little-noticed report issued by analyst firm KLAS last year raises questions as to whether the Epic steamroller can maintain its momentum. According to the report, which admittedly came out about a year ago, “the competition between Epic and Cerner is closer than it has been in years past as customers determine their future purchasing plans,” analysts wrote.

According to KLAS researchers, potential EMR buyers are largely legacy customers deciding how to upgrade. These potential customers are giving both Cerner and Epic a serous look, with the remainder split between Meditech and McKesson upgrades.

The KLAS summary doesn’t spell out exactly why researchers believe hospital leaders are beginning to take Cerner as seriously as Epic, but some common sense possibilities occur to me:

The price:  I’m not suggesting that Cerner comes cheap, but it’s become clear over the years that even very solvent institutions are struggling to pay for Epic technology. For example, when traditionally flush-with-cash Brigham and Women’s Hospital undershoots its expected surplus by $53 million due (at least in part) to its Epic install, it’s gotta mean something.

Budget overruns: More often than not, it seems that Epic rollouts end up costing a great deal more than expected. For example, when New York City-based Health and Hospital Corp. signed up to implement Epic in 2013, the deal weighed in at $302 million. Since then, the budget has climbed to $764 million, and overall costs could hit $1.4 billion. If I were still on the fence I’d find numbers like those more than a little concerning. And they’re far from unique.

Scarce specialists:  By the company’s own design, Epic specialists are hard to find. (Getting Epic certified seems to take an act of Congress.) It must be quite nerve-wracking to cut a deal with Epic knowing that Epic itself calls the shots on getting qualified help. No doubt this contributes to the high cost of Epic as well.

Despite its control of the U.S. market, Epic seems pretty sure that it has nowhere to go but up. But that’s what Microsoft thought before Google took hold. If that comparison bears any weight, the company that will lap up Epic’s business and reverse its hold on the U.S. market probably already exists. It may not be Cerner, but Epic will face meaningful competition sometime soon.

Background On Cerner’s Capture Of DoD EHR Data Center Biz

Posted on January 6, 2016 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.

As many readers will know, the Department of Defense awarded Cerner the $4.3 billion Defense Healthcare Management System Modernization contract this summer, through its partnership with Leidos and Accenture. In doing so the partners beat out some formidable competition, including an Epic/IBM bid and a group, led by Computer Sciences Corp., whose partners included Allscripts and HP.

This is a system integration project on the grandest scale, connecting healthcare systems located at Army hospitals, on Naval vessels, in battlefield clinics across the glove. The idea is to bring all of this data — on active-duty members, reservists and civilian contractors — into a single open, interoperable platform. The new platform should serve 9.5 million military beneficiaries in roughly 1,000 locations.

Now, just six months into the 10-year deal, the DoD has decided to change the rules a bit. Military officials have concluded that the new records system capabilities won’t function at their best unless they’re hosted in a Center datacenter. The new system, officials said, “requires direct access to proprietary Cerner data, which is only available within Cerner-owned-and-operated data centers.”

I’m not sharing this tidbit because it nets the partnership more money — Cerner will take in a comparatively trivial $5 million per year to host the government health data — but for a few other reasons that offer ongoing perspective on this massive deal:

  • While there’s no concrete way to prove this, the buzz around the time of Cerner winning the contract was that it won because it was perceived as more open than Epic. Arguably, if the DoD has to transfer data hosting because it needs access to proprietary algorithms, maybe the whole open thing was a fake-out. Certainly, needing access to Cerner logic locks down the deal even further than a straight ahead contract award.
  • Why couldn’t the DoD anticipate that their own data centers wouldn’t meet the needs of the project?  And why didn’t planners know, in advance, that they’d need access to Cerner’s “quantitative models and strategies” prior to signing on the dotted line? Admittedly, this is a sprawling project, but planning for appropriate network architecture seems pretty basic to me. Did Cerner deliberately raise this issue only after the deal was done?
  • In the notice the DoD issued outlining its intention to shift hosting to Cerner, it noted that while it wasn’t seeking competitive proposals, “any firm believing that they can fulfill the requirement of providing these services may be considered by the Agency.” The key for late entrants would be to prove that they could both meet hosting requirements and connect to proprietary Cerner data.
  • Was the intent always to host the EHR at the Cerner data centers and this was a way to do an end around the bid process and make the initial bid look more attractive (ie. cheaper) so it won the contract? I wonder how many more of these late additions the DoD will have when implementing the Cerner EHR. We’ve seen many hospital EHR implementation budgets have skyrocketed. It’s not hard to imagine the same scenario playing out with the DoD EHR budget. This might be the first of many EHR add-ons that weren’t part of the original contract.

