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E-Patient Update: The Kaiser Permanente Approach To Consumer Health IT

Posted on May 19, 2017 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.

Usually, particularly when I have complaints, I don’t name the providers or vendors who serve my healthcare needs, largely because I don’t want to let my personal gripes overshadow my analysis of a particular health IT issue.

That being said, I thought I’d veer from that rule today, as I wanted to share some details on how Kaiser Permanente, my new provider and health plan, supports consumers with health IT functions. Despite having started with Kaiser – in this case the DC metro division – less than a week ago, being an e-patient I’ve had my hands all over its Web – and mobile-based options for patients.

I’m not going to say the system is perfect by any means. There are some blind alleys on the web site, and some problems in integrating clinical information into consumer records, but so far their set-up largely seems thoughtful and well-managed.

Having allegedly spent $4 billion plus on its Epic rollout, it’s hard to imagine how Kaiser could have realized that big a return even several years later, but it seems that the healthcare giant is at least doing many of the right things.

Getting enrolled

My first contact with Kaiser, after signing up with Healthcare.gov, was a piece of snail-mail which provided us with our insurance cards and a summary of our particular coverage. The insurance cards included my health plan ID/medical record number.

To enroll on the core Kaiser site, kp.org, I had to supply the record number, my birth date and a few other basic pieces of information. I also downloaded the KP app, which offers a far-more-elegant interface to the same functions.

Medical appointments

Once logged in, it was easy to choose a primary care doctor and OB/GYN by searching the site and clicking a selection button. If you wished you could review physician profiles and educational history as well as testimonial quotes from patients about that doctor before you chose them.

Having chosen a doctor, booking an appointment with them online was easy.  As with Zocdoc.com, you entered a range of dates for a possible consult, then chose the slot that worked for you. And if you need to cancel one of those appointments, it’s easy to do so online.

Digital communication

I was glad to see that the Kaiser portal allows you to email your doctor directly, something which is less common than you might think. (My last primary care group wouldn’t even put their doctors on the phone.)

Not only that, everyone I’ve talked to at KP so far– three medical appointments, as I was playing catch-up — has stressed that the email function isn’t just for show. My new providers insisted that they do answer email messages, and that I shouldn’t hesitate to write if I have questions or concerns.

Another way KP leverages digital communications is the simple, but effective, device of texting me when my prescriptions are due for a refill. This may not sound like much, but convenience matters! (I can also check med reminders by logging in to a custom KP meds app.)

Data sharing

Given that everyone at Kaiser uses the same Epic EMR, clinicians are of course more aware of what their colleagues are doing than my past gaggle of disconnected specialists. They seem quite serious about reading this history before seeing me, something which past physicians haven’t always done, even if I was previously seen by someone else in their practice.

KP also uses Epic’s Care Everywhere function, which allows them to pull in a limited summary of care from other Epic-based providers. While Care Everywhere has limits, the providers are making use of what they can.

One small wrinkle was that prior to two of my visits, I filled out a questionnaire online and when asked to submit it to my electronic patient record, did so. Nonetheless, I was asked to fill out the same questionnaire again, on paper, when I saw a specialist.

Test results

KP seems to be set up appropriately to share standard test results. However, I’ve already had one test, a mammogram, and in doing so found out that their data sharing infrastructure isn’t quite complete.

After being scanned, I was told that I’d receive my results via snail-mail, in about two weeks. I’m glad that this was a routine screening, rather than a test to investigate something scary, as I would have been pretty upset with this news if I was worried.

My conclusions

I don’t want to romanticize Kaiser’s consumer HIT services. After all, looked at one way, KP is only doing what integrated health systems are supposed to do, and not without at least a few hitches.

Still, at least on first view, on the whole I’m pretty happy with how Kaiser’s interactive functions are deployed, as well the general attitude staff members seem to have about consumer use of HIT tools. Generally speaking, they seem to encourage it, and for someone like me that’s quite welcome.

As I see it, if providers outside of the Kaiser bubble were as married to a shared infrastructure as KP providers are, my care would be much improved. Let’s see if I still if I still feel that way after the new health plan smell has worn off!

