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Cerner Dev Partnership With Advocate Fits Emerging Model

Posted on April 17, 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.

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For most of the time I’ve spent covering health IT — going back to the early 90s — vendor and provider technology development hung out in separate silos. Sure, the smarter vendors at least took time to talk with customers about their needs, but most pushed products and features developed in a vacuum.

While that’s still the case today for many vendors, I believe the paradigm has begun to shift. These days, health IT vendors are increasingly working with providers to create products for rapidly-emerging arenas like population health and tools to support ACO management.

One great example of this trend is a deal recently struck between Cerner and Kansas City, MO-based Advocate Health Care, along with Advocate Physician Partners (announced, not too surprisingly, the Friday before the glory that is HIMSS). While this deal is extending an existing long-term partnership, not kicking off a new project, it’s still gives us a nice look at how vendor/provider partnerships are evolving.

To be sure, Cerner is still playing the traditional vendor role to some extent. For example, Advocate has invested in Cerner’s HealtheCare, a community-based care management solution, as well as having the vendor keep hosting Advocate’s Cerner EMR through 2024. But that’s just the tip of the iceberg.

The heart of the deal is the development partnership, which if all goes well should give both parties a leg up in creating technologies that aren’t just shovelware. With the Advocate folks will bring their on-the-ground population health and process smarts to the table, and Cerner will share its population health and EMR technology.

Over the next seven years, the Physician Partners group will help Cerner develop a sophisticated set of population health tools. Meanwhile, Physician Partners gets access to HealtheRegistries, a tool which aggregates clinical, financial and operational data to offer a broad look at patient activity.

While this may seem like dressed-up vendor sales win puffery, my instinct is that it’s more than that. After all, both Cerner and Advocate stand to benefit substantially if they truly work together. Advocate gets the first look at EMR and population health tools that could shape their patient care strategy for decades, and Cerner gets vital provider input on a line of business which could prove to absorb EMR technologies in its wake.

And that, my friends, is why a vendor the size of Cerner — which could probably force its internally-designed products down the throat of health systems for quite a while — is developing real partnerships with its customers. In the emerging world of health IT, providers may very well filter their care management and documentation in ways that relegate the EMR to back-end status.

If other vendors are smart enough to see that the “we make it, you buy it” model of health IT dev isn’t aging well, the great engines that power care are likely to be robust, relevant and productive. If not, well, what’s the harm if Cerner turns a bigger profit over the next several years?

Fascinating Drawings from #DoMoreHIT Dell Healthcare Think Tank Event

Posted on March 20, 2015 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.

This week I got the change to spend the day at SXSW at the Dell Healthcare Think Tank event. This is my third year in a row participating and it’s always an exciting event. In case you missed it, I’ve embedded the 3 Healthcare Think Tank sessions on EMR and HIPAA so you can watch the recorded video stream from the event.

Also, during each of the three sessions of the event, an artist was capturing what was being said. You can see each of the three drawings below (Click on the drawing to make it larger).

Session 1: Consumer Engagement & Social Media
Consumer Engagement and Social Media

Session 2: Bridging the Gap Between Providers, Payers and Patients
Bridging the Gap Between Payers Providers and Patients

Session 3: Entrepreneurship & Innovation
Healthcare Entrepreneurship and Innovation

Why Meaningful Use Should Balance Interoperability With More Immediate Concerns

Posted on March 12, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Frustration over the stubborn blockage of patient data sharing is spreading throughout the health care field; I hear it all the time. Many reformers have told me independently that the Office of the National Coordinator should refocus their Meaningful Use incentives totally on interoperability and give up on all the other nice stuff in the current requirements. Complaints have risen so high up that the ONC is now concentrating on interoperability, while a new Congressional bill proposes taking the job out of their hands.
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Remote Patient Monitoring and Small Practices

Posted on February 18, 2015 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.

We’ve started to see the proliferation of wireless health devices that can track a wide variety of health data and more of these devices are becoming common place in the home. Here’s a great tweet that contains an image of some of the popular devices:

While many of these devices are being purchased by the patients and used in the home, there are a number of other programs where healthcare organizations (usually hospitals) are purchasing the devices for the patients who then use the device at home. These programs are designed for hospitals to remotely monitor a patient and identify potential health issues early in order to avoid a hospital readmission.

For those who work in hospitals, you know how important (financially and otherwise) it is for hospitals to reduce their readmissions. While this is great for hospitals, how does this apply to small practices and general and family practice doctors in particular. There’s no extra payment for a small practice doctor to help reduce the readmission of their patient to the hospital. At least I haven’t seen a hospital pay a doctor for their help in this service yet.

What then would motivate a small practice doctor to leverage these types of remote patient monitoring tools?

Sadly, I don’t think there is much motivation for the standard small practice office to use them. It’s easy to see where a concierge doctor might be interested in these technologies. As a concierge doctor or direct primary care doctor, it’s in their best interest to keep their patient population as healthy as possible. As this form of care becomes more popular, I think these types of technology will become incredibly important to their business model.

