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Partnerships Between Behavioral Health & Telemedicine Drive Real Value and Impact Outcomes

Posted on April 24, 2015 I Written By

The following is a guest blog post by Dr. Bill Bithoney, Managing Director and Chief Physician Executive with The BDO Center for Healthcare Excellence & Innovation.
Bill Bithoney
The behavioral health and medical care delivery systems have long been separate, but the tides are changing. We’re starting to see more of a push to integrate the two, and it’s a trend expected to continue. Increased efforts to grow behavioral health service capacity through better integration with clinical care have health systems turning toward telemedicine. The benefits of this partnership are almost considered a “no brainer” when you take a look at the numbers and the opportunity for growth:

  • $6 billion: Where the telemedicine market will grow by 2020, according to the American Medical Association.
  • 7 million: The number of individuals with co-occurring substance abuse disorders and mental health issues, according to SAMHSA’s most recent National Survey on Drug Use and Health.
  • 38 percent: The number of adults with diagnosable mental health problems who actually receive needed treatment, according to the Department of Health and Human Services.

Still, providers and payors often find themselves asking, “How can I ensure this partnership will drive real value for the organization and impact outcomes?”

Telemedicine provides caregivers the ability to be in multiple locations at once – and provides patients access to care at times and places more convenient to them. As noted above, only 38 percent of adults with diagnosable mental health problems actually receive treatment. This means that more than 60 percent of individuals who know they need help aren’t able to receive it due to commonly cited challenges of not knowing where to go, inconvenience and lack of transportation. Further, psychiatrists, particularly those certified in addiction treatment, are in high demand nationwide. Indiana, which is experimenting with behavioral health telemedicine, has 462 in a state that should have 600.

And telemedicine has been proven effective in behavioral health treatment in numerous studies. Smartphones and apps are actually preferred by patients over prescriptions for medication. Through practices such as screening, brief intervention and referral to treatment (SBIRT)—included in Medicare telehealth services since 2013­­—problematic use issues, abuse and dependence on alcohol and illicit drugs can be proactively identified, reduced and prevented before ballooning into something greater. Moreover, the reduction in facility costs and increased access to patients makes telehealth, and telepsychiatry specifically, a cost-effective alternative to in-person treatments, while delivering much needed care.

Virtual visits and virtual early intervention through SBIRT impact not only the consumer’s health by extending the potential reach of substance abuse and mental health providers, but also the finances of the individual’s employer and insurer since the risks of costly and unanticipated urgent care and emergency department visits are greatly reduced. Additionally, insurers view this aggregation of data as a way to proactively monitor patients’ health, which can help prevent the risk of costly hospital admissions and readmissions.

The era of a partnership between behavioral health and telemedicine is upon us. Developing new avenues to deliver care that support behavior change, while engaging individuals in their own health, can not only be a more cost-effective strategy than simply providing more (or different) health care services, but can also be a smarter strategy to ensure better quality of care.

Dr. Bill Bithoney is a Managing Director and Chief Physician Executive with The BDO Center for Healthcare Excellence & Innovation. He can be reached at bbithoney@bdo.com

 

Innovative Collaboration on Medication Management and Community Resources

Posted on April 23, 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.

Although experts agree that the future of health is coordinated care, it is sorely lacking in the US health care system now. This article focuses on the single, relatively simple issue of medication management. Patients are prescribed barrels of pills, but there is little coordination other than looking for contra-indications and drug interactions–and these often suffer from the caretaker’s not knowing the patient’s full complement of drugs.

Sandra Raup, president of Datuit, points out that all kinds of subtleties get lost when patients are simply told how often to take a medication. For instance, if medications are spaced out throughout the day instead of being being taken all at once when we remember to take them (as so many people do), they may be absorbed more effectively and tolerated by the body. Patients–especially those with lower incomes and less education, who are more likely to be on multiple medications in the first place–need all sorts of support.

Here we come to an interesting twist: coordinated care does not have to be initiated by doctors. Given the doctor shortage and the forces keeping clinicians from adopting new models of treatment, other professionals can take on the long-term goals of improving patient health.