Dogged By Privacy Concerns, Consumers Wonder If Using HIT Is Worthwhile

Posted on May 17, 2017 I Written By

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

I just came across a survey suggesting that while we in the health IT world see a world of possibilities in emerging technologies, consumers aren’t so sure. The researchers found that consumers question the value of many tech platforms popular with health execs, apparently because they don’t trust providers to keep their personal health data secure.

The study, which was conducted between September and December 2016, was done by technology research firm Black Book. To conduct the survey, Black Book reached out to 12,090 adult consumers across the United States.

The topline conclusion from the study was that 57 percent of consumers who had been exposed to HIT through physicians, hospitals or ancillary providers doubted its benefits. Their concerns extended not only to EHRs, but also to many commonly-deployed solutions such as patient portals and mobile apps. The survey also concluded that 70 percent of Americans distrusted HIT, up sharply from just 10 percent in 2014.

Black Book researchers tied consumers’ skepticism to their very substantial  privacy concerns. Survey data indicated that 87 percent of respondents weren’t willing to divulge all of their personal health data, even if it improved their care.

Some categories of health information were especially sensitive for consumers. Ninety-nine percent were worried about providers sharing their mental health data with anyone but payers, 90 percent didn’t want their prescription data shared and 81 percent didn’t want information on their chronic conditions shared.

And their data security worries go beyond clinical data. A full 93 percent responding said they were concerned about the security of their personal financial information, particularly as banking and credit card data are increasingly shared among providers.

As a result, at least some consumers said they weren’t disclosing all of their health information. Also, 69 percent of patients admitted that they were holding back information from their current primary care physicians because they doubted the PCPs knew enough about technology to protect patient data effectively.

One of the reason patients are so protective of their data is because many don’t understand health IT, the survey suggested. For example, Black Book found that 92 percent of nurse leaders in hospital under 200 beds said they had no time during the discharge process to improve patient tech literacy. (In contrast, only 55 percent of nurse leaders working in large hospitals had this complaint, one of the few bright spots in Black Book’s data.)

When it comes to tech training, medical practices aren’t much help either. A whopping 96 percent of patients said that physicians and staff didn’t do a good job of explaining how to use the patient portal. About 40 percent of patients tried to use their medical practice’s portal, but 83 percent said they had trouble using it when they were at home.

All that being said, consumers seemed to feel much differently about data they generate on their own. In fact, 91 percent of consumers with wearables reported that they’d like to see their physician practice’s medical record system store any health data they request. In fact, 91 percent of patients who feel that their apps and devices were important to improving their health were disappointed when providers wouldn’t store their personal data.

Researcher Puts Epic In Third Place For EMR Market Share

Posted on May 16, 2017 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 research report tracking market share held by EMR vendors puts Epic in third place, behind Cerner and McKesson, a conclusion which is likely to spark debate among industry watchers.

The analyst firm behind the report, Rockville, MD-based Kalorama Information, starts by pointing out that despite the hegemony maintained by larger EMR vendors, the competition for business is still quite lively. With customers still dissatisfied with their systems, the hundreds of vendors still in the market have a shot at thriving, it notes.

Kalorama publisher Bruce Carlson argues that until the larger firms get their act together, there will still be plenty of opportunity for these scrappy smaller players: “It’s still true to say no company, not even the largest healthcare IT firms, have even a fifth of this market,” Carlson said in a published statement. “We think that is because there’s still usability, vendor-switching, lack of mindshare in the market and customers are aching for better.”

In calculating how much each vendor has of the EMR market, the analyst firm estimated each vendors’ hardware, software and services revenue flowing directly from EMRs, breaking out the percentage each category represented for each vendor. All projects were based on 2016 data.

Among the giants, Kalorama ranks Cerner as having the biggest market share, McKesson as second in place and Epic as third. The report’s observations include:

  • That Cerner is picking up new business, in part, due to the addition of its CernerITWorks suite, which works with hospital IT departments, and Cerner RevWorks, which supports revenue cycle management functions. Kalorama also attributes Cerner’s success to the acquisition of Siemens IT and its having won the Department of Defense EMR contract.
  • That McKesson is building on its overall success as a health IT vendor, which puts it in a good position to build on its existing technology. For example, it has solutions addressing medication safety, information access, revenue cycle management, resource use and physician adoption of EMRs, including Paragon, Horizon, EHRM, Star and Series for hospitals, along with Practice Partners, Practice Point Plus and Fusion for ambulatory care.
  • That Epic serves giant customers like Kaiser Permanente, as well as holding a major share of new business in the EMR market. Kalorama is predicting that Epic will pick up more ambulatory customers, which it has focused on more closely of late.