Time For A Health Tracking Car?

Posted on December 30, 2015 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.

Several years ago, I attended a conference on advanced health technologies in DC. One of the speakers was Dr. Jay Sanders, president and CEO of The Global Telemedicine Group. And he had some intriguing things to say — especially given that no one had heard of a healthcare app yet and connected health was barely a vision.

One of Dr. Sanders’ recommendations was that automobile seat belts should integrate sensors that tracked your heart rhythm. After all, he noted, many of us spend hours a day behind the wheel, often under stressful conditions — so why not see how your heart is doing along the way? After all, some dangerous arrhythmias don’t show up at the moment you’re getting a checkup.

Flash forward to late 2015, and it seems Dr. Sanders’ ideas are finally being taken seriously. In fact, Ford Motor Co. and the Henry Ford Health System are co-sponsoring a contest offering $10,000 in prize money to employees creating smartphone apps linking healthcare with vehicles. While this doesn’t (necessarily) call for sensors to be embedded in seat belts, who knows what employees will propose?

To inspire potential entrants, the Connected Health Challenge sponsors have suggested a few ideas for possible designs, including in-vehicle monitoring and warnings and records access from the road. Other suggestions included appointment check-ins and technology allowing health data to be transmitted to providers. The contest kicks off on January 20th.

In some ways, this isn’t a huge surprise. After all, connected vehicles are already a very hot sector in the automotive business. According to research firm Parks Associates, there will be 41 million active Internet connections in U.S. vehicles by the end of this year.

At present, according to Parks, the connect car applications consumers are most interested in include mapping/navigation, information about vehicle performance, Bluetooth technology and remote control of vehicles using mobile phones. But that could change quickly if someone finds a way to interest the well-off users of wearables in car-based health tracking. (A possible direction for Fitbit, perhaps?)

Ordinarily, I’d have some doubts about Henry Ford Health System employees’ ability to grasp this market. But as I’ve reported elsewhere on Healthcare Scene, Henry Ford takes employee innovation very seriously.

For example, last year HFHS awarded a total of $10,000 in prizes to employees who submitted the best ideas for clinical applications of wearable technology. Not only that, the health system offers employees a 50% share of future revenues generated by their product ideas which reach the marketplace.

Now, it’s probably worth bearing in mind that the wearables industry is far more mature than the market for connected health apps in automobiles. (In fact, as far as I can tell, it’s still effectively zero.) Employees who participate in the challenge will be swinging at a far less-defined target, with less chance of seeing their ideas be adopted by the automotive industry.

Still, it’s interesting to see Ford Motor Co. and HFHS team up on this effort. I think something intriguing will come of it.

FDA Limitations Could Endanger Growth Of mHealth

Posted on December 28, 2015 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.

mHealth technology has virtually unlimited potential. But until the FDA begins putting its stamp of approval on mHealth tools, many providers won’t take them seriously. And that could be a big problem for mHealth’s future.

Unfortunately, early signs seem to suggest that the FDA is in over its head when it comes to regulating mHealth. According to speakers at a recent FDA Law Institute conference, it could be years before the agency even has a solid idea of how to proceed, Bloomberg reports.

