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Mercy Shares De-Identified Data With Medtronic

Posted on October 20, 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.

Medtronic has always performed controlled clinical trials to check out the safety and performance of its medical devices. But this time, it’s doing something more.

Dublin-based Medtronic has signed a data-sharing agreement with Mercy, the fifth largest Catholic health system in the U.S.  Under the terms of the agreement, the two are establishing a new data sharing and analysis network intended to help gather clinical evidence for medical device innovation, the company said.

Working with Mercy Technology Services, Medtronic will capture de-identified data from about 80,000 Mercy patients with heart failure. The device maker will use that data to explore real-world factors governing their response to Cardiac Resynchronization Therapy, a heart failure treatment option which helps some patients.

Medtronic believes that the de-identified patient data Mercy supplies could help improve device performance, according to Dr. Rick Kuntz, senior vice president of strategic scientific operations with Medtronic. “Having the ability to study patient care pathways and conditions before and after exposure to a medical device is crucial to understanding how those devices perform outside of controlled clinical trial setting,” said Kuntz in a prepared statement.

Mercy’s agreement with Medtronic is not unique. In fact, academic medical centers, pharmaceutical companies, health insurers and increasingly, broad-based technology giants are getting into the health data sharing game.

For example, earlier this year Google announced that it was expanding its partnerships with three high-profile academic medical centers under which they work to better analyze clinical data. According to Healthcare IT News, the partners will examine how machine learning can be used in clinical settings to sift through EMR data and find ways to improve outcomes.

“Advanced machine learning is mature enough to start accurately predicting medical events – such as whether patients will be hospitalized, how long they will stay, and whether the health is deteriorating despite treatment for conditions such as urinary tract infections, pneumonia, or heart failure,” said Google Brain Team researcher Katherine Chou in a blog post.

As with Mercy, the academic medical centers are sharing de-identified data. Chou says that offers plenty of information. “Machine learning can discover patterns in de-identified medical records to predict what is likely to happen next, and thus, anticipate the needs of the patients before they arise,” she wrote.

It’s worth pointing out that “de-identification” refers to a group of techniques for patient data protection which, according to NIST, include suppression of personal identifiers, replacing personal identifiers with an average value for the entire group of data, reporting personal identifiers as being within a given range, exchanging personal identifiers other information and swapping data between records.

It may someday become an issue when someone mixes up de-identification (which makes it quite difficult to define specific patients) and anonymization, a subcategory of de-identification whereby data can never be re-identified. Such confusion would, in short, be bad, as the difference between “de-identified” and “anonymized” matters.

In the meantime, though, de-identified data seems likely to help a wide variety of healthcare organizations do better work. As long as patient data stays private, much good can come of partnerships like the one underway at Mercy.

Current Security Approaches May Encourage EMR Password Sharing

Posted on October 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.

In theory, you want everyone who accesses a patient’s health data to leave a clear footprint. As a result, it’s standard to assign every clinician using EMR data to be assigned a unique user ID and password. Most healthcare organizations assume that this is a robust way to document who is using the system and what they do when they’re online.

Unfortunately, this may not be the case, which in turn means that providers may know far less about health data users than they think. In fact, this approach may actually undermine efforts to track health data access, according to a new study appearing in the journal Healthcare Informatics Research.

The researchers behind the study created a Google Forms-based survey asking medical and para-medical personnel whether they’d ever obtained another medical staff member’s password, and if so, how many times and what their reasons were.

They gathered a total of 299 responses to their questions. Of that total, 220 respondents (just under 74%) had “borrowed” another staff member’s password. Only 57% answered the question of how many times this had happened, but among those who did respond the average rate was 4.75 episodes. All of the residents taking part had obtained another medical staff member’s password, compared with 57.5 percent of nurses.

The reasons medical staffers gave for sharing passwords included that “I was not given a user account despite having to use the system to fulfill my duties.” This response was particularly prevalent among students. Researchers got similar results when naming the reason “the permissions granted to me did not allow me to a fulfill my duties.”

Given their working conditions, it may be hard for medical staff members to avoid bending the rules. For example, the authors suggest that doctors will at times feel compelled to share password information, as their duties are wide-ranging and may involve performing unplanned services. Also, during on-call hours, interns and residents may need to perform activities that require them to use others’ EMR account information.

The bottom line, researchers said, is that the existing approach to health data security are deeply flawed. The current password-based approach used by most healthcare organizations is “doomed” by how often clinicians share passwords, they argue.