The report also lists Allscripts Healthcare Solution, which came in fourth. Meanwhile, it tosses in GE Healthcare, Athenahealth’s Intersystems, QSI/NextGen, MEDITECH, Greenway and eClinicalWorks in with a bundle of at least 600 companies active in the EMR market.

The report summary we editors got didn’t include some details on how the market components broke down. I would like to know more about the niches in which these vendors play.

For example, having seen a prediction earlier this year that the physician practice market would hit $17.6 billion worldwide within seven years, it would be interesting to see that dot connected with the rest of the market share information. Specifically, I’d like to know how much of the ambulatory EMR market included integrated practice management software. That would tell me something about where overall solutions for physicians were headed.

However, I still got something out of the information Kalorama shared.  As our esteemed publisher John Lynn often notes, all market share measurements are a bit, um, idiosyncratic at best, and some are not even that reliable. But as I see it the estimates are worth considering nonetheless, as they challenge us to look at the key moving parts in the EMR market. Hey, and it gives us something to talk about at tradeshow parties!

The Sexiest Data in Health IT: Datapalooza 2017

Posted on May 15, 2017 I Written By

Healthcare as a Human Right. Physician Suicide Loss Survivor. Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare. twitter: @coherencemed

The data at this conference was the Best Data. The Biggest Data. No one has better data than this conference.

The sexiest data in all of healthIT was highlighted in Washington DC at Datapalooza April 27-28, 2017.  One of the main themes was how to deal with social determinants of health and the value of that data.  Sachin H. Jain, MD of Caremore Health reminded us that “If a patient doesn’t have food at home waiting for them they won’t get better” social data needs to be in the equation. Some of the chatter on the subject of healthcare reform has been criticism that providing mandatory coverage hasn’t always been paired with knowledge of the area. If a patient qualifies for Medicaid and has a lower paying job how can they afford to miss work and get care for their health issues?
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Rural areas also have access issues. Patient “Charles” works full time during the week and qualifies for Medicaid. He can’t afford to miss a lot of work but needs a half a day to get treatments which affect his ability to work. There is no public transportation in his town to the hospital in a city an hour and a half away. Charles can’t afford the gas or unpaid time off work for his treatment.

Urban patient “Haley” returns to her local ER department more than once a week with Asthma attacks.  Her treatments are failing because she lives in an apartment with mold in the walls. As Craig Kartchner from the Intermountain Healthcare team responded to the #datapalooza  hashtag online- These can be the most difficult things to change.

The 2016 report to Congress addresses the difficulty of the intersection between social factors and providing quality healthcare in terms of Social Determinants of Health:

“If beneficiaries with social risk factors have worse health outcomes because the providers they see provide low quality care, value based purchasing could be a powerful tool to drive improvements in care and reduce health disparities. However, if beneficiaries with social risk factors have worse health outcomes because of elements beyond the quality of care provided, such as the social risk factors themselves, value based payment models could do just the opposite. If providers have limited ability to influence health outcomes for beneficiaries with social risk factors, they may become reluctant to care for beneficiaries with social risk factors, out of fear of incurring penalties due to factors they have limited ability to influence.”

Innovaccer just launched a free tool to help care teams track and monitor Medicare advantage plans. I went to their website and looked at my county and found data about the strengths in Salt Lake where I’m located. They included:

  • Low prevalence of smoking
  • Low Unemployed Percentage
  • Low prevalence of physically inactive adults

Challenges for my area?

  • Low graduation rate
  • High average of daily Air pollution
  • High income inequality
  • High Violent crime rate per 100,000 population

Salt Lake actually has some really bad inversion problems during the winter months and some days the particulate matter in the air creates problems for respiratory problems. During the 2016-2017 winter there were 18 days of red air quality and 28 days of yellow air quality. A smart solution for addressing social determinants of health that negatively impact patients in this area could be addressing decreasing air pollution through increased public transportation. Healthcare systems will see an increase in cost of care during those times and long term population health challenges can emerge. You can look at your county after you enter your email address on their site. This kind of social data visualization can give high level insights into the social factors your population faces.