Jeffrey Shapiro, a member of the Washington, D.C. law firm of Hyman Phelps & McNamara P.C., told the conference the FDA just isn’t equipped to handle the flood of new mHealth approaches. “Experience has shown that the FDA’s almost 40-year-old regulatory framework is a bad fit for much of today’s health IT with its networked ecosystems, rapid iterative improvement, deep collaboration between providers and end-users and focus on clinical decision support rather than direct diagnosis or treatment,” he told the audience.

The FDA dismisses the notion that it’s not prepared to regulate mHealth technologies. Bakul Patel, the agency’s associate director for digital health, told Reuters that the agency is planning to fill three new senior health scientist positions focused on digital health soon. That’s an encouraging step, though given that there are more than 165,000 health apps on the market, probably an inadequate one.

Sure, few of those app developers will apply for FDA approval. And the agency only plans to demand approval for technologies that are designed to be used as an accessory to a regulated medical devices, or transform a mobile platform into a regulated medical device. mHealth devices it has already approved include Airstrip Remote Patient Monitoring, the AliveCor Heart Monitor for iPhone and McKesson Cardiology’s ECG Mobile.

On the other hand, if Shapiro is right, the FDA could become a bottleneck which could severely stunt the growth of the U.S. mHealth industry. If nothing else, mHealth developers who seek FDA approval could be faced with a particularly prolonged approval process. While vendors wait for approval, they can keep innovating, but if their proposed blockbuster product is in limbo, it won’t be easy for them to stay solvent.

Not only that, if the FDA doesn’t have the institutional experience to reasonably evaluate such technologies, the calls it makes as to what is safe and efficacious may be off base. After all, apps and remote monitoring tools don’t bear much resemblance to traditional medical devices.

In theory, upstart mHealth companies which don’t have the resources to go through the FDA approval process can just proceed with their rollout. After all, the agency’s guidelines for requiring its approval are reasonably narrow.

But in reality, it seems unlikely that providers will adopt mHealth devices and apps wholesale until they get the FDA stamp of approval.  Whether they geniunely consider non-approved devices to be too lightweight for use, or fear being sued for using questionable technology, providers seem unlikely to integrate mHealth technology into their daily practice without the agency’s green light.

Given these concerns, we’d best hope that the FDA doesn’t begin requiring its approval for EMRs. Or at the very least, we should be glad that it didn’t jump in early. Who knows where EMR infrastructure would be if vendors had had to play patty-cake with the FDA from day one?

The Case For Dumping EMR Interoperability Goals

Posted on December 22, 2015 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.

The new year is upon us, and maybe we should consider some new approaches, or even throw out accepted wisdom. Why not consider some major pain points and reconsider how we’re handling them?

In that spirit, my question is this: Should we give up on the idea that EMR vendors will ever allow their data will be interoperable? While this conclusion isn’t exactly a no-brainer, many of us have certainly toyed with the idea. So let’s take ‘er out for a spin.

One major consideration is that EMR vendors have some very compelling reasons for keeping things as they are. Perhaps most notably, interoperability would mean that providers wouldn’t be trapped in deals with a single vendor, as they could just shift the data over to a new platform if the need arose. If I sold EMRs I’d fight tooth and nail to prevent my product from being dumped too easily.

As if that weren’t enough of a disincentive, EMR vendors would need to spend big bucks to achieve interoperability, with no direct reward in sight. Somehow, I doubt that they’re ever going to make such an investment to win some “nice guy” award from the industry.

And even if they could somehow achieve interoperability without breaking a sweat, we’ve got to contend with inertia. Making changes on that scale takes a great deal of effort, and EMR vendors have very little reason to do so.

Maybe the federal government could achieve interoperability through some kind of epic power play, like refusing to issue Medicare reimbursement to providers whose EMRs didn’t meet some ONC interoperability standard.

