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MIPS Penalties Include Medicare Part B Drugs – MACRA Monday

Posted on November 13, 2017 I Written By

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.

I’m sure most regular readers can tell that we’re pretty worn out and tired of MACRA, MIPS, and related government regulation. No doubt you’ll see us posting fewer MACRA Mondays going forward, but we’ll still try to cover major MACRA events as they occur. We just won’t be publishing MACRA Monday every Monday like we’ve been doing.

Jim Tate recently posted about the Real MIPS Timeline which included:

  • Phase 1 – Denial
  • Phase 2 – Shock/Anger
  • Phase 3 – Acceptance

You should read his full writeup, but he’s right. There’s a lot of denial that’s going to lead to shock and anger until the majority of healthcare have to finally accept that MIPS and MACA aren’t going anywhere.

Jim Tate also wrote another important piece related to the MIPS penalties and Medicare Part B drugs. You can read the full details of the change, but for those too lazy to click over, here’s the summary:

  • Many organizations argued that Medicare Part B Drug Costs Shouldn’t be Included in the MIPS Penalties (I mean…payment adjustments)
  • The MACRA Final rule still includes Medicare Part B drug costs (for the majority of people) in the MIPS reimbursement and eligibility calculations

If you’re a practice with a high volume of part B drugs, you better start figuring out your MIPS strategy now! Otherwise, that payment adjustment is going to hit pretty hard.

Thanks Jim for the great insights into MACRA and MIPS. If you need help with MIPS, be sure to check out Jim’s company MIPS Consulting.

Patients May like Their Physician…But That Doesn’t Mean They’ll Stay

Posted on November 8, 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

Medical providers are dealing with a more impatient, demanding patient base than ever before. Armed with research, awareness, and a plethora of online data, today’s consumer patients treat their search for a medical provider in much the same way they would any purchasing decision.

They weigh the pros and cons of each provider, evaluating how each practice would fit their lifestyle and then make a decision.

Unfortunately, that is not the end of the process. Even after a patient chooses a specific practice, they are not even close to becoming loyal patients.

Smooth processes trump provider loyalty

It often surprises medical practices to discover that retaining patients has less and less to do with the medical competence of the office. Today, it may not be enough for a patient to simply like their physician.

For busy patients, the road to loyalty goes directly through the processes and procedures of an office. Studies back this up. Consider this. Sixty-one percent of patients say they are willing to visit an urgent care clinic instead of their primary care clinic for non-urgent issues. This is true regardless of whether they like their primary care provider or not.

The #1 reason they prefer urgent care? Because of difficulty scheduling appointments and long wait times with a primary care physician. According to a study by Merrit Hawkins, wait times have increased by 30 percent since 2014. Patients have noticed.

These long wait times were also noted as one of the key reasons patients will switch practices according to respondents of the Patient Provider Relationship study:

  • Sixty-eight percent say that wait times in their medical office are not reasonable.
  • Sixty-six percent say that they have to wait too long to schedule an appointment.
  • Sixty-eight percent say they feel like messages are not returned in a timely manner.

Reducing wait times is crucial to patient retention

In order to increase patient retention levels, practices must find ways to offset the frustration of long wait times. Consider implementing these three methods of wait-time optimization.

  1. Self-scheduling. It is common for doctors to have calendars booked out months in advance. This can cause patient frustration and turnover. When practices allow patients to schedule themselves, however, this frustration is minimized. With self-scheduling, they can quickly see which doctors are available and when. Since 41 percent of patients would be willing to see another doctor in the practice to reduce their wait, this is a simple way to optimize your scheduling without sacrificing patient experience.
  2. Communication. There are times when long waits are unavoidable. This is where communication is key. Studies show that 80 percent of patients would be less frustrated if they were kept aware of the issue. When you know an appointment is going to be delayed, send out an email or text letting them know.
  3. Texting. If your patient has a question, texting can save them a lot of time. Research shows that it takes just 4 seconds to send the average text message. Compare that to the several minutes it takes to make a phone call. Factor in playing phone tag and you’ve saved both time and headaches. Unfortunately, the Patient-Provider Relationship Study found that while 73 percent of patients would like to be able to be able to send a text message to their doctor’s office, just 15 percent of practices have that ability. Practices in that 15 percent will stand out from their competitors.