In a pilot ramping up in a residence for low-income seniors and the disabled in Maryland, Connected Health Resources is working with Alfa Specialty pharmacy using its Community Health Gateway to help patients straighten out their medications and keep to their schedules. This works because the pharmacy is in a somewhat unusual position: they have supported this community for some time and have built relationships with patients informally. The Gateway pilot has created a service, using Datuit’s SafeIX public API, that can potentially fulfill these needs with less work on the pharmacist’s part. The service is designed for easy navigation by the patients and their family caregivers, making it attractive to the patients and the pharmacists.

Connected Health Resources logo

The SafeIX Platform is designed using modern programming technologies to integrate data from multiple sources (including EHRs and HIEs) into a patient record for both patients and healthcare providers to use, based on their rights to access and share it. In the Gateway implementation, the pharmacist uses the SafeIX Platform to receive CDA documents from the HIE and to auto-assist medical data reconciliation between the various documents.

This information, along with the pharmacist recommendations, are organized into a daily medication calendar using an application from Polyglot Systems Incorporated, a company that offers medication regimen summaries in 18 languages. Low health literacy and the estimated 50 million people who do not speak English at home result in many patients not understanding their medication instructions. The plain language and multilingual, easy-to-use daily calendar can make the difference between understanding and total confusion.

Datuit’s SafeIX Platform uses interoperability standards (including, in test mode, the next-generation FHIR standard) to create a patient record that can show patients everything seen by multiple clinicians and allow a patient’s self-selected care team to view and add to a shared care plan. Datuit is encouraging app developers to build mobile apps for SafeIX that would prompt patients to take medications and record whether they did so, but that’s outside the scope of the pilot. There are plenty of challenges just fulfilling the tasks they have already taken on.

First, Connected Health Resources has to break down the clinical data silos that make it difficult for patients to collect their information. According to co-founder Shannah Koss, Maryland has a relatively advanced Health Information Exchange (HIE) called CRISP. However, it is defined as a provider-to-provider exchange, so it was only after a long-term relationship and negotiation that Connected Health Resources could collect medical data on behalf of the patients. This is the first time CRISP has allowed data to be retrieved for a patient-facing organization that is not a provider.

When enrolling, the patient gives the Gateway permission to get data through CRISP. Family and friends can be invited by patients to be part of their health community and enroll in the Gateway. The invitation includes a unique code that allows the Gateway to securely share records and help with health and social services navigation. If the patient wants help or is incapable of managing the medication list, a caregiver can do so.

CRISP transmits data primarily from hospitals. To round out a more comprehensive listing of medications from clinics and other healthcare providers, CRISP has enabled the ability to query Surescripts, which provides prescription fill data from chain pharmacies and pharmaceutical benefit management companies.

Pilot participants authorize the Gateway and the Alfa pharmacists to access their medication information and maintain, share, and augment the information in the secure SafeIX Platform. The CRISP data gives more complete medication records for the pilot participants. CRISP also provides an event notification system that let’s the pharmacist know whether a patient has been admitted to a hospital or visited the emergency department. These types of transition are precisely when medications get changed, but the clinicians at those crucial junctures often don’t know all of a patient’s current medications.

Finally, over-the-counter (OTC) medications can play an important role in a patient’s care. This has to be added to the daily calendar. The Alfa Pharmacist is helping round out the complete medication picture by working with the patient and family to identify OTC medications, supplements, and the medications that are actually being taken through the medication therapy management (MTM) program. The Gateway provides the means for everyone to better understand and manage the medicines for the best outcomes.

Further, the Gateway Community Resource Finder has enabled information about important resources such as transportation, meal delivery, social services, and home nursing. The MTM pharmacist knows that patients without food or transportation to their physicians cannot adequately manage their health or medications. The underlying SafeIX Platform also allows the Gateway to offer secure messaging that looks like email and lets the pharmacist, patient, friends, and family exchange messages about the patient’s care.

Traditional EHRs don’t accommodate treatment plans of the specificity designed by the pharmacy for patients in the pilot. This is where Datuit is pushing the EHR to new horizons: its SafeIX Platform helps multiple clinicians (including long term care providers), patients, and family caregivers contribute data. For example, patients can enter their own healthcare problems, such as fear of falling. The patients, families, and clinicians can then add interventions to address them.

