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Are Healthcare Orgs Dumping Today’s Interoperability Tech?

Posted on December 8, 2016 I Written By

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

Recently, I took a survey on interoperability issues sponsored by a health IT organization. And one of their questions seemed so interesting — to me at least — that I thought I’d share it with you.

As part of the survey, the HIT group asked how healthcare organizations planned to split their future investments in interoperability, on a scale ranging from 20% technology/80% services to 100% technology. (In the “services” category, they were looking for investments which would transform core technologies to achieve higher value interoperability goals, such as improved clinical workflow integration or significant practice outcomes.)

As I see it, this was not only a good but a provocative question as well. On the surface, I admit, it sounds like a routine query, which attempts to get a feel for what resources healthcare groups may already have invested in interoperability and how they plan to support those investments. Looked at that way, it was a fairly routine inquiry as such surveys go.

But I believe that there’s another way to look at this question, and I bet the authors did too. To my mind, the question is really evaluating whether respondents think current interoperability technology will ever meet their needs, and how far along they are in making that decision. In other words, answering this question says a lot about the strategy and vision for the future, not just how you plan to keep the infrastructure running.

How does this work? To choose one obvious example, organizations that expect to spend 100% of their future interoperability budget on new technology obviously aren’t fans of the technologies available today. That suggests, to me, that they’ve also lost patience to a greater or lesser degree with other current interoperability approaches like FHIR or the use of HIE technology. They probably doubt their current EHR vendor will ever play ball either.

Meanwhile, organizations that expect to spend 80% of the future interoperability budget on related services may be making the opposite statement. Either they are satisfied that the technology they’ve got is at least performing adequately, can be enhanced to perform adequately or can be repurposed if the right services are put in place. The difference between the two may be as simple as whether they’re in a strong partnership with the right vendor, or a difference in philosophy, but either way this group is hunkered down.

As for those in the middle, who expect to vote 40% to 80% of their budget to new technology, it’s harder to read where they’re headed. But assuming the health IT organization repeats the survey in future years, it will be interesting to how the organizations in the middle progress. My guess is that over the next few years, surveys like these will tell us pretty definitively whether current approaches to interoperability can survive.

Advice On Winning Attention For Digital Health Solutions

Posted on December 7, 2016 I Written By

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

Some of you reading this are probably involved with a digital health startup to one degree or another. If so, you’ve probably seen firsthand how difficult it can be to get attention for your solution, no matter how sophisticated it is or how qualified its creators are. In fact, given the fevered pace of digital health’s evolution, you may be facing worse than typical Silicon Valley odds.

That being said, there are strategies for standing out even in this exploding market, according to participants at a recent event dedicated to getting beyond health tech hype. The event, which was written up by health tech startup incubator Rock Health, featured experts from Dignity Health, Humana, Kaiser Permanente and Evidation Health.

Generally speaking, the panelists from these organizations spelled out how health tech startups can make more convincing pitches, largely by providing more robust forms of evidence:

  • They said that standard metrics demonstrating the effectiveness of your solutions — such as randomized trials and evidence-based reviews — probably weren’t enough, as they sometimes don’t translate to real-world results. Instead, what they’d like to see is the product “used under some stress or duress and how it’s received by caregivers, members, patients and their families,” said Dr. Scott Young, who serves as executive director and senior medical director of Kaiser Permanente’s Care Management Institute.
  • They want you to produce “softer feedback” such as stories and testimonials directly from customers and users. “So many solutions claim to do the same thing,” said Karen Lee, innovation and strategic partnerships leader at Humana. “This softer feedback allows us to really get a feel for that experience and whether or not it’s effective.”
  • They expect you to be able to nail down how your product meets their strategic objectives, and can help them achieve the specific outcomes they have in mind. If you can’t do that, though just reach out to someone who can.
  • They want to bear in mind that even if they’re quite interested in what you’re doing, there’s typically a lot of politics to navigate before they can the pilot with your technology, much less implement fully. “Beyond the evidence, a successful pilot, and research, there are some complexities that you have to be patient and working through,” says Lee.
  • Perhaps most importantly, they need to know that you’ve kept the patient in mind. “The patient needs to know how to use [your technology], and should be using it,” said Dr. Manoja Lecamwasam, executive director of intellectual property and strategic innovations at Dignity Health. “You have to first build that foundation – look at it there, and a lot of people want to talk to you.”