In this era of consumer-driven behavior, practices need to prioritize ways to create smooth processes for patients. Medical offices should look at ways to optimize their processes to reduce frustration and wait times for patients.

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.

MACRA Twitter Roundup – MACRA Monday

Posted on October 30, 2017 I Written By

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.

We took last week off from our MACRA Monday series of blog posts. It seems like we’re in a kind of lull period for the program. Either you’ve started collecting the data you’ve needed or you haven’t. Plus, we’re kind of waiting for the next MACRA Final rule to drop for more details.

With that in mind, I did want to see what some of the latest things that were being shared on Twitter when it comes to MACRA. I found a lot of strong opinions about the program, some good resources, and some forward-looking thoughts on what could be coming in the next MACRA final rule.


It’s hard to argue with John. Not just because he’s a smart guy, but because he’s right that it’s hard to imagine a path forward that’s fee for service and doesn’t include a shift to value based care in some form or fashion. At least given the current market dynamics.


This caution from Workflow Chuck should have us all nervous about the shift. I see a lot of healthcare organizations going after the target as opposed to the goal of value based care.


MACRA is going to impact your biz. I liked the way Kelly broke it out into 4 areas. No doubt some of these things could be argued both ways.


This is still how most doctors I know feel about MACRA and even meaningful use before it. They feel like they’ve been thrown under the bus.

Here are two forward looking resources that look at what we might get from the MACRA Final Rule:

What else are you hearing about MACRA? Would love to hear your thoughts, insights, questions, perspectives, rants, etc in the comments.

Independent Clinical Archive Brings Complete Patient Record Together in One Place

Posted on October 27, 2017 I Written By

The following is a guest blog post by Tim Kaschinske, Senior Product Manager, North America, BridgeHead Software.

How many photos and documents do you have stored on your home computer or in the cloud? How easily would it be to find those photos of, say, the family beach vacation you took in 2010? What about the trip in 2001? Most of us would have to search blindly through scores of electronic file folders and myriad devices before finding what we need.

Now think about your physicians who need to access historical patient information, such as baseline mammograms, medication history, lab results or the course of a patient’s cancer treatment. Nearly every hospital is on its second or third EMR, and any new EMR vendor wants as little previous data to come over from legacy systems as possible to help ensure a “clean” install. So that leaves physicians and assistants poring through older EMRs, or other applications and media to find needed data. This takes time away from direct patient care, an increasingly critical consideration in value-based care arrangements.

But that older information still has value, for both patient care as well as for regulatory reasons. The problem, then, is how to store, protect and share that information in a way it remains readily accessible, available and readable even as technology changes.

Disparate data, common archive

The answer is an independent clinical archive (ICA) that can accept disparate data from multiple systems such as an EMR or a PACS and store it using open data standards commonly found in healthcare. An ICA does not replace an EMR or a PACS – it works in concert with them, allowing a hospital to formally retire previous EMRs, PACS and other IT systems while ensuring the electronic patient data contained within lives on as part of the 360-degree patient view. This saves money on licensing fees, storage costs and IT personnel costs to maintain and update rarely used technology.

An ICA is a centralized, standards-based data repository that ingests disparate data types such as DICOM images, HL7 reports, physician notes and other unstructured data. Information is managed based on unique patient information and further subdivided by specialty or date, for example. The ICA works best when integrated with a hospital’s EMR (via an application programming interface (API)), allowing providers to seamlessly compile a complete, longitudinal patient record without having to remember additional log-ins.

APIs are also used to connect to multiple legacy systems. However, security protocols on legacy systems are not as stringent as they are with newer technology, leaving hospitals potentially vulnerable to accidental or intentional data breaches. A hospital using an ICA as a central data repository only requires APIs among the ICA, the EMR and the PACS. Plus, the ICA has built-in security and protection features to ensure the safeguarding of critical patient data.