Like other new organizations I’ve spoken too in health care, Connected Health Resources has grand plans beyond the current pilot. They are taking it slow, because Koss believes personal health records (PHRs) have tried to do too much at once and have overwhelmed their users with too many possibilities. But she would like Connected Health Resources to grow in response to what patients and families say they need. The Gateway tools already include the ability to generate multi-lingual discharge instruction from Polyglot. The initial pilot purposefully focuses on the more narrow scope of medications along with the health and social services support. The next step will be to engage hospitals to provide the plain language multi-lingual discharge instructions.

Chronic care ultimately goes beyond medications to things supported by a patient-centered medical home (PCMH), community health workers, and the many community-based service providers. The Gateway in partnership with the Datuit SafeIX Platform are poised to allow all participants identified by the patient and families to contribute to and be part of their health community.

Slickest Solution I Saw at HIMSS15

Posted on April 22, 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 probably says something about me, but I’m always intrigued by really slick solutions that leverage creativity to solve a problem. While at HIMSS amidst all the vendor noise, I saw a solution that I fits this description. The solution came from a scanning company called Ambir and the solution is called nForm. Yes, I was a bit surprised that it came from a scanner company too, but that’s the beauty of HIMSS. You never know where you going to find something interesting.

In any office, one of the biggest annoyances during an EHR implementation is that you can’t go fully electronic. There are still a large number of forms that require a patient signature. In 95% of cases this means that you’re handing the patient a stack of paper forms which they can sign. Most organizations then scan those forms into their EHR. It makes for an awful workflow and we all know it.

The nForm solution from Ambir solves this problem and makes the process electronic. You can literally scan in any form and nForm will make that paper form an electronic form that can be completed electronically on an iOS, Android or the nForm 410x tablet device. The patient can literally fill out the form on the screen as if they were filling out the form on paper. Then, once the patient completes the form, nForm will upload it to your EHR using the same workflow you’d been using when you’d scan the form into your EHR.
nForm
To me the most powerful part of this solution is that it uses your paper form workflow without requiring any sort of new integration from your EHR vendor. Even if you usually print out your intake forms from your EHR, you can “print” them to nForm and then when the patient fills out the forms they’ll get pushed back to the EHR. If you’re a clinic that just has a stack of intake paperwork that you attach to a clipboard for the patient, you can have those already queued up on nForm and just hand the tablet to the patients to complete.

While I’ve talked about the intake forms, you can also use this for other forms you might need signed later in the office visit as well. We all know those pesky consent for treatment forms that we’re still doing on paper and hopefully scanning in later.

I love that this is a slick solution for healthcare, but I’m also interested in the product for my own personal use. The only things I print these days are when I need to sign something. How much nicer will it be for me to just print to nForm, sign it and then send it to the receiving party? Saves the hassle of going to the printer. Saves ink and paper which will make all you eco friendly people happy.

While nForm supports you writing anything on a form (it literally is like an electronic piece of paper), I’m skeptical about how well it will do for a really detailed form. Obviously in healthcare we’re moving these forms to a patient portal so we can get the granular data elements stored as unique data elements. So, we’re not handing a patient a lengthy paper form as much anymore.

With that said, I’m not sure how a lengthy health history form would look using nForm. People’s bad handwriting together with the digital input might make it hard to read. For signatures or basic forms it won’t be an issue at all. Plus, they’ve made it so the virtual pen color is different from the background of the form. It’s actually really easy to look at a form and see what was completed (or not completed) by the patient. In that way, it makes the form more legible than a paper form. Although, it still depends on the quality of their handwriting.

All in all, I’m really impressed with the nForm solution. I’ve implemented a Topaz style signature pad solution before, but that required integration with the EHR (which very few have done) and still felt awkward since you weren’t actually signing on the document itself. nForm has all the advantages of the paper form, but in a nice electronic solution. I love slick solutions like this.

Full Disclosure: Ambir is a Healthcare Scene advertiser.

Epic Belatedly Accepts Reality And Drops Interoperability Fees

Posted on April 21, 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.

Unbeknownst to me, and perhaps some of you as well, Epic has been charging customers data usage fees for quite some time.  The EMR giant has been quietly dunning users 20 cents for each clinical message sent to a health information exchange and $2.35 for inbound messages from non-Epic users, fees which could surely mount up into the millions if across a substantial health system.  (The messages were delivered through an EMR module known as Care Everywhere.)