In other words, putting these particular safeguards in effect may actually have the paradoxical effect. Though organizations might be tempted to strengthen the authentication process, doing so can actually worsen the situation by encouraging system workarounds.

To address this problem over the long-term, widely-accepted standards for information security may need to be rethought, they wrote. Specifically, while the ISO standard bases infosec on the principles of confidentiality, integrity and availability, organizations must add usability to the list. Otherwise, it will be difficult to get an-users to cooperate voluntarily, the article concludes.

Telemedicine Becoming Popular, But Seldom Profitable

Posted on October 18, 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.

New research suggests that while most physicians are supportive of telemedicine, others have grave reservations about providing this type of care, and that more than half of organizations aren’t making money delivering telemedicine services.

In an effort to learn more about attitudes toward telemedicine, Reaction Data surveyed 386 physicians, physician leaders, IT leaders and nurse leaders as well as differences in adoption levels between different types of organizations.,

Some of the top benefits of telemedicine cited by respondents included that it helped providers to meet demand for simpler and more cost-effective care delivery (28%), allowed them to treat more patients (23%) and that it was easing demands on staff (19%). Interestingly, just 10% said that telemedicine was proving to be a viable source of revenue, and elsewhere in the survey, 14% reported that telemedicine was revenue-negative.

The majority of physicians (68%) reported that they were in favor of telemedicine, while another 15% took a neutral position. Only 17% didn’t support widespread telemedicine use.

Their responses varied more, however, when it came to how much of care could be effectively delivered via telemedicine.

Thirty-two percent felt that 0 to 20% of care could be delivered this way; 33% of physician respondents felt that 30 to 40% care could be delivered digitally; 19% of respondents said 50 to 60% of care could be provided via telemedicine; 14% felt that 70 to 80% of care could be provided digitally. Just 2% felt that 90 to 100% of care could be delivered via this channel.

When it came to actually delivering the care themselves — rather than a hypothetical situation — respondents seemed less flexible. For example, 33% said that they would never contract with an outsourced telemedicine company to provide patient consults.

On the other hand, 50% said they’d considered moonlighting as a telemedicine consultant, 7% said they’d already done so frequently, 8% said they delivered such consults occasionally 2% said that was all they did for a living.

Regardless, many healthcare organizations are adopting this approach on a corporate level. Sixty-one percent of hospitals in a health system said they adopted telemedicine: 40% of standalone hospitals had done so; 58% practices owned by a health system has that this technology. Only 17% of physician-owned practices had done so, which could reflect cultural issues, costs or technology adoption concerns.

Physicians that were delivering telemedicine services most often used them to reach patients in rural areas (24%), provide follow-up care (24%) and manage specific patient populations (23%).

Among organizations that haven’t adopted telemedicine, many are scarcely getting their feet wet. While one in three providers are evaluating telemedicine options currently, 20% are two years or more away from adoption and 26% said they would never move in this direction.

Meanwhile, roughly one-third of physician-owned practices reported that they would never adopt telemedicine. One responding physician called it “inherent malpractice,” and another called it a “blatant attempt to circumvent the physical examination.” It seems unlikely that these clinicians will change their views on this topic.

Medical Groups Can Use EHR Data To Analyze Clinical Workflows

Posted on October 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.

Typically, ambulatory care organizations don’t do workflow studies, as leaders assume they have neither the time nor the data available to make it happen.

They may have more options than they think, however. A group of researchers has concluded that timestamp data found in their EHR can be used to predict ambulatory workflow.

The research article, which appears in the Journal of the American Medical Informatics Association, notes that workflow studies typically require large amounts of timing data which are too expensive to collect through observation or tracking devices. Historically, ambulatory care organizations have had to make do with observation and intuition rather than sophisticated interventions.

In fact, the relationship between health IT and ambulatory care workflow redesign hasn’t been a friendly one. A 2015 study by the Agency for Healthcare Research and Quality concluded that health IT implementations could make a mess of existing workflows. Problems included “a redistribution of clinicians’ and clinic staff’s time on different clinical tasks, repurposed usage of workspace, increased level of interruptions, multitasking, and off-hours work activities.”

According to the current group of researchers, however, these organizations may have the data they need at their fingertips. The study, which used EHR timestamp data to predict ambulatory workflow timings, suggests that this approach is valid.