A true, 360-degree patient view

When an ICA is properly implemented, providers access the information being populated from the EMR and the information coming from the ICA through one system and in the appropriate context for the patient. And that’s the holy grail of patient information: one environment aggregating all of the information outlining chronic conditions, physician notes, medications, diagnoses, surgeries and much more.

And if a physician needs to drill down into radiology reports, for instance, he can pull up just that data. Finding information about a specific hospitalization is as easy as inputting the correct date range to locate just those records.

While Software-as-a-Service revolutionized the delivery of IT services, an ICA can revolutionize the way physicians find all of the data they need, quickly and within their normal workflows. At the same time, hospitals can save money and increase data security by retiring older electronic systems.

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.

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.

How Does Age Impact Patient Satisfaction?

Posted on September 13, 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

If you walked into the average medical practice on any given day, you would see patients ranging in age from 1 to 101. Understanding and adapting to the needs of such a diverse group of patients is challenging. Many offices are struggling with this, and patient dissatisfaction is at an all-time high.

In the Patient-Provider Relationship Study, recently commissioned by Solutionreach, researchers found that one in three patients are likely to switch practices within the next couple of years.

The question is why. What is happening to patient loyalty? And more importantly—what can medical offices do to stem the tide?

In addition to studying patient switching preferences, the study also examined the dynamics of generational satisfaction and preferences, posing the following questions:

  • What impact does age have on patient satisfaction and retention?
  • What role does it play in patient loyalty?
  • Which services create satisfaction for the different generations?

A Closer Look at How Age Impacts Patient Satisfaction

To better understand how age impacts patient retention, it is important to take a closer look at the results from each of the key age groups.

  1. Millennials—Satisfaction levels among the youngest cohort were dismal. Millennials are the least satisfied with all aspects of the practice, including the doctor, office team, and practice logistics. In fact, a stunning 81 percent say that they are not completely satisfied with their medical office. Unsurprisingly, millennials are also extremely likely to switch practices in the upcoming years. Nearly half—46 percent—of millennials say they will probably move on to a new medical practice in the next couple of years.
  2. Gen X—The satisfaction levels of Gen Xers lies somewhere between millennials and boomers. The numbers are still concerning, however. Two out of three Gen Xers are not satisfied with their medical office. Around 35 percent say they will probably change practices in the near future.
  3. Baby Boomers—While millennials are three times more likely to switch providers than boomers, there are still a significant number of unhappy patients in this demographic. Nearly 60 percent of boomers are not completely satisfied with their medical office and one in five will switch practices in the near future.

Regardless Of Age—Technology Boosts Patient Satisfaction

It’s easy to assume that everyone who moves on to a new practice does so because they move or change insurance providers. The truth is a growing number are switching for other reasons.

Why are they so dissatisfied?

Picture the average patient in your mind. What characteristics about them have changed over the past few decades?

The biggest thing is that we have become unbelievably attached to technology—it’s rare to find any of us without either a phone, tablet, or computer. We use technology for virtually everything.

This is the area in which medical practices are struggling to keep up. Solutionreach’s study found that this is the exact category in which patients are least satisfied with their medical office. This is true regardless of age. Millennials, Gen Xers, and baby boomers all want more technology.

The biggest gap between what patients want and what medical practices offer is around texting. Texting has been the most used form of communication for over a decade now, but according to the survey less than 30 percent of practices offer any texting options. Today, every office should be able to:

  • Send a text—94 percent of millennials and 87 percent of Gen Xers want to receive texts from your office. But it’s not just the “youngsters.” Two out of three baby boomers also want you to text them.
  • Receive a text—While some offices have started sending out reminder texts, far fewer actually have the ability to have a patient initiate text messaging through the office number. Eighty-seven percent of millennials and seventy-nine percent of Gen Xers say that they want to be able to text their doctor. Once again, boomers are also on board—58 percent say they want to send a text to their medical practice.

Today’s patient lives are completely intertwined with technology. Medical practices will need to adapt to using technology in new ways to connect with patients or risk losing one in three patients in the coming two years.