At this point, readers, I realize some of you are probably feeling frustrated, as it may seem that many potential digital health adopters have set the bar for adoption very high, even once you’ve proven that your solution works by most conventional methods. Still, it doesn’t hurt to get an idea of how the “other side” thinks.

A Look At An Interoperability Option For Lab Tests and Services

Posted on December 6, 2016 I Written By

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

Maybe I don’t go to the right parties, but I hadn’t heard that HL7 had released an implementation guide offering a standardized way for providers and other health organizations to exchange catalogs of lab tests and services. But I just learned the basics from a recent article on ONC’s HealthIT Buzz blog, and thought you might find them interesting.

The article, which was authored by execs with the American Clinical Laboratory Association, says the new guide can help labs share data electronically in a way that wasn’t possible before. Right now, the article notes, most clinical practice managers in the US must manually curate lab test catalogs. While the article doesn’t specify, it’s hard to imagine how this could fail to be a very time-consuming process.

However, under the new model, things are much different. The HL7 invitation guide describes how labs can provide electronic Directory of Services (eDOS) information to all providers ordering lab work, regardless of whether they are using EHRs, laboratory information systems or other platforms. Also, the guide explains how these labs can enable lab-to-EHR interoperability by using data formats that EHRs can incorporate into lab ordering systems.

The release of the eDOS guide follows a long-term effort by the American Clinical Laboratory Association to standardize lab catalogs for most commonly-ordered tests. The article authors, Steven Posnack and Thomas Sparkman of the ACLA, contend that by using the guide to automate eDOS, practices can reduce labor costs, improve test ordering accuracy through clinical decision support and even phase in precision medicine more rapidly as labs add new services. What’s more, using eDOS, EHRs would be able to import lab test companion information directly, in minutes, which is not possible in most current configurations.

And hear them tell it, the benefits to providers will be tangible. They note that according to ACLA estimates, a typical practice ordering an average of 1,000 frequently-ordered lab tests could potentially save $94,500 solely by using eDOS.

The article also suggests that eDOS implementations are good for labs and health IT developers. They point out that in most cases, specs for laboratory interfaces are customized one offs and nonstandard, but that under eDOS, the specs standardize laboratory data exchange from end to end.

As a non-developer, I can’t comment on how effective this framework is, though the argument made by the ACLA seems promising from a business standpoint. Still, speaking as an observer of this industry for quite some time, I still wish I was hearing about broader solutions that might actually work, rather than solving the problems within one of healthcare’s many silos.

That being said, if it’s actually possible to dramatically boost the efficiency of lab data sharing, the industry should have at it. We can’t let the ideal be the enemy of the better, I suppose.

Advanced APM Timeline – MACRA Monday

Posted on December 5, 2016 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 post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

Last week we posted about the APM Expansion in MACRA and the new PTAC Committee. Today we’ll dive into the timelines for APMs. They can get pretty confusing, so hopefully after you read this post you’ll have a better idea on how the APM timelines work.

Before we dive into the timelines, I also wanted to make a quick note of the benefits related to participating in an APM. The APM benefits really didn’t change in the MACRA final rule so our previous post on Advanced APM incentives is still accurate as well.

As we noted before, participating as an advanced APM provides incentives on top of whatever rewards are part of your original APM agreement. Under MACRA, you just get an extra 5% bonus on top of your pre-MACRA rewards for being in an APM. Here are the 3 main benefits of participating as an advanced APM under MACRA:
advanced-apm-benefits

As far as reporting as an Advanced APM, CMS will take three “snapshots” on March 31, June 30, and August 31 in order to determine which eligible providers are eligible as an Advanced APM and meet the thresholds to become a Qualified APM participant.