One of the themes of HealthDataPalooza was how to use system change to navigate the intersection between taking care of patients and not finding way to exclude groups. During his panel discussion of predictive analytics, Craig Monson the medical director for analytics and reporting discussed how “data analytics is the shiny new toy of healthcare.”    In addition to winning the unofficial datapalooza award for the most quotes and one liners – Craig presented the Clinical Risk Prediction Initiative (CRISPI).  This is a multi variable logistic regression model with data from the Atrius health data warehouse. His questions for systems to remember in their data analysis selection are “Who is the population you are serving? What is the outcome you need? What is the intervention you should implement?”

Warning- Craig reminds us that in a world of increasing sexy artificial intelligence coding a lot of the value analysis can be done with regression. Based on that statement alone I think he can be trusted. I still need to see his data.

CRISPI analyzed the relative utility of certain types of data, and didn’t have a large jump in utility when adding Social Determinant Data. This data was one of the most popular data sets during Datapalooza discussions but the reality of making actionable insights into system improvement? Craig’s analysis said it was lacking. Does this mean social determinant data isn’t significant or that it needs to be handled with a combination of traditional modeling and other methods?  Craig’s assertion seemed to fly in the face of the hot new trend of Social Determinants of Health data from the surface.

Do we have too much data or the wrong use of the data? Most of the companies investing into this space used data sources outside the traditional definition to help create solutions with social determinate of health and Patient outcomes. They differed in how they analyzed social determinant data. Traditional data sources for the social determinants of health are well defined within the public health research.  The conditions in which you work and live impact your health.

Datapalooza had some of the greatest minds in data analytics and speakers addressed gaps in data usefulness. Knowing that a certain large county wide population has a problem with air quality might not be enough to improve patient outcomes. There is need for analysis of traditional data sources in this realm and how they can get meaningful impact for patients and communities. Healthcare innovators need to look at different data sources.  Nick Dawson, Executive director of Johns-Hopkins Sibley Innovation Hub responded to the conversation about food at home with the data about Washington DC.  “DC like many cities has open public data on food scarcity. But it’s not part of a clinical record. The two datasets never touch.” Data about food scarcity can help hospital systems collaborate with SNAP and Government as well as local food programs. Dawson leads an innovation lab at Johns Hopkins Sibley where managers, directors, VPs and C Suite leaders are responsible for working with 4 innovation projects each year.

Audun Utengen, the Co Founder of Symplur said “There’s so much gold in the social media data if you choose to see it.” Social data available online helps providers meet patients where they are and collect valuable data.  Social media data is another source to collect data about patient preferences and interactions for reaching healthcare populations providers are trying to serve. With so much data available sorting through relevant and helpful data provides a new challenge for healthcare systems and providers.

New Data sources can be paired with a consultative model for improving the intersection of accountable care and lack of access due to social factors. We have more sophisticated analytic tools than ever for providing high value care in the intersection between provider responsibility and social collaboration. This proactive collaboration needs to occur on local and national levels.  “It’s the social determinants of health and the behavioral aspects that we need to fund and will change healthcare” we were reminded. Finding local community programs that have success and helping develop a strategy for approaching Social Determinants of Health is on the mind of healthIT professionals.

A number of companies examine data from sources such as social media and internet usage or behavioral data to design improvements for social determinants of health outcomes.   They seek to bridge the gaps mentioned by Dawson. Data sets exist that could help build programs for social determinants of health.  Mandi Bishop started Lifely Insights centered around building custom community plans with behavioral insights into social determinant data. Health in all Policies is a government initiative supporting increased structure and guidelines in these areas. They support local and State initiatives with a focus on prevention.

I’m looking forward to seeing how the data landscape evolves this year. Government Challenges such as the Healthy Behavior Data Challenge launched at Datapalooza will help fund great improvements. All the data people will get together and determine meaningful data sets for building programs addressing the social determinants of health. They will have visualization tools with Tableau. They will find ways to get food to patients at home so those patients will get better. Programs will find a way to get care to rural patients with financial difficulty and build safe housing.