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.

Why Delaying the Transition to 2015 Edition Technology Would Be a Problem for Patients and Families – MACRA Monday

Posted on September 11, 2017 I Written By

The following is a guest blog post by Erin Mackay, Associate Director, Health Information Technology Policy and Programs, National Partnership for Women & Families.  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.

The National Partnership for Women & Families recently weighed in on the Centers for Medicare & Medicaid Services’ (CMS) proposed rule for 2018 updates to the Quality Payment Program (QPP). In our comments, we express concerns that many of the proposed requirements would have a chilling effect on the country’s badly needed transition to a health care system that rewards quality and value over volume. Of particular concern to us is the proposed delay in clinicians’ transition to the 2015 Edition electronic health record (EHR) certification requirements.

Putting off requirements to use more advanced health IT would be a one-two punch to health transformation. First, new models of care that demand high-quality, efficient practices and coordinated care rely on robust health IT. Likewise, these new models only succeed when patients have the information – about their medications, health status, diagnoses and treatment received – they need to participate in their care and make informed decisions with their health care teams.

Here are three ways the proposed rule would delay critical functionalities that are foundational to a patient and family-centered health care system:

1) Delaying Availability of APIs for Consumer Access
It would undermine the commitment to patient engagement to delay the availability of application programming interfaces (APIs) as a way for patients and their caregivers to access, download and share health data. When available, APIs will let consumers choose from a range of apps that pull in health data from various health care providers and hospitals, helping form a comprehensive picture of their health and health care and facilitating information sharing. Gone will be the days when patients and family caregivers struggled to remember passwords for multiple patient portals, or were able to view only one aspect of their medical history at a time.

2) Slowing More Robust Collection of Demographic Data
To enhance health equity, we must first be able to identify disparities by gathering standardized, granular demographic data. Right now, certified EHRs are not designed to distinguish among Chinese, Indian or Vietnamese patients, for instance, instead collapsing these identities into a single “Asian” category. Similarly, EHRs cannot currently store structured information about patients’ sexual orientation or gender identity. In both these examples, this information has clinical relevance and is vital for improving health outcomes. For example, too often transgender individuals do not receive appropriate “gendered” preventive screenings such as Pap tests, mammograms and prostate exams.

3) Failing to Capture Information on Social Determinants of Health
In addition to better demographic information, to best support providers in delivering patient- and family-centered care, EHRs should also capture information about non-clinical factors pertinent to individuals’ health. The 2015 Edition includes a new criterion to capture relevant social, psychological and behavioral data. This includes information on financial resource strain, educational attainment, stress, depression, physical activity, alcohol use, social connection and isolation, and intimate partner violence. At the individual level, this information could help clinicians and care teams determine treatment options that address the unique needs of the patients and families they serve. To improve population health, clinicians, hospitals and community organizations need this information to identify communities that need additional support in order to get and stay healthy.

Conclusion
Overall, the proposed rule for QPP 2018 raises a number of concerns for the National Partnership, particularly the proposed delay of 2015 Edition certified health IT products. We strongly encourage CMS to maintain the current requirements and timeline for clinicians transitioning to the 2015 Edition to provide the necessary infrastructure for the kind of patient- and family-centered health system our country urgently needs.

Fear, Loathing, and Documentation. Why Do Doctors Still Say They Hate EHR?

Posted on August 29, 2017 I Written By

The following is a guest blog post by Daniel Sabido, Director of Product Marketing at CareCloud.

It’s been 10 years since the start of the modern EHR era. Why do doctors still report hating the technology so much? Electronic health records (EHR) have been fairly universally villainized in surveys of physicians. Here’s a recent sampler for you:

  • 54% of physicians reported being unhappy with their EHR system in 2014, according to an American EHR survey.

  • 82% of users in a survey by Peer 60 said they would actively discourage other medical professionals from using one particularly hated EHR vendor.

  • Physicians blame EHR for lost productivity — spending more time on documentation (85%) and seeing fewer patients (66%) in an IDC report on tech dissatisfaction.