Here’s the official timeline details from CMS:

cms-apm-determination-timeline

At point B, the snapshots are taken to determine eligibility and at point D in the graph above, eligible providers will be notified of their APM eligibility. Yes, this is a very compressed timeline, so it behooves you to get started early. Remember that if you don’t qualify as an Advanced APM, then you still have to participate in MIPS.

The timeline for paying the 5% reward for being part of a qualified Advanced APM is still 2019 for reporting year 2017. 2018 reporting year will determine payouts for 2020 and so forth. That’s no change from the proposed MACRA rule.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

E-Patient Update: Patient-Doctor Communication Still Needs an Update

Posted on December 2, 2016 I Written By

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

A few weeks ago, I called my PCP’s after-hours line to address an urgent medical concern. The staff at the answering service took my name, reached out to the doctor on call and when he was ready, connected him to me.

While this procedure was entirely standard, as always I found it a bit offputting, as to me it implies that I can’t be trusted to use the doctor’s cell phone number with some discretion. Don’t get me wrong, part of me understands why the doctors in this practice preferred to preserve their privacy and select when they want to speak to patients. On the other hand, however, it makes me uneasy, as I already have a very superficial relationship with my PCP and this approach doesn’t help.

While this is very much an old-school problem, to me it points to a larger one which has largely gone unnoticed as we plunge forward with the evolution of health IT. In theory, we are living in a far more connected world, one which puts not only family and friends but the professionals we work with on far more of a one-to-one basis with us. In practice, however, I continue to feel that patient-doctor communication has benefited from this far less than one might think.

I know, you’re going to point out to me how many doctors are using portals to email with patients these days, and how some even text back and forth with us. I’ve certainly been lucky enough to benefit from the consideration of providers who have reached out via these channels to solve urgent problems. And I know some health organizations — such as Kaiser Permanente — have promoted a culture in which doctors and patients communicate frequently via its portal.

The thing is, I think Kaiser’s experience is the exception that proves the rule. Yes, my doctors have indeed communicated with me directly via portals or cell. But the email and text messages I’ve gotten from them are typically brief, almost pointillistic, or if longer and more detailed, typically written days or even weeks after the original request on my end. In other words, these communications aren’t a big improvement over what they could accomplish with an old-fashioned phone call – other than being asynchronous communication that doesn’t require we hook up in real-time.

In saying this, I’m not faulting the clinicians themselves. Nobody can communicate with everyone all the time, particularly doctors with a large caseload. And I’m certainly not suggesting that I expect them to be Facebook buddies with me and chat about the weather. But it is worth looking at the way in which these communication technologies have seemingly failed to enrich the communication between patient and doctor in many cases.

Until we develop a communication channel for patients and doctors which offers more of the benefits of real-time communication — while helping doctors manage their time as they see fit — I think much of the potential of physician-patient communication by Internet will be wasted. I’m not sure what the solution is, but I do hope we find one.

OIG Says HHS Needs To Play Health IT Catch-Up

Posted on December 1, 2016 I Written By

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

A new analysis by the HHS Office of the Inspector General suggests that the agency still has work to do and appropriately managing health information technology and making sure it performs, according to Health Data Management. And unfortunately, the problems it highlights don’t seem likely to go away anytime soon.

The critique of HHS’s HIT capabilities came as part of an annual report from the OIG, in which the oversight body lists what it sees as the department’s top 10 management and performance issues. The OIG ranked HIT third on its list.

In that critique, auditors from the OIG pointed out that there are still major concerns over the future of health data sharing in the US, not just for HHS but also in the US healthcare system at large. Specifically, the OIG notes that while HHS has spent a great deal on health IT, it hasn’t gotten too far in enabling and supporting the flow of health data between various stakeholders.

In this analysis, the OIG sites several factors which auditors see as a challenge to HHS, including the lack of interoperability between health data sources, barriers imposed by federal and state privacy and security laws, the cost of health IT infrastructure and environmental issues such as information blocking by vendors. Of course, the problems it outlines are the same old pains in the patoot that we’ve been facing for several years, though it doesn’t hurt to point them out again.