And now, Epic chose #HIMSS15 to announce grandly that it was no longer charging users any fees to share clinical data with organizations that don’t use its technology, at least until 2020, according to CEO Judy Faulkner.  In doing so, it has glossed over the fact that these questionable charges existed in the first place, apparently with some success. For an organization which has historically ducked the press routinely, Epic seems to have its eye on the PR ball.

To me, this announcement is troubling in several ways, including the following:

  • Charging fees of this kind smacks of a shakedown.  If a hospital or health system buys Epic, they can’t exactly back out of their hundreds-of-millions-of-dollars investment to ensure they can share data with outside organizations.
  • Forcing providers to pay fees to share data with non-Epic customers penalizes the customers for interoperability problems for which Epic itself is responsible. It may be legal but it sure ain’t kosher.
  • In a world where even existing Epic customers can’t share freely with other Epic customers, the vendor ought to be reinvesting these interoperability fees in making that happen. I see no signs that this is happening.
  • If Epic consciously makes it costly for health systems to share data, it can impact patient care both within and outside, arguably raising costs and increasing the odds of care mistakes. Doing so consciously seems less than ethical. After all, Epic has a 15% to 20% market share in both the hospital and ambulatory enterprise EMR sector, and any move it makes affects millions of patients.

But Epic’s leadership is unrepentant. In fact, it seems that Epic feels it’s being tremendously generous in letting the fees go.  Here’s Eric Helsher, Epic’s vice president of client success, as told to Becker’s Hospital Review: “We felt the fee was small and, in our opinion, fair and one of the least expensive…but it was confusing to our customers.”

Mr. Helsher, I submit that your customers understood the fees just fine, but balked at paying them — and for good reason. At this point in the history of clinical data networking, pay-as-you-go models make no sense, as they impose a large fluctuating expense on organizations already struggling to manage development and implementation costs.

But those of us, like myself, who stand amazed at the degree to which Epic blithely powers through criticism, may see the giant challenged someday. Members of Congress are beginning to “get it” about interoperability, and Epic is in their sights.

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?

Annual Evaluation of Health IT: Are We Stuck in a Holding Pattern? (Part 2 of 3)

Posted on April 14, 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.

The previous installment of this article was devoted to the various controversies whirling around Meaningful Use. But there are lots of other areas of technology and regulation affecting the progress (or stasis) of health IT.

FHIR: Great Promise, But So Far Just a Promise

After a decade or so of trying to make incompatible formats based on obsolete technology serve modern needs such as seamless data exchange, the health IT industry made a sudden turn to a standard invented by a few entrepreneurial developers. With FHIR they pulled on a thread that will unravel the whole garment of current practices and standards, while forming the basis for a beautiful new tapestry. FHIR will support modern data exchange (through a RESTful API), modern security, modern health practices such as using patient-generated data, and common standards that can be extended in a structured manner by different disciplines and communities.

When it’s done, that is. FHIR is still at version 0.82. Any version number less than 1, in the computer field, signals that all sorts of unanticipated changes may still be made and that anyone coding around the standard risks having to rip out their work and starting over. Furthermore, FHIR is a garment deliberately designed with big holes to be filled by others:

  • Many fields are defined precisely, but elements of the contents are left open, such as the units in which medicine is measured. This is obviously a pretty important detail to tie down.

  • Security relies on standards in the OpenID/OAuth area, which are dependable and well known by developers through their popularity on the Web. Still, somebody has to build this security in to health IT products.

  • Because countries and medical disciplines vary so greatly, the final word on FHIR data is left to “profiles” to be worked out by those communities.

One health data expert I talked to expressed the hope that market forces would compel the vendors to cooperate and make sure these various patches are interoperable as they are pieced into the garment. I would rather design a standard with firm support for these things.

Some of the missing pieces can be supplied relatively painlessly through SMART, an open API that predates FHIR but has been ported to it. An impressive set of major vendors and provider organizations have formed the Argonaut project to carry out some tasks with quick pay-offs, like making security work and implementing some high-value profiles. Let’s hope that FHIR and its accompanying projects start to have an impact soon.