The other trend in play is the shift to value based reimbursement and ACOs. Will these types of remote patient monitoring technologies become important in this new reimbursement world? I think the jury is still out on this one, but you could see how they could work together.

I’ve recently had a number of doctors hammering me on Twitter and in the comments of blog posts about how technology is not the solution to the problems and that technology is just getting in the way of the personal face to face connection that doctors have been able to make in the office visit of the past. Their concern is real and those implementing the technology need to take this into account. The technology can get in the way if it’s implemented poorly.

However, these people who smack the technology down are usually speaking from a very narrow perspective. EHR and other technology can and does disrupt many office visits. We all know the common refrain that the doctor was looking at the computer not at me. This is a challenge that can be addressed.

While the above is true, how impersonal is a rushed 10-15 minute office visit with a doctor? How impersonal is it for the doctor to prescribe a medication to you and never know if you actually filed it? How impersonal is it for a doctor to prescribed a treatment and never follow up with you to know if the treatment worked? How impersonal is it for the doctor to never talk or interact with you and your health unless you proactively go to that doctor because you’re sick?

Technology is going to be the way that we bridge that gap and these remote patient monitoring technologies are one piece of that puzzle. I believe these technologies and others make healthcare so much more personal than it is today. It changes a short office visit to treat a chief complaint into actually caring for the patient.

This is what most doctors I know would rather be doing anyway. They don’t want to churn patients anymore than the patient wants to be churned, but that’s how they get paid. Hopefully the tide is changing and we’ll see more and more focus on paying providers for using technology that provides this type of personal care.

Partners Health Care Not to Expand – Can’t We All Just Get Along?

Posted on February 6, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

So the deal is off for the mega-medical conglomerate that dominates Boston’s health care scene. Partners Healthcare, which came so close to buying up several competitors, got slammed by a newly installed attorney general and a judge presiding over the merger decision. So big is Partners in health care–and health care in the Boston market–that this news made the lead headline in the Boston Globe on January 30.

Partners may go ahead with the mergers and face a lawsuit, but my guess is that they’ll sense the trending of the political tides and back away. Everyone understands that dominant health care providers tend to raise costs–but what might we have lost in preventing the merger?
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By Supporting Digital Health, EMRs To Create Collective Savings of $78B Over Next Five Years

Posted on December 1, 2014 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.

Here’s the news EMR proponents have been insisting would emerge someday, justifying their long-suffering faith in the value of such systems.  A new study from Juniper Research has concluded that EMRs will save $78 billion cumulatively across the globe over the next five years, largely by connecting digital health technologies together.

While I’m tempted to get cynical about this — my poor heart has been broken by so many unsupportable or conflicting claims regarding EMR savings over the years — I think the study definitely bears examination. If digital health technologies like smart watches, fitness trackers, sensor-laden clothing, smart mobile health apps, remote monitoring and telemedicine share a common backbone that serves clinicians, the study’s conclusions look reasonable on first glance.

According to Juniper, the growth of ACOs is pushing providers to think on a population health level and that, in turn, is propelling them to adopt digital health tech.  And it’s not just top healthcare leaders that are getting excited about digital health. Juniper found that over the last 18 months, healthcare workers have become significantly more engaged in digital healthcare.

But how will providers come to grips with the floods of data generated by these emerging technologies? Why, EMRs will do the job. “Advanced EHRs will provide the ‘glue’ to bring together the devices, stakeholders and medical records in the future connected healthcare environment,” according to Juniper report author Anthony Cox.

But it’s important to note that at present, EMRs aren’t likely to have the capacity sort out the growing flood of connected health data on their own. Instead, it appears that healthcare providers will have to rely on data intermediary platforms like Apple’s HealthKit, Samsung’s SAMI (Samsung Architecture for Multimodal Interactions) and Microsoft Health. In reality, it’s platforms like these, not EMRs, that are truly serving as the glue for far-flung digital health data.

I guess what I’m trying to say is that on reflection, my cynical take on the study is somewhat justified. While they’ll play a very important role, I believe that it’s disingenuous to suggest that EMRs themselves will create huge healthcare savings.

Sure, EMRs are ultimately where the buck stops, and unless digital health data can be consumed by doctors at an EMR console, they’re unlikely to use it. But even though using EMRs as the backbone for digital health collection and population health management sounds peachy, the truth is that EMR vendors are nowhere near ready to offer robust support for these efforts.

Yes, I believe that the combination of EMRs and digital health data will prove to be very powerful over time. And I also believe that platforms like HealthKit will help us get there. I even believe that the huge savings projected by Juniper is possible. I just think getting there will be a lot more awkward than the study makes it sound.