To conduct the study, the researchers studied the workflow at four outpatient ophthalmology clinics associated with the Oregon Health and Science University, observing their workflows and timing each workflow step. They then mapped the EHR timestamps to workflow steps to see how they compared.

They found that workflow times generated by EHR timestamp analysis were within three minutes of observed times for greater than 80% of the appointments. What variance they did observe between observed times and timestamps seems to have been due to EHR use patterns.

Even giving these variances, ambulatory care organizations can get a lot of value out of EHR timestamp data, researchers said. “EHR timestamps…can be used to create simulation models, analyze HR use, and quantify the impact of trainees on workflow,” they concluded.

Even given this option, few ambulatory care organizations are likely to conduct formal workflow studies unless they’re backed by a deep-pocketed health system. Most medical practices have their hands full collecting what they’re owed by health plans and managing operations on a day-to-day basis.

This isn’t to suggest that they are unsophisticated, but rather, that workflow studies may require a level of time, commitment and resources that smaller practices simply don’t have. Most U.S. medical practices are small businesses.

Still, it’s good to know that if they choose, medical groups can use data already available in their EHR to make meaningful workflow improvements. Perhaps it’s time for vendors to step forward and support the use of EHRs for this purpose.

In What Seems Like An Effort To Make Nice, eClinicalWorks Joins OpenNotes Initiative

Posted on October 12, 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.

eClinicalWorks has decided to try something new. The health IT vendor has announced that it will support the OpenNotes project, an initiative in which doctors share their notes with patients.

As most readers will know, it recently came to light that eClinicalWorks had gotten itself into some very hot water with the feds. eCW was forced to pay a $155 million settlement when the U.S. Department of Justice concluded that it had faked compliance with EMR certification standards.

Now, perhaps in an effort to make nice, eCW is making it possible for its customers to share visit notes using its patient portal. Actually, to be precise, the patient portal already had the ability to offer visit summaries to patients, but OpenNotes capabilities enhance these summaries with additional information.

OpenNotes, for its part, got its start in 2010, when Beth Israel Deaconess Medical Center, Geisinger Health System and Seattle’s Harborview Medical Center decided to study the effects of letting patients read their medical notes via a portal.

The study, the results of which were published in the Annals of Internal Medicine in 2012, concluded that patients approved of note-sharing wholeheartedly, felt more in control of their care and had an easier time with medication adherence. Also, while some doctors reported changing documentation during this process, the study also found that doctors saw no significant changes in workload.

Perhaps most telling, at the end of the process 99% of patients wanted OpenNotes to continue, and none of the participating doctors opted out. A movement had been launched.

Since then, a long list of organizations has come on board to drive implementation of open notes, including Kaiser Permanente Northwest, Providence Health System, Salem Health and Oregon Health and Science University. This year, OpenNotes announced that 16 million Americans now had access to their medical notes online.

Back in 2012, I asked readers whether OpenNotes would eventually influence EMR design. Today, I would suggest that the answer is both “yes” and “no.”

On the one hand, I have little doubt that the project helped to advance the notion that patients should have on-demand access to their healthcare information, and moreover, to use it in managing their care. While some doubted this approach would work, OpenNotes can now be said to have sold the idea that health data transparency is a good idea. While the initiative had its doubters at its outset, today patient record access is far better accepted.

On the other hand, eClinicalWorks is the first EMR vendor I’m aware of to explicitly announce its support for OpenNotes. While it’s hard to tell what this means, my guess is that its competitors don’t see a need to take a position on the matter. While vendors are certainly being forced to take patient-facing data access into account, we clearly have a long way to go.

Bridging the Gap between What Patients Want and What Practices Offer

Posted on October 11, 2017 I Written By

The following is a guest blog post by Jim Higgins, Founder & CEO at Solutionreach. You can follow him on twitter: @higgs77

With the growing pressure of increasingly complex healthcare regulations, malpractice litigation, and expectations of quality care, modern-day medical practices face an unprecedented set of challenges when it comes to running a successful practice.

Throw in marketing, billing, scheduling, appointment reminders, and all of the other day-to-day aspects of running a practice, and many practices are maxed out.

But while practices are busy juggling this growing number of expectations, patient satisfaction has been falling.

Today’s patients have become accustomed to a buyer-centered approach in nearly every industry. Likewise, they expect the same from their healthcare professionals. Unfortunately, many practices have been slow to adapt.