In particular, the OIG’s report argues, it’s essential for HHS to improve the flow of up-to-date, accurate and complete electronic information between the agency and providers it serves. After all, it notes, having that data is important to processing Medicare and Medicaid payments, quality improvement efforts and even HHS’s internal program integrity and operations efforts. Given the importance of these activities, the report says, HHS leaders must find ways to better streamline and speed up internal data exchange as well as share that data with Medicare and Medicaid systems.

The OIG also critiqued HHS security and privacy efforts, particularly as the number of healthcare data breaches and potential cyber security threats like ransomware continue to expand. As things stand, HHS cybersecurity shortfalls abound, including inadequacies and access controls, patch management, encryption of data and website security vulnerabilities.  These vulnerabilities, it noted, include not only HHS, but also the states and other entities that do business with the agency, as well as healthcare providers.

Of course, the OIG is doing its job in drawing attention to these issues, which are stubborn and long-lasting. Unfortunately, hammering away at these issues over and over again isn’t likely to get us anywhere. I’m not sure the OIG should have wasted the pixels to remind us of challenges that seem intractable without offering some really nifty solutions, or at least new ideas.

Accountable Care HIT Spending Growing Worldwide

Posted on November 30, 2016 I Written By

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

A new market research report has concluded that given the pressures advancing the development of accountable care models, the market for solutions serving ACOs should expand worldwide, though North America is likely to lead the segment for the near future.

The report, by research firm Markets & Markets, covers a wide range of technologies, including EHRs, healthcare analytics, HIE, RCM, CDSS, population health, claims management and care management. It also looks at delivery mode, e.g. on premise, web and cloud and end-user, which includes providers and payers. So bear that in mind when you look at these numbers. That being said, providers accounted for the largest share of this niche last year, and should see the highest growth in the sector over the next five years.

Broadly speaking, Markets & Markets reports that the accountable care solutions market grew a healthy growth rate during the last decade. Researchers there expect to see this market grow at a CAGR of 16.6% over the next five years, to hit $18.86 billion by 2021.

When it comes to leaders in the sector, researchers identify Cerner, IBM, Aetna and Epic as leaders in the current ACO solutions market and probable future winners between 2016 and 2021. Other major players in the space include UnitedHealth Group, Allscripts, McKesson, Verisk Health, Zeomega, eClinicalWorks and NextGen. Given how broadly they define this category, I’m not sure how important this is, but there you have it.

According Markets & Markets, the growth of the ACO solutions market worldwide is due to forces we know well, including shifting government regulations, the rollout of initiatives shifting financial risk from payers to providers, the demand to slow down healthcare cost increases in the advance of IT and big data capabilities. (Personally, I’d add the desire of health systems – ACO-affiliated or not – to differentiate themselves by performing well at the population health level.)

If your view is largely US-centric, as is mine, you might be interested to note that the trend towards ACO-like entities in the Asia-Pacific and Latin American regions is expanding, the researchers report. Most specifically, Markets & Markets researchers found that there is notable growth occurring in Asian countries, which, it reports, are modifying regulations and monitoring the implementation of procedures, policies and guidelines to promote innovation and commercialization. This has led to an increasing number of hospitals and academic institutions interested in the sector, along with a government focus on implementing health IT solutions and infrastructure – factors likely to generate an expanding ACO solutions market there.

After reading all of this, the question I’m left with is whether there’s any point in differentiating an “ACO” specific player as these researchers have. Maybe I’m playing with words too much hear, but wouldn’t it be more accurate to say that the definition of health system infrastructure is evolving, whether it’s part of an ACO as such or not?

AMA Approves List Of Best Principles For Mobile Health App Design

Posted on November 29, 2016 I Written By

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

The American Medical Association has effectively thrown her weight behind the use of mobile health applications, at least if those apps meet the criteria members agreed on at a recent AMA meeting. That being said, the group also argues that the industry needs to expand the evidence base demonstrating that apps are accurate, effective, safe and secure. The principles, which were approved at its recent Interim Meeting, are intended to guide coverage and payment policies supporting the use of mHealth apps.