From a healthcare delivery perspective the idea of collaborating about data models can help improve community health and decrease provider and payer cost. The social determinants of health can cost healthcare organizations more money than data modeling and proactive community collaboration.

Great regressions, saving money and improving outcomes?

That is Datapalooza.

Does Your EHR Sell Your EHR Data?

Posted on May 12, 2017 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.

I recently saw a tongue-in-cheek tweet from Howard Green, MD about how healthcare shares data:

There has always been a disconnect between providers and EHR vendors saying they can’t share data and then EHR vendors can easily sell and share EHR data to the healthcare industry. If you don’t think this happens at large scales in healthcare, then you need to look no further than IMS which last I checked was a multi billion dollar public company on the back of our health data.

The “sharing” or should we say selling of EHR data is big business and happening a lot more than we realize. I know the Patient Privacy Rights organization was trying to make a map of all the ways your health data was being shared. However, you can imagine that’s an almost impossible task to accomplish. I think most of us would be shocked to see how far and wide are health data is shared.

I wonder how many doctors know the answer to this question, “Does your EHR sell your EHR data?”

My guess is that most doctors assume that their EHR data is not being sold. For a number of EHR vendors, that’s probably true. However, my guess is that most doctors don’t know their EHR vendor’s policy on selling EHR data. If you don’t know, you should ask your EHR vendor and find out.

For those EHR vendors that are selling EHR data, you can be sure that they will happily reply that any EHR data they sell is de-identified. They’ll argue that it’s not a violation of HIPAA because it doesn’t have any PHI because they’ve de-identified the data and only sell the data in aggregate. No doubt there are many that would argue that there’s no perfect way to totally de-identify your EHR data and that when combined with other sources, they can often identify your patients.

This is big business and so it’s easy to see why an EHR vendor would give the go ahead to de-identify and sell the data stored in their EHR. Although, it is disappointing when they’re doing this and their users don’t know that’s the case.

If you’ve asked your vendor if they sell your EHR data, we’d love to hear what they say. How did they respond? Are you ok with your EHR selling your de-identified EHR data?

Using AI To Streamline EMR Workflow For Clinicians

Posted on May 10, 2017 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.

Understandably, most of the discussion around AI use in healthcare focuses on data analytics for population health management and predictive analytics. Given the massive scale of the data we’re collecting, that’s no surprise.

In fact, one could argue that using AI technologies has gone from an interesting idea to an increasingly established parto the health IT mix. After all, few human beings can truly understand what’s revealed by terabytes of data on their own, even using well-designed dashboards, filters, scripting and what have you. I believe it takes a self-educating AI “persona,” if you will, to glean advanced insights from the eternity of information we have today.

That being said, I believe there’s other compelling uses for AI-fueled technologies for healthcare organizations. If we use even a relatively simple form of interpretive intelligence, we can improve health IT workflows for clinicians.

As clinicians have pointed out over and over, most of what they do with EMRs is repetitive monkey work, varied only by the need to customize small but vital elements of the medical record. Tasks related to that work – such as sending copies of a CT scan to a referring doctor – usually have to be done in another application. (And that’s if they’re lucky. They might be forced to hunt down and mail a DVD disc loaded with the image.)

Then there’s documentation work which, though important enough, has to be done in a way to satisfy payers. I know some practice management systems that integrate with the office EMR auto-populate the patient record with coding and billing information, but my sense is that this type of automation wouldn’t scale within a health system given the data silos that still exist.

What if we used AI to make all of this easier for providers? I’m talking about using a predictive intelligence, integrated with the EMR, that personalizes the way data entry, documentation and follow-up needs are presented. The AI solution could automatically queue up or even execute some of the routine tasks on its own, leaving doctors to focus on the essence of their work. We all know Dr. Z doesn’t really want to chase down that imaging study and mail it to Albany. AI technology could also route patients to testing and scans in the most efficient manner, adjusted for acuity of course.

While AI development has been focused on enterprise issues for some time, it’s already moving beyond the back office into day-to-day care. In fact, always-ahead-of-the-curve Geisinger Health System is already doing a great deal to bring AI and predictive analytics to the bedside.

Geisinger, which has had a full-featured EMR in place since 1996, was struggling to aggregate and manage patient data, largely because its legacy analytics systems couldn’t handle the flood of new data types emerging today.