The Patient-Provider Relationship Study recently found that the average medical provider with a panel of 2,000 patients could lose around 700 patients in the next couple of years. A large number of these patients are leaving due to dissatisfaction with their experience at a practice.

Much of the growing dissatisfaction from patients is in relation to practices not offering the services and technology that they have come to expect. Experts warn that the medical field lags behind every other industry in the adoption of new technology. This inevitably leads to a gap between what patients expect from their medical practice and what practices actually offer.

Perform a thorough gap assessment

According to the study, 60 percent of patients are not completely satisfied with practice logistics such as appointment scheduling, reminders, and communication. In fact, logistics is the area in which patients have the greatest overall dissatisfaction with their practice.

It is important that practices both understand what patients want the most and then complete an assessment to determine areas that need improvement.

The Patient-Provider Relationship Study found that patients want many additional touchpoints, including:

  • Text appointment reminders
  • Appointment alerts by email
  • Appointment alerts by text
  • Being able to text message back and forth with the practice
  • Allowing patients to initiate text messages to the practice

Unfortunately, a large number of practices do not offer these services. The following chart highlights how many practices offer each of these services, compared to a goal of 100 percent implementation.

With the majority of patients expressing dissatisfaction with the logistics offered by their medical practice, it is clear that changes need to be made. This requires the implementation of new, or more robust, technology.

Implement technology without distress

Practices want to be more efficient and provide an improved patient experience, but the fear of making the wrong choices around new technology can hold them back. Each of the aforementioned services have the potential to either improve processes and efficiency or make them more difficult. The outcome depends on the practice’s ability to carefully assess each piece of technology before moving forward.

There are steps you can take to eliminate some of the risk when choosing a new technology. One of the most important things you can do is to ask right questions before and during the selection process. Consider the following:

  1. Who will be impacted by this change?
  2. How will the technology affect your current workflow?
  3. Is the technology compatible with your current systems?
  4. Will the technology meet current and future compliance requirements?
  5. What will the implementation process include?
  6. How have other offices felt about the technology?
  7. What type of on-going customer service and training does the company offer?

When it comes to achieving high levels of patient satisfaction, it is critical that practices bridge the gap between what patients want and what is currently being offered. After performing a gap assessment and carefully vetting available technology, practices will be able to move forward in a way that will reduce the load on employees, create meaningful improvements in the practice, and boost the bottom line.

Solutionreach is a proud sponsor of Healthcare Scene. As the leading provider of patient relationship management solutions, Solutionreach is dedicated to helping practices improve the patient experience while saving time for providers and staff. Learn more about the Patient-Provider relationship survey here.

Optimizing Your EHR for MIPS and Other Quality Payment Programs – MACRA Monday

Posted on October 9, 2017 I Written By

The following is a guest blog post by Meena Ande currently acts as Director of Implementation for Advantum Health. This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program (QPP) and related topics.

As quality reporting requirements ramp up under value-based payment programs like MIPS, healthcare organizations are busy retrofitting their EHRs to make way for new measures. In some settings, not much has changed by way of tech utilization since initial EHR investments were made. Many outpatient settings still lack the internal expertise needed to optimize their implementations.

The truth is many EHRs have the functionality providers need for quality reporting, but many providers don’t know that due to limited exposure to the system. Couple that stunted tech knowledge with the well documented lack of familiarity with MACRA and the recent rise of the service model in healthcare is no surprise. Many practice administrators are relying on their EHR vendor or engaging outside experts to help lead the charge on system reconfiguration to meet Quality Payment Program demands.

There are several EMR capabilities providers can take advantage of to support QPP reporting efforts. Here are a few tips to keep in mind as you customize your EHR for MIPS and other value-based models.

Don’t boil the ocean when selecting CQMs.

Most EHRs give the option of tracking more than what is required for quality reporting. Initially, track applicable measures that exceed reporting requirements. After three to four weeks you’ll know which are your strong areas. Pick the best of the litter and proceed.

Providers can be overwhelmed by too many measures, particularly in multi-specialty practice settings. While it can be difficult to find overlap in measures between specialties, taking advantage of shared metrics whenever possible can reduce reporting burdens. Sit down as early as possible and develop an EHR configuration that works for your practice’s various clinicians.

Case in Point:

A gastroenterologist and a cardiologist may work in the same multi-specialty organization and on the same EHR, but the clinical quality measures they care about differ. There is no reason to give the gastroenterologist access to the cardiology problem list in the EHR. Specialty views improve ease-of-use and support more complete documentation.