What’s happening in healthcare? Is EHR really the most universally despised technology in America? Or is it a scapegoat for other changes in medicine? Let’s take a closer look at a couple of key trends:

A higher standard for EHR

Crucially, not all EHRs have been created equal. For years, the health technology market was swamped with expensive, server-based systems. These antiquated platforms were easily 20 years behind your average first-generation iPhone and looked more like Windows 95 than Mac iOS 10. When Meaningful Use incentives were prescribed under the 2008 economic stimulus plan, it created a surge in adoption for a technology landscape that frankly was not ready for primetime. Medical practices and physicians were right to complain about this rushed technology.

In recent years, we’ve seen a readjustment with a hot rip-and-replace market for EHR technology. Software Advice found that the number of clinicians replacing their EHRs increased 59% between 2014 and 2015. They’re not just upgrading to better systems; these medical groups are seeing the huge advances made in other industries and moving to the cloud. Black Book Rankings reported in 2015 that 7 out of 10 small medical practices were using a cloud-based EHR.

Changing health economics

At the same time that healthcare technology has been getting better, the economic pressure on medical practices and physicians has been getting more intense. The shift to value-based care and other policy changes have increased administrative burden. “About 80% of physician burnout is really due to workflow issues…the electronic medical record has contributed to burnout as one component,” said Steven Strongwater, a rheumatologist and CEO at Atrius Health in a New England Journal of Medicine interview.

It’s not just the recording process, but how much physicians are being asked to record that is interfering with the clinical workflow. There’s an epidemic of “just one more thing” creep in regulatory policy. Asking physicians to record a relatively simple new health marker, such as smoking status, can quickly compound into an extra hour a week of work. EHR systems don’t need to just keep up, they also need to speed ahead of increasing efficiency drag in the practice of medicine.

Perception vs. reality

Health technology has undoubtedly created stress on physicians in the past decade. Research also shows tremendous benefit. Contrary to the common belief that EHR gets in the way of patient experience, research shows that patients prefer it when their physician uses a computer. A whopping 76% of patients said they prefer their doctor to use EHR over paper charts, according to a survey by the Office of the National Coordinator (ONC).

In our 2017 Practice Performance Index, we found that high-performing medical practices were twice as likely to be adopting new health technology compared to practices that were falling behind. In our upcoming Patient Experience Index, a full 85% of patients said that it was important for medical practices they visit to be “modern and up to date.”

What comes next for EHR?

I believe we’re entering a new era of EHR in healthcare. Thanks to the shift to cloud-based systems, there is a faster pace of innovation in the sector. Cloud-based systems can roll out upgrades in a few hours, instead of a few months of costly consultant-driven updates. We’re seeing a new focus on tools that intelligently streamline administrative tasks and that connect what happens inside the exam room with the patient experience outside it. The same kind of technology that helps recommend movies on Netflix and send friendly timely reminders on Runkeeper are coming to healthcare, helping physicians provide a better patient experience and improve overall outcomes.

There are also new risks emerging to this rosy future. Meaningful Use created bad behaviors in the EHR market — the kinds of rote, administrative bulk that led to physicians despising their systems. MACRA could be heading down the same path. Can health technology companies stop history from repeating this time?

At the end of the day, patients want their doctors to be using modern technology, and patient satisfaction is a crucial part of the shift to value-based care economics. Physicians who want to be successful in their practice will need to find a way to love their EHR — or look for one that can keep up with new demands. It’s up to those of us in the health technology sector to meet them halfway.

About Daniel Sabido
Daniel Sabido is CareCloud’s Director of Product Marketing, where his responsibilities span the entire portfolio of products, and is particularly focused on identifying trends that will affect the performance of medical groups across the country. Previous to joining CareCloud, he was an Engagement Manager at OC&C, a global management consultancy, based in their London HQ where he focused on B2B clients. Daniel has also held strategic planning roles at McCann Worldgroup in New York and at the Monitor Group as a consulting analyst.