The AMA attendees agreed on the following principles, which are intended to guide the use of not only mobile health apps but also associated devices, trackers and sensors by patients, physicians and others. They require that mobile apps and devices meet the following somewhat predictable criteria:

  • Supporting the establishment or continuation of a valid patient-physician relationship
  • Having a clinical evidence base to support their use in order to ensure mHealth apps safety and effectiveness
  • Following evidence-based practice guidelines, to the degree they are available, to ensure patient safety, quality of care and positive health outcomes
  • Supporting data portability and interoperability in order to promote care coordination through medical home and accountable care models
  • Abiding by state licensure laws and state medical practice laws and requirements in the state in which the patient receives services facilitated by the app
  • Requiring that physicians and other health practitioners delivering services through the app be licensed in the state where the patient receives services, or will be providing these services is otherwise authorized by that state’s medical board
  • Ensuring that the delivery of any service via the app is consistent with the state scope of practice laws

In addition to laying out these principles, the AMA also looked at legal issues physicians might face in using mHealth apps. And that’s where things got interesting.

For one thing, the AMA argues that it’s at least partially on a physician’s head to school patients on how secure and private a given app may be (or fail to be). That implies that your average physician will probably have to become more aware of how well a range of apps handle such issues, something I doubt most have studied to date.

The AMA also charges physicians to become aware of whether mHealth apps and associated devices, trackers and sensors are abiding by all applicable privacy and security laws. In fact, according to the new policy, doctors are supposed to consult with an attorney if they don’t know whether mobile health apps meet federal or state privacy and security laws. That warning, while doubtless prudent, must not be helping members sleep at night.

Finally, the AMA notes that there are still questions remaining as to what risks physicians face who use, recommend or prescribe mobile apps. I have little doubt that they are right about this.

Just think of the malpractice lawsuit possibilities. Is the doctor liable because they relied on inaccurate app results collected by the patient? If the app they recommended presented inaccurate results? How about if the app was created by the practice or health system for which they work? What about if the physician relied on inaccurate data generated by a sensor or wearable — is a physician liable or the device manufacturer? If I can come up with these questions, you know a plaintiff’s attorney can do a lot better.

APM Expansion and New PTAC Committee – MACRA Monday

Posted on November 28, 2016 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 post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

Most of the general details about APMs was changed in the final rule (See our previous post about APMs and whether you should take part in an APM or MIPS within MACRA). However, if you want to dive into the details of APMs, then check out this CMS webinar and slides that dive into the APM program. One thing that didn’t change much yet is the types of programs that counted as possible advanced APMs:

  • Shared Savings Program (Tracks 2 and 3)
  • Next Generation ACO Model
  • Comprehensive End Stage Renal Disease Care Model (Two-Sided Risk Arrangements)
  • Comprehensive Primary Care Plus (CPC+)
  • Oncology Care Model (OCM) (two-sided risk track)

However, as CMS mentioned previously, their goal is to get more and more people involved in the APM program. As part of that effort, a number of other programs are likely to be eligible as an advanced APM in 2018:

  • Comprehensive Care for Joint Replacement (CJR) Payment Model (CEHRT)
  • Advancing Care Coordination through Episode Payment Models Track 1 (CEHRT)
  • ACO Track 1+
  • New Voluntary Bundled Payment Model
  • Vermont Medicare ACO Initiative (as part of the Vermont All-Payer ACO Model)

In fact, some of these might even be available in 2017. The MACRA final rule also created a new committee called the PTAC (Physician-Focused Payment Model Technical Advisory Committee). This committee will accept suggestions on other programs that should be considered an advanced APM. Then, they make recommendations to the HHS secretary on which programs should be added as Advanced APMs.

All updates on programs that qualify as an Advanced APM will be available on the CMS Quality Payment Program (MACRA) website.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

Mission Impossible – Liberate Legacy Medical Records Video

Posted on November 23, 2016 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.

With the Thanksgiving Holiday upon us, I thought I’d share a fun video that ChartCapture shared with me. When you watch this video it’s no wonder they won an award at this year’s Healthcare IT Marketing and PR Conference. I love the creativity and I think Mission Impossible is the way many people feel when it comes to accessing and converting their legacy EHR data. Enjoy the video below!

Happy Thanksgiving to everyone! I hope you have a lovely holiday.