The ONC has repeatedly expressed enthusiasm for FHIR, and CMS has alerted vendors that they need to start working on implementations. Interestingly, the Meaningful Use Stage 3 recommendation from CMS announces the opinion that health care providers shouldn’t charge their patients for access to their data through an API. An end to this scandalous exploitation of patients by both vendors and health care providers might have an impact on providers’ income.

Accountable Care Organizations: Walls Still Up

CMS created ACOs as a regulatory package delivering the gifts of coordinated care and pay-for-value. This was risky. ACOs require data exchange to effect smooth transfers of care, but data exchange was a rare occurrence as late as 2013, and the technical conditions have not changed since then so I can’t imagine it’s much better.

Pay-for-value also calls for analytics so providers can stratify populations and make rational choices. Finally, the degree of risk that CMS has asked ACOs to take on is pretty low, so they are not being pushed too hard to make the necessary culture changes to benefit from pay-for-value.

All that said, ACOs aren’t doing too badly. New ones are coming on board, albeit slowly, and cost savings have been demonstrated. An article titled “Poor interoperability, exchange hinders ACOs” actually reports much more positive results than the title suggests. There may be good grounds for ONC’s pronouncement that they will push more providers to form ACOs.

Still, ACOs are making a slow tack toward interoperability and coordinated care. The walls between health care settings are gradually lowering, but providers still huddle behind the larger walls of incompatible software that has trouble handling analytics.

I’ll wrap up this look at progress and its adversaries in the next installment of this article.

There Are Some Things You Just Can’t Do Without an EHR

Posted on March 24, 2015 I Written By

The following is a guest post by Tom Giannulli, MD, MS, Chief Medical Information Officer, Kareo. Follow and engage with him on Twitter @drtom_kareo or @GoKareo.
Tom Giannulli - Kareo EHR
Over the past two years, there has been a lot of talk about a big EHR switching trend. Some of this has been because of Meaningful Use, and some of it has been because of market changes. There are simply more options today if you are unhappy with your current EHR.

Surveys show that many physicians are frustrated with the cost or functionality in their EHR, which has prompted considering a switch. There is also frustration with too much third party interference and regulation. Despite some of these challenges, one thing is clear. Most physicians believe EHRs improve care, reduce errors, and improve billing.

What sometimes gets left out are the other opportunities created by using an EHR. Some of these are new revenue sources that might be impossible or very hard to access without one. Here are a few examples, but certainly not the only ones.

Medicare Programs
There are some new codes that have come out in the last two years for services that are revenue generators, but you really do need an EHR to manage them. The first is transitional care management (TCM). While TCM doesn’t require you to use an EHR, the complexity of it makes it hard to do without one. The ability to easily put in your notes and set reminders for needed follow up makes managing TCM much easier. With reimbursement ranging anywhere from about $100 to over $200 per patient, this can be a great opportunity for providers who see many patients who need post hospitalization follow ups.

The other Medicare program is newer and does require the use of a certified EHR. It is the Chronic Care Management (CCM) code that came out this year. The reimbursement is about $42 per patient and can be billed once a month. The requirement is that the patient has two or more chronic conditions that are expected to last at least 12 months or until the patient’s death. Clinical staff must spend at least 20 minutes performing CCM services for the patient each month that the code it billed. The services are non-face-to-face and direct supervision is not required, which means that nursing staff or non-physician practitioners can render CCM even if the physician is not in the office. Again, if your practice sees a lot of patients with chronic health problems, this can be a great way to add revenue by using nursing or mid-level staff.

Affordable Care Act Opportunities
By now I hope everyone knows that preventive care services are covered with no copays or deductibles. What many providers still aren’t very aware of are the other types of programs that are now covered by insurance that can be great revenue generators. While they don’t require an EHR, this is another area where using an EHR makes running these programs much easier. The two programs that make a lot of sense for primary care providers and specialists who see patients with certain types of qualifying conditions are group visits and weight loss programs.