Daniel holds an MBA with Distinction from the London Business School and completed his undergraduate at the University of Pennsylvania’s Wharton School with majors in Finance and Operations.

EHR Innovation & Regulation: Friends or Foes?

Posted on August 16, 2017 I Written By

The following is a guest blog post by Stephen Dart, Sr. Director of Product Management at AdvancedMD.

Healthcare insiders often point out how far behind the industry is in taking advantage of technology when compared to industries like retail or finance.

Technology providers get their share of blame for not designing it with a user in mind, a common argument heard in relation to the Electronic Health Record (EHR) ill-fitting place in the physician’s workflow. What is not talked about much is the role regulations play in shaping the technology and its use in healthcare.

Designing for compliance

Regulations are present in every industry and serve an important function of protecting individuals’ privacy and rights. Healthcare is highly regulated compared to many other industries due to the sensitive nature of Protected Health Information.  There is a good deal of additional regulations regarding programs such as MACRA, dedicated to monitoring provider performance and reporting it back to the government for reimbursement. As such, technology for providers must be designed to capture and report such data.

For vendors like AdvancedMD, one of the challenges is not in designing software to address the regulations, but rather in designing it under the ever-evolving guidelines and shifting deadlines. At times, well-meaning standards also fail to function as intended because they are not enforced end-to-end.

As an example, Meaningful Use Stage 2 required the EHR to meet a standard for interfacing with state immunization registries. For certification, technology providers had to produce a standard-format file and transmit it to the state immunization registry. However, every state had its own set of requirements and most states would not accept the format designated as the certification requirement but instead have their own additional or different requirements.

Consider lab results as another example. The EHR has to meet the engineering standard for using a LOINC code when receiving lab results to enable the physician to report metrics for regulatory attestation. Unfortunately, labs are not held to the same standard, and if the lab does not send results using the LOINC code, the physician cannot get credit when reporting or has to manually add a code for it to be considered for meeting the performance metric.

Naturally, there is cost incurred to design compliance features for vendors. At AdvancedMD, it has a significant impact on our research and development (R&D) budget. It also influences the other two R&D categories that have a direct impact on the end-user experience – keeping the technology on the cutting edge and innovation.

Integrating compliance into workflow

If regulations require physicians to report more data, vendors have a choice of designing compliance features to either ask the physician to input that information manually or to capture it automatically for reporting.

At AdvancedMD, a lot of effort goes into automating the regulatory requirements and integrating the necessary data collection naturally into providers’ existing workflow. If software identifies that the physician has just written an electronic prescription, there is no reason to ask him or her to go into a separate system and attest manually to having done so. This regulatory tracker can be natively built into the platform.

All roads lead to innovation

There is a lot of pressure on everyone in healthcare today and the industry is undergoing constant changes. Patients expect more as they pay more under high-deductible plans.  They increasingly rely on wearables to tell them how well they sleep and how many steps they need to take as part of a larger trend of taking command of their own health. Doctors and patients alike will benefit from this data being integrated into patient records.  If this patient-captured data can be merged into the patient chart, machine learning and analytics algorithms can in some cases predict what an independent practice needs to do next. This next step could be to streamline administrative processes for outreach messaging and improve care through electronic follow-up, leading to increased profitability and better care. Importantly, the EHR, practice management and all other technologies designed for providers need to liberate them to focus on patient care, not distract from it.

All these advanced features are the next frontier in healthcare and require vendors to dedicate a lot more effort and budget to innovation. While healthcare technology can’t be expected to catch up with an Apple or Facebook overnight with regard to user experience, there is much that can be done to close the gap. The industry as a whole will get there much faster when regulations and technology align to advance that goal.

Incremental regulatory steps in areas where standards can be controlled and enforced cradle-to-the-grave will benefit all parties. Vendors can plan their engineering budgets in advance and design fully functional compliance features. The industry will benefit from designing with the user in mind, furthering the role regulations play in shaping technology and its use in healthcare. Ultimately, regulations should allow providers to focus on care and to engage more meaningfully with their patients, thus optimizing the EHR’s role in the physician’s workflow.