Most EHRs offer role-based and specialty-based customization. Administrators can enable or disable EHR features related to some quality measures at the practice level and sometimes at the individual provider level. Clinical quality measures are based on details about the patient, but what is captured at each point of care should be tailored to the specific provider role.

Consider the roles impacted by different CQMs.

Keep the role of the person who may be responsible for different quality measures and Advancing Care Information workflows in mind when selecting and carving out space for CQMs in your EHR. Select measures that spread reporting work across multiple roles to relieve clinicians of unnecessary burdens.         

Case in Point:

The insurance eligibility verification required under Meaningful Use is managed by the front office. Front-office staff members should be made aware of the processes they need to complete before a patient checks in, and where to document that task in the EHR.

Control what is included in MIPS denominators.

Like Meaningful Use, patient encounter volume is important under MIPS. The size of the patient pool under any given quality measure directly impacts your adherence percentage. While most primary care encounters do meet patient visit requirements under MACRA, that is not always the case in specialty settings. Clinicians can exercise some control in determining what is included in patient denominators when reporting under MIPS.

Case in point:

Some primary care visits can be omitted. Let’s say a two-physician practice sees 50 patients a day. Only 15 of those patients might be seen by a physician. The rest of the patients may be there for a simple procedure like a blood pressure screening, stress test, or echocardiogram, where quality reporting elements are not verified. Such visits should be excluded.

Evaluate your reporting paths.

MIPS offers both EHR-based and registry-based reporting paths. Most specialties can submit CQM data via their EHR while others will have to rely on paid registry reporting. Additional reporting options might include submitting through associations that member clinicians are affiliated with, or through registries created by large hospital affiliates to help related providers.

Another hurdle for clinicians is deciding whether to submit data as a group or independently. Groups interested in participating in MIPS via the CMS web interface or administering the CAHPS for MIPS survey had until June 30, 2017, to register. Beyond that, clinicians have until the March 31, 2018, MIPS submission deadline to decide whether to report independently or as a group.

Case in point:

Big groups with different levels of EHR proficiency among providers may be better suited reporting at an individual level. Individual reporting takes more time for attestation, but the advantage is that higher-performing clinicians can avoid a penalty if the group doesn’t collectively meet reporting criteria.

Each month, sample 10 percent of EHR CQM data, including instances where criteria have been met and where it has not. Catch outliers with trouble following through on processes and extend targeted training to the team members bringing numbers down.

Conclusion

Optimizing the EHR and other tech resources providers have in place can be a huge MIPS enablement factor. Up-front customization work helps providers meet reporting requirements and save time over the long run. EHR optimization also enables future value-based care initiatives and lays the groundwork for population health management programs. Gains made in EHR use benefit the life of the practice through increased efficiency and, at the end of the day, better patient care.

About Meena Ande
Meena Ande currently acts as Director of Implementation for Advantum Health where she manages Implementation of services along with EHR optimization, with emphasis on workflow management for value-based reporting.

Usability, Interoperability are Political Questions: We Need an EHR Users Group

Posted on October 6, 2017 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Over the years, writers on blogs such as this and EMRandHIPAA have vented their frustration with lousy EHR usability and interoperability problems. Usability has shown no real progress unless you count all the studies showing that its shortcomings cost both time and money, drives users nuts, and endangers patient lives.

The last administration’s usability approach confused motion with progress with a slew of roadmaps, meetings and committees. It’s policies kowtowed to vendors. The current regime has gone them one better with a sort of faith based approach. They believe they can improve usability as long it doesn’t involve screens or workflow. Interoperability has seen progress, mostly bottom up, but there is still no national solution. Patient matching requires equal parts data, technique and clairvoyance.

I think the solution to these chronic problems isn’t technical, but political. That is, vendors and ONC need to have their feet put to the fire. Otherwise, in another year or five or ten we’ll be going over the same ground again and again with the same results. That is, interop will move ever so slowly and usability will fade even more from sight – if that’s possible.

So, who could bring about this change? The one group that has no organized voice: users. Administrators, hospitals, practioners, nurses and vendors have their lobbyists and associations. Not to mention telemed, app and device makers. EHR users, however, cut across each of these groups without being particularly influential in any. Some groups raise these issues; however, it’s in their context, not for users in general. This means no one speaks for common, day in day out, EHR users. They’re never at the table. They have no voice. That’s not to say there aren’t any EHR user groups. There are scads, but vendors run almost all of them.