With group visits, the practice identifies a group of patients who have a similar, chronic condition that requires frequent visits. You can do this using your EHR (it would be tough using paper charts). Some examples include HIV, chronic pain, COPD, and hypertension. Vitals are done individually as patients arrive and then the whole group spends the rest of the 1.5 – 2 hour visit together with the provider. Once a group visit is completed, each patient’s insurance is billed for the appropriate E&M code for their individual situation. The ability to use templates and copy note features in the EHR can make documenting after the group visit much faster and easier than it would be if done by hand.

For patients with certain conditions, a weight loss program may be mostly or fully covered by insurance like preventive care. The great thing about this is that it can be as simple or complex as you are willing to manage. You can do simple nutritional counseling and weigh-ins or go for a fully formed program through a third party that includes food and supplements. Again, using an EHR makes it much easier and faster to manage and track multiple follow up appointments, set reminders, and copy notes and simply update them each time. You can even have a group visit component!

The key to all of these opportunities is that an EHR helps reduce the complexity of managing the requirements and helps insure that you can quickly and easily show accurate, thorough documentation to payers. Without an EHR, these revenue generating programs would simply seem too difficult to manage. In a time when every penny counts, you can’t ignore opportunities like these.

Kareo, the leading provider of cloud-based software and services for independent medical practices, is a sponsor of EMR and EHR. Find out more about Kareo’s award-winning solutions at http://www.kareo.com/.

Unlocking EHR Data to Accelerate Clinical Quality Reporting & Enhance Renal Care Management

Posted on March 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.

The following is a guest blog post by Christina Ai Chang from DaVita and Vaishali Nambiar from CitiusTech Inc.
Christina and Vaishali
When healthcare providers began achieving Meaningful Use (MU) — the set of standards, defined by CMS, that allows for providers to earn incentive dollars by complying with a set of specific criteria — a health IT paradox emerged. The reports required for incentive payments are built on data the EHR captures, however, EHRs don’t typically have built-in support for automated reporting. This places a time-intensive manual burden on physicians as they report for MU quality measures. In other words, a program intended to increase the use of technology inadvertently created a new, non-technical, burden. The need to manually assemble information for reports also extended to the CMS Physician Quality Reporting System (PQRS) incentive program. As with many providers, EHR reporting shortcomings for these CMS programs severely impacted the kidney care provider, DaVita Healthcare Partners, Inc. (DaVita).

As one of the largest and most successful kidney care companies in the United States, DaVita has constantly focused on clinical outcomes to enhance the quality of care that it provides to its patients. In its U.S. operations that include 550 physicians, DaVita provides dialysis services to over 163,000 patients each year at more than 2,000 outpatient dialysis centers. These centers run Falcon Physician, DaVita’s nephrology-focused solution that largely eliminates paper charting by capturing data electronically and providing a shared patient view to caregivers within the DaVita network.

Falcon Physician serves DaVita very well in its design: renal-care specific EHR capabilities and workflows to support patients with chronic kidney disease (CKD). However, federal incentive programs like MU and Physician Quality Reporting System posed their own challenges. Falcon, like most EHRs, did not have the sophisticated data processing and analytics capabilities needed to meet the complex clinical quality reporting mandated by these programs. With limited built-in support for automated reporting, DaVita physicians had to manually calculate denominators and complete forms for submission to CMS for quality measures reporting, typically taking five to six days per report. With the organization averaging 800 encounters per physician each month, this placed a highly time-intensive and manual burden on physician offices. In addition, manual reporting often resulted in errors, since physician offices had to manage ten or more pieces of data to arrive at a single measure calculation, and do that over and over again.

The Need to Automate Reporting – But How?

To address the time and accuracy issues, DaVita recognized it would need to unlock the data captured by the EHR and use an effective data analytics and reporting tool. To begin evaluating options, the organization put together a team to explore two potential paths: creating a proprietary reporting capability within the EHR, or integrating a third-party solution.

It became clear that proprietary development would be challenging, mainly because of the technological expertise that would be needed to build and maintain sufficiently advanced analytics capabilities. It would require special skillsets to build the rules engine, the data mapping tools, and the visualizations for reporting. In addition, DaVita would need to maintain a clinical informatics and data validation team to assess the complex clinical quality measures, develop these measures, and test the overall application on an ongoing basis. Further, DaVita would also need to get this functionality certified by CMS and other regulatory agencies on a periodic basis.

