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EHR: What’s Next?

Posted on September 19, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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 realize this is a simple concept with a million answers. In fact, that’s why I’m posting about it and hopefully starting a rich discussion. A huge portion of the healthcare system has adopted EHR software. I now ask the question:

What’s Next?

I know that some of you reading this will reply meaningful use. Ok. We get that. We know what meaningful use requires. Let’s get beyond meaningful use and talk about what you’re doing with your EHR.

I’m really starting this as a conversation starter. Hopefully you can break it down into two areas:

1. What are you doing with your EHR to optimize your use of your EHR?

2. Now that you have an EHR, what are you going to do next? What are you working on next?

I look forward to hearing your thoughts and answers. Hopefully we’ll get a broad cross section of responses from small practices, hospitals, vendors, etc. I’ll join in the comments as well.

10 Health IT Rockstars and Their #NHITWeek Happenings

Posted on September 18, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

It’s National Health IT Week and so I thought it would be fun to take a quick look at what some health IT social media rockstars are doing to celebrate #NHITWeek.

Mandi Bishop (@mandibpro) is sorting through her petabytes of #HITHeroes selfies and creating a t-shirt that says “I Heart Big Data.”

Farzad Mostashari, MD (@Farzad_MD) is sending out bow ties to prospects for his new company Aledade.

Charles Wesbter, MD (@wareflo) is programming his Google Glass controlled robot to improve EHR workflow.

Wen Dombrowski, MD (@healthcarewen) is practicing to break the World Record for most tweets sent during a conference session.

Gregg Masters (@2healthguru) is reading the latest Flex-IT act and Final Rule on meaningful use flexibility from his surfboard in the ocean.

Cari McLean (@carimclean) and Michael Gaspar (@MichaelGaspar) are fighting over which Health IT meme is more likely to go viral.

Geeta Nayyar, MD (@gnayyar) is making medicine fun and meaningful.

Regina Holliday (@ReginaHolliday) is painting a Walking Gallery jacket for a statue dedicated to the patient that will be put in the CMS lobby in Washington.

Matthew Holt (@boltyboy) is creating a new conference dedicated to Health IT buzzwords. Sessions include #HealthAnalytics, #HealthcareSocialMedia, #ACOs, #PatientEngagement, #HIE, and many more.

Keith Boone (@motorcycle_guy) is doing an HL7 crossword puzzle.

What are you doing for National Health IT week? Feel free to add what other people are doing for #NHITWeek as well. Bonus points if you write what I’m doing for #NHITWeek.

Rise of the Digital Patient Infographic

Posted on September 17, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The social people behind CDW Healthcare are doing a good job putting out some great content on social media. A great example of this is this Digital Patient Infographic that they recently posted:
mHealth_DigitalPatient_Infographic_0914_1000

I recently took part in a webinar with Dodge Communications (I’ll add a link to the webinar once it’s available) yesterday and I made the comment that telemedicine is more efficient for the patient, but I wasn’t sure telemedicine was more efficient for the doctor. There might be a disconnect of benefits there that needs to be reconciled.

As I look at the infographic above, I’m reminded of something similar. The stats in the infographic and just some basic common sense says how much patients would love to do an eVisit. If this is the case, why is it that healthcare hasn’t filled this customer demand? I think the answer is the disconnect of benefits.

What are your thoughts?

Also, since CDW created the infographic above, It’s worth mentioning that CDW also listed this blog on their list of Top 50 Health IT blogs for 2014. I’m not sure I agree that it’s the top 50 health IT blogs since EMR and HIPAA and a number of other Healthcare Scene blogs aren’t on the list, but there are a lot of great bloggers on the list just the same.

#20HIT Comments on Health IT by HL7 Standards

Posted on September 16, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

Many of you know that I’m extremely active on social media (see @techguy and @ehrandhit to start). I love the way it can connect people. It’s so powerful. One of the companies that’s done an amazing job with social media for their company is Corepoint Health and their HL7 Standards blog. The blog is most notable for being the home and birthplace of the #HITsm chat. If you haven’t participated in an #HITsm chat, then you’re missing out. Lots of great health IT discussions every Friday.

Along with being the home of the #HITsm chat, the HL7 Standards blog is a great place to find blog posts from voices throughout the #HITsm community. Plus, they recently started doing