To address the problem, the system rolled out a unified data architecture which allowed it to integrate current data with its existing data analytics and management tools. This includes a program bringing together all sepsis-vulnerable patient information in one place as they travel through the hospital. The tool uses real-time data to track patients in septic shock, helping doctors to stick to protocols.

As for me, I’d like to see AI tools pushed further. Let’s use them to lessen the administrative burden on overworked physicians, eliminating needless chores and simplifying documentation workflow. And it’s more than time to use AI capabilities to create a personalized, efficient EMR workflow for every clinician.

Think I’m dreaming here? I hope not! Using AI to eliminate physician hassles could be a very big deal.

MACRA Insights from Around the Twittersphere – MACRA Monday

Posted on May 8, 2017 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.

For this week’s MACRA Monday, I thought I’d offer some insights and perspectives on MACRA from around the Twittersphere. There’s a lot of information about MACRA shared on Twitter and here are some of the best ones I found.


I admit that I’d never heard of BKDHelathcare before, but this 2 minute video offers some good insights into the MACRA decision making process.


SA Ignite is one of the top companies working on MACRA reporting tools. So, it’s no surprise that they’re producing some great content on how to approach MACRA, MIPS and APMs. I hadn’t thought about tracking MIPS even if you’re in an APM, but SA Ignite offers a number of good reasons why organizations might want to consider doing both.


I love a good infographic. We’ve covered most of this in MACRA Monday, but this might be useful for those of you who are just catching up with the details.


The above is a politically correct plea from a doctor. There are other pleas that are a little stronger:


and…

Unfortunately, the rebel forces currently aren’t large enough to move the needle. We’ll be watching to see if that changes.

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

EHRs Were Never Designed to Influence Medicine

Posted on May 4, 2017 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 is a concept I’ve been chewing on for a couple years. When you look at the history of EHR software, EHRs were not designed to influence medicine. They weren’t designed to improve care. They weren’t designed to ensure patient safety. Looking back, they were designed as big billing and documentation engines.

When you look at their feature sets, this becomes abundantly clear. EHRs were designed to better help a practice document the visit and bill the insurance company. The idea of improving patient care, better patient safety and other ideas came along much later.

As I mentioned, I’ve written about this idea before. Usually, I proceed to talk about how doctors and practices that expect their EHR to improve care have been misled. I still think that’s largely the case and that expectations need to be adjusted. However, today I realized that there’s another important lesson that needs to be learned by the history of EHR software and that lesson is for EHR vendors.

EHR vendors need to realize that their systems weren’t designed to improve care. Write as many blog posts as you want. Add whatever signage you want to your exhibit hall booth or to your email campaigns. You still weren’t designed to improve care. This is not necessarily a bad thing, but it’s important that a company knows who it is and knows its limitations.

Think about how valuable it would be for an EHR vendor to come to this realization. Once they realize this to be the case, then their approach to working with other companies would shift dramatically. Instead of seeing other companies that do improve patient care as the enemy, they could see them as partners that could enable their EHR users to improve care. That’s right. An EHR software doesn’t have to be the end all be all.

Even if your EHR software can improve care in a few ways, this concept still applies. An EHR vendor has limited bandwidth. They can’t do everything and so they can’t improve care across every medical specialty and every opportunity. Even within a specialty, there are often innovations that other companies can provide that the EHR vendor doesn’t have time, expertise, knowledge, or capability to provide. This is why an EHR vendor that has amazing partner relationships is going to be so valuable moving forward.

I actually only know one EHR company that was truly started to modernize medicine. However, even they can’t do everything. Every EHR vendor will have to rely on partners if they really want to influence medicine the way they could and the way they should.

Is It Time To Divorce Your HIT Vendor?

Posted on May 2, 2017 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.

Few organizations are totally satisfied with their technology vendors. Even if they’re doing their best, their relationship with you can be disrupted by issues like staff turnover, changes in the product roadmap or an acquisition. Depending on how well your partnership worked in the first place – and how dependent you are on their technology – you may choose to ride out such issues.