What’s needed is a national association that represents EHR users’ interests. Until they organize and earn a place along vendors, etc., these issues won’t move. Creating a group won’t be easy. Users are widely dispersed and play many different roles. Then there is money. Users can’t afford to pony up the way vendors can. An EHR user group or association could take many forms and I don’t pretend to know which will work best. All I can do is say this:

EHR Users Unite! You Have Nothing to Lose, But Your Frustrations!

Health System Sues Cerner Over Billing-Related Losses

Posted on October 5, 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.

If I asked you what issues cause the biggest conflicts between EMR vendors and their clients, you might guess that clinical data management disputes or customer service issues topped the list. But actually, in my experience the most common problems health systems encounter in their EMR rollouts are billing-related.

For example, Dana-Farber Cancer Institute just announced a $44.2 million operating loss for the third quarter of fiscal 2017. The Boston-based hospital attributes at least part of its losses to billing issues associated with its Epic system. Leaders at Dana-Farber said that these billing issues had cost the hospital roughly $25 million since it rolled out Epic in May 2015, according to Becker’s Hospital CFO Report.

Another instance comes from Healthcare IT News, which reports that Cerner is being sued by a health system accusing the vendor of selling it faulty billing software.

The suit, by Wisconsin-based Agnesian Healthcare, accuses Cerner of fraud and breach of warranty, and asserts that issues with Cerner’s revenue cycle software led to losses of more than $16 million. The hospital system contends that these problems have damaged its reputation and generated $200,000 a month in damages. (Cerner disputes these allegations, of course.)

According to HIN, the hospital system went live with Cerner’s RCM software in 2015, for which it paid $300,000. Agnesian’s suit says that problems with the Cerner package began shortly after rollout, generating widespread errors in its patient billing statements.

According to the health system, its billing process was so compromised that it had to send out statements by hand. (Yes, I can feel you cringing from here.) Given the delays inherent in relying on manual processes, Agnesian ended up with a huge backlog of unprocessed statements, some of which it deemed uncollectible and wrote off.

When the health system alerted Cerner about its concerns, the vendor got involved, and in 2016 it told Agnesian that problems have been addressed.  Nonetheless, this year the health system found “major additional coding errors” which led to another round of lost revenue, Agnesian says.

And brace yourself for more cringing: according to the suit, the Cerner RCM software had been writing off reimbursable charges without informing the health system. If you’re an RCM leader or CFO, this is the stuff of nightmares.

Ultimately, Cerner agreed that the RCM solution needed to be rebuilt given the depth of the coding errors found in the software, but that didn’t happen, the suit says. In a final indignity, the personnel tasked with rebuilding the RCM solution left Cerner before completing the rebuild.

Given all the aforementioned mishegas, it will be many a month before billing processes normalize even if Cerner fixes its RCM software, the health system says. And of course, it’s likely to end up writing off more bills under the circumstances, which has got to be very painful by this point.

Agnesian’s suit asks the court to cancel the Cerner contract and award it direct, indirect and punitive damages. Cerner, meanwhile, seems to want to go into arbitration. We’ll see which side blinks first.

#SHSMD17 in 17 Tweets – Perspectives on Healthcare Marketing

Posted on October 4, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

The AHA’s Society for Healthcare Strategists and Marketing Development recently held its annual conference – SHSMD17 – in Orlando Florida. For three full days, 1,500 attendees shared ideas and traded insights on the latest trends healthcare marketing trends. The 60+ concurrent sessions covered a variety of topics including:

  • Developing online support groups for patients
  • Successful blog-driven content marketing
  • Media relationships
  • Communication and preparedness during a crisis
  • Chatbots
  • Consumerism

For daily summaries of SHSMD17, check out these Day 1, Day 2 and Day 3 blogs. As well see this blog on the release of SHSMD’s Bridging Worlds 2.0 report during the conference.

If I had to pick an overall theme for SHSMD17 it would have to be “perspective”. The four keynote speakers and many of the session presenters urged the audience to break out of our boxes in order to truly “see” healthcare from multiple viewpoints – including patients, clinicians and government. Only by putting ourselves into the shoes of healthcare’s various stakeholders can we create effective marketing campaigns and hospital programs.

During the conference, there was a lot of live-tweeting and there were many conversations happening via social media with people who were not in attendance. I thought it would be fun to highlight 17 tweets from SHSMD17.

Here goes.

Fun SHSMD17 Tweets