While looking for a third-party solution that could easily integrate with Falcon, DaVita came across CitiusTech, whose offerings include the BI-Clinical healthcare business intelligence and analytics platform. This platform comes with pre-built apps for multiple reporting functions, including MU and PQRS. Its application programming interface (API) simplifies integration into software like Falcon. The platform aligned closely with DaVita’s needs, and with a high interest in avoiding the expense, time and skillset hiring needed to build a proprietary reporting function, the organization decided to move forward with third-party integration.

Accelerated Implementation and Integration

Implementation began with a small proof of concept that delivered a readily scalable integration in fewer than six weeks. DaVita provided the database views and related data according to the third-party solution’s specifications. This freed DaVita not just from development, but also from testing, installation, and configuration of the platform; thereby, saving time and money, and creating a more robust analytics platform for DaVita’s physicians. In the end, going with an off-the-shelf solution reduced implementation time and cost by as much as two-thirds.

Integration with the third-party platform enabled DaVita’s Falcon EHR system to completely automate the collection and reporting of clinical quality measures, freeing up tremendous physician time while improving report accuracy. With additional capabilities that go beyond solving the reporting problem, the new solution translates EHR data into meaning performance dashboards that assist DaVita physicians in the transition to pay-for-performance medicine.

The platform with which DaVita integrated is ONC-certified for all MU measures for eligible professionals (EPs) and eligible hospitals (EHs). Falcon was able to leverage these certifications and achieve both MU Stage 1 and Stage 2 certification in record time. This also enabled Falcon to accelerate its PQRS program and offer PQRS reporting and data submission capabilities.

Automated Reporting and Dashboards in Action        

Today, hundreds of DaVita physicians use the upgraded EHR, and the integrated business intelligence and analytics function eliminates the need for these doctors to perform manual calculations for MU and PQRS measures. Where manually creating reports used to take five to six days, pre-defined measure sets now complete reports and submit data almost instantly.

With the manual reporting problem solved, DaVita’s physicians now take automation for granted. What they see on a daily basis are the quality-performance dashboards. These dashboards give them a visual, easily understood picture of how they’re doing relative to quality measures, and the feedback has been extremely positive. Many powerful reporting features are highly appreciated, such as key measurements appearing in red when it’s time to change course in care provision to meet a particular measure. Such information, provided in real-time with updates on a daily basis, has led to very strong adoption of the new reporting capabilities among physicians.

Currently, DaVita is working to develop a benchmarking tool that can rate all physicians within a location. The focus on quality-measurement rankings relative to their peers, with drill-downs to specific indicators such as hypertension and chronic kidney disease progression, will allow physicians to focus on enhancing care delivery.

Unlocking data located in the EHR has helped DaVita comply with MU and PQRS. In the coming years, the upgraded EHR will help physicians comply with evidence-based guidelines and optimize increasingly complex reimbursement requirements.

Healthcare Interoperability in Action

Posted on March 16, 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.


100+ live clinical information systems sharing health data at HIMSS makes for a good headline. What’s not clear to me is how this is really any different than the past 2-3 interoperability showcases at HIMSS. Don’t get me wrong. I love that these systems can interoperate, but they’ve been able to interoperate for a long time. At least that’s what you believe from the headlines coming out of every interoperability showcase at HIMSS.

I’m hoping to learn at HIMSS why there’s such a wide gap between interoperability between systems at HIMSS and the real world. Is it a lack of desire on the part of healthcare organizations? Is it that the sandbox environment is much simpler than trying to share data between EHR systems which have had a series of customizations as part of every EHR implementation?

I also think there’s a major gap between hospital interoperability and ambulatory care. Most doctors I know aren’t working on interoperability at all. They wouldn’t even know where to start. They just assume that their EHR vendor is going to eventually solve that problem for them. Sure, they wish that it would happen, but I don’t think doctors feel like they have any power in making it a reality. I’d love to hear if you think that’s a good or bad assumption on the part of doctors.

Talking HIMSS interoperability showcase headlines, how much more powerful would it be to have the headline say “100s of live clinical information systems sharing data throughout the country.” 100s still feels weak, but at least we’d be talking about interoperability in a real life situation and not just the perfectly designed test systems.

I guess I’m still interested in “A little less healthcare interoperability talk…a lot more action.

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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