But there are times that you have to make some hard decisions about your future with a vendor, particularly if their overall strategy diverges from yours. If you’re wondering how to sort out whether you need to part ways, you might want to consider some suggestions from Dick Taylor, MD, executive vice president with healthcare IT consulting firm MedSys Group. Dr. Taylor’s “Signs Your Vendor’s Not That Into You” include:

  • The new upgrade comes with sticker shock: If the new software calls for a costly “forklift upgrade,” and all told will create a lot of expense and issues, be concerned.
  • Their technology is very dated: If the vendor hasn’t adopted current technologies like virtualization, web services and the cloud – or at least considered whether they’re appropriate for customer needs — it’s a bad sign. Remember that part of your maintenance fees should go to long-term planning by the vendor that incorporates emerging tech as needed.
  • They haven’t stayed in touch post-sale: Expect for not only sales people to touch base, but also experts from R&D, support engineering and implementation to check in and ask about your needs and concerns. If they don’t, maybe they just see you as a revenue stream.
  • Their engineering staff has been gutted: Some vendors reduce their engineering roster, particularly if they’ve acquired the product in question, seemingly in the belief that their source code will maintain itself. This will not end well.
  • They don’t have customers like you on board anymore: You don’t want to be part of a dying customer base. In fact, you want to make sure other customers like you – such as, say, other large health systems – are still part of the mix. Otherwise, it’s unlikely developers will address your specific interests.
  • They’ve lost their focus: Given the rapid pace at which new healthcare technologies emerge, it’s easy for vendors to get distracted. Of course, it’s all well and good that they’re aware of cutting-edge technologies. That being said, make sure they don’t plan to rush in a new direction and ignore your needs.

Other vendor warning signs that came to mind for me included:

  • They don’t respond promptly to service requests
  • The people who interact with you are rude or poorly trained
  • Their new contract has hidden “gotchas” in it that they won’t consider addressing
  • The product can no longer do the job for which you acquired it, and they don’t seem capable of fixing it to your satisfaction

In some ways, important vendor relationship are like marriages in that every situation is different and that some give and take is involved. But if your relationship isn’t working, or undermining your plans, you’ve probably reached the end of the road.

MACRA Burnout – MACRA Monday

Posted on May 1, 2017 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.

It’s May 2017 and I’m already burnt out of MACRA. Does anyone else feel this way? The MACRA program has just gotten started and I’m already pretty sick and tired of talking about the details. I can only imagine how a doctor feels at this point. It feels a little bit like groundhog day doesn’t it?

I’m sure much of what contributes to this is the layers and layers of government requirements that we’ve had to go through over the past 5-6 years. It started with meaningful use and PQRS and then we realized there were multiple stages of meaningful use. We’ve been through stage 1 and stage 2. Of course, related to that is all the EHR certification regulation. Then, ICD-10 hit us upside the head. We worked through it, but it wasn’t fun and didn’t add much value to our patients or our organizations. Now we’re hit by MACRA. Aren’t we all just a little tired of these regulations?

Don’t get me wrong. Healthcare is a highly regulated industry, so this is the norm. Plus, I’m not saying that practices should just shun MACRA. Most practices I know need to at least avoid the penalties. So, they’ll have to participate, but I don’t know a single doctor that’s excited about the benefits of any piece of the MACRA legislation. That should tell us something and we should listen.

Think about what an achievement that is by MACRA. Doctors aren’t excited about any of it. It’s actually kind of embarrassing to think about. If you are a doctor that’s excited about some piece of MACRA and especially MIPS, I’d love to hear about it. How is any of it going to improve care, lower costs, or improve productivity? I’ll be waiting in the comments, but I certainly won’t be holding my breathe.

How sad that millions of dollars and millions of hours are going to be wasted on a legislation that isn’t too hard, but also doesn’t add value. That’s a travesty and I don’t see it changing.

I’m trying to think what would reinvigorate organizations. Is there a legislation that doctors would get excited about? That’s a hard thing to crack, but the best I could do is interoperability. What if we scraped all of MACRA and just focused on penalizing organizations that aren’t sharing data with each other.

Even this change would leave a lot of people wondering the exact value. However, there’s a pretty solid case to be made that exchanging healthcare data could improve care and lower costs. Those are things that people can get behind.

All of this said, I’m not expecting any changes. MACRA is here to stay and EHR vendors and healthcare organizations are going to have to grind it out and participate. However, that doesn’t make the MACRA burnout any less poignant.

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