Open Source Electronic Health Records: Will They Support the Clinical Data Needs of the Future? (Part 1 of 2)

Posted on November 10, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Open source software missed out on making a major advance into health care when it was bypassed during hospitals’ recent stampede toward electronic health records, triggered over the past few years by Meaningful Use incentives. Some people blame the neglect of open source alternatives on a lack of marketing (few open source projects are set up to woo non-technical adoptors), some on conservative thinking among clinicians and their administrators, and some on the readiness of the software. I decided to put aside the past and look toward the next stage of EHRs. As Meaningful Use ramps down and clinicians have to look for value in EHRs, can the open source options provide what they need?

The oncoming end of Meaningful Use payments (which never came close to covering the costs of proprietary EHRs, but nudged many hospitals and doctors to buy them) may open a new avenue to open source. Deanne Clark of DSS, which markets a VistA-based product called vxVistA, believes open source EHRs are already being discovered by institutions with tight budgets, and that as Meaningful Use reimbursements go away, open source will be even more appealing.

My question in this article, though, is whether open source EHRs will meet the sophisticated information needs of emerging medical institutions, such as Accountable Care Organizations (ACOs). Shahid Shah has suggested some of the EHR requirements of ACOs. To survive in an environment of shrinking reimbursement and pay-for-value, more hospitals and clinics will have to beef up their uses of patient data, leading to some very non-traditional uses for EHRs.

EHRs will be asked to identify high-risk patients, alert physicians to recommended treatments (the core of evidence-based medicine), support more efficient use of clinical resources, contribute to population health measures, support coordinated care, and generally facilitate new relationships among caretakers and with the patient. A host of tools can be demanded by users as part of the EHR role, but I find that they reduce to two basic requirements:

  • The ability to interchange data seamlessly, a requirement for coordinated care and therefore accountable care. Developers could also hook into the data to create mobile apps that enhance the value of the EHR.

  • Support for analytics, which will support all the data-rich applications modern institutions need.

Eventually, I would also hope that EHRs accept patient-generated data, which may be stored in types and formats not recognized by existing EHRs. But the clinical application of patient-generated data is far off. Fred Trotter, a big advocate for open source software, says, “I’m dubious at best about the notion that Quantified Self data (which can be very valuable to the patients themselves) is valuable to a doctor. The data doctors want will not come from popular commercial QS devices, but from FDA-approved medical devices, which are more expensive and cumbersome.”

Some health reformers also cast doubt on the value of analytics. One developer on an open source EHR labeled the whole use of analytics to drive ACO decisions as “bull” (he actually used a stronger version of the word). He aired an opinion many clinicians hold, that good medicine comes from the old-fashioned doctor/patient relationship and giving the patient plenty of attention. In this philosophy, the doctor doesn’t need analytics to tell him or her how many patients have diabetes with complications. He or she needs the time to help the diabetic with complications keep to a treatment plan.

I find this attitude short-sighted. Analytics are proving their value now that clinicians are getting serious about using them–most notably since Medicare penalizes hospital readmissions with 30 days of discharge. Open source EHRs should be the best of breed in this area so they can compete with the better-funded but clumsy proprietary offerings, and so that they can make a lasting contribution to better health care.

The next installment of this article looks at current support for interoperability and analytics in open-source EHRs.

Which Comes First in Accountable Care: Data or Patients?

Posted on September 30, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The headlines are stark and accusatory. “ACOs’ health IT capabilities remain rudimentary.” “ACOs held back by poor interoperability.” But a recent 19-page survey released by the eHealth Initiative tells two stories about Accountable Care Organizations–and I find the story about interoperability less compelling than another one that focuses on patient empowerment.
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ACO by ACO Savings and Payments Report

Posted on September 26, 2014 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.

One of my favorite former CMS people, Travis Broome, recently shared a link to the ACO Savings and payment report. It provides an interesting view into the year 1 results of the Medicare Shared Savings Program (Medicare ACO program if you prefer).

It’s interesting to see which ACOs and other organizations got paid, but probably even more interesting to see ones that didn’t get paid at all. My guess is that many of them dropped out. If I’m reading the report properly, I could only find one organization that incurred a loss. It seems that Dean Clinic and St. Mary’s Hospital ACO in Wisconsin owes $3.96 million. Looks like they took the high risk-high reward option and lost. I’d love to talk to someone from that organization and hear what happened.

Travis Broome offered a number of other insights into the ACO report:

What do you think of the ACO program? I think it’s a bad sign that so many organizations fell out of the program. However, the trend and move towards this reimbursement is going to happen. I really don’t see how it could stop.

Are Limited Networks Necessary to Reduce Health Care Costs?

Posted on September 10, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Among the dirty words most hated by health care consumers–such as “capitation” and “insufficient medical necessity”–a special anxiety infuses the term “out-of-network.” Everybody harbors the fear that the world-famous specialist who can provide a miracle cure for a rare disease he or she may unexpectedly suffer from will be unavailable due to insurance limitations. So it’s worth asking whether limited networks save money, and whether they improve or degrade health care.
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