But even that kind of brute force wouldn’t solve the interoperability problem with one stroke. Such an approach would come with a raft of serious concerns. What interoperability standard would ONC use, and how long would it take to choose? Then, how long would vendors have to meet the standard?  How long would providers have to decommission their existing EMR — and let’s not forget, quite possibly interlocking HIT systems — and where would they get the money for the new/upgraded systems?

Not only that, it would it cost billions of dollars, without a doubt, to make this transition. It could take a decade before the transition was complete. A lot can happen to derail such an initiative over that amount of time, and market forces could render the premises of such an effort obsolete.

On top of that, any effort which encouraged providers to dump their existing EMR platform would greatly diminish, if not erase, the value of the billions of dollars invested in Meaningful Use incentives. A lot of effort has gone into workflow and interface designs that support MU compliance, and starting from scratch on a new platform would NOT be a walk in the park.  So meeting MU goals might be possible over time, but could fall by the wayside for the short term.

All told, it seems that we may be chasing our tails trying to push through interoperability. In theory it sounds good, but when you look at the details it seems unlikely to happen. That being said, the need to share patient data isn’t going to go away, so what alternatives might work? I’ll follow up with some additional thoughts.

Are EMR Templates Really That Bad?

Posted on December 16, 2015 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.

Recently, I read an interesting blog item by healthcare veteran Bobby Gladd, kicking around the notion of whether structured EMR data is killing medical practice. In the item, Gladd makes as good of a case as I’ve seen that while open text has its place, the lack of same is NOT single-handedly killing medicine.

In the blog item, Gladd ribs critics of template-driven medicine such as Margalit Gur-Arie, who has called structured data “the one foundational problem plaguing current EHR designs.” Gur-Arie argues that templated data controls clinical interviews, a phenomenon she calls “Bingo Medicine”:

“When your note taking is template driven, most of your cognitive effort goes towards fishing for content that fits the template (like playing Bingo), instead of just listening to whatever the patient has to say.”

Gladd does concede that templates for Meaningful Use can be “simply stupid,” for example in the case of the MU Core 9 measure of smoking status. But do free-written EMR entries support the care process better?  Maybe we do actually need “open-ended analytical narrative in the progress note, replete with evocative, dx-illuminating metaphors and analogies and elegant turns of phrase in lieu of blunt instrument categorical and ordinal ‘structured data,'” Gladd notes wryly.

Ultimately, perhaps critics of templates have gone overboard, the blog contends. Gladd suggests that Gur-Arie’s “bingo medicine” argument is more sound than substance: “I have to be a bit skeptical that (it) is anything more than a motivated-reasoning assertion of opinion lacking evidentiary underpinning comprised of adequate psychometrically valid studies of physicians’ cognitive processes while at work, perhaps using docs on paper charts as the differential ‘control’ group.”

As Gladd sees things, the real issue with templates isn’t their existence, as such. For one thing, as readers are likely to know, EMRs almost always come with free-text narrative options from many different points in the workflow. So it’s not that there’s no opportunity for clinicians to write detailed prose about their patient encounters.

Also, the issue isn’t necessarily that doctors are having templates forced upon them, either. As Gladd rightfully points out, at least the Meaningful Use-related data gathering requirements have been extensively vetted by the public, with each stage generating thousands of recommendations from physicians. And both CMS and ONC incorporated as much as possible from that flood of commentary.

Ultimately, the problem isn’t that physicians are being asked to adhere to digital documentation styles at times, Gladd contends. The true problem is the “productivity treadmill” requirements that push doctors to see 25-30 patients a day. “If the typical physician only had to see an average of one patient per hour…adequate documentation would be way less onerous,” Gladd concludes.

And there you have it. Overwork is the bane of any profession requiring brain work, and turning back to all narrative-style documentation does little to remedy the problem. (In fact, it could make things worse — for if doctors don’t have time to use templates, how good are their long-form notes going to be?)

Maybe templates have some downsides. In fact, if someone tried to get me to practice blogging with word templates I’d probably object. But it’s worth bearing in mind that template medicine may be a symptom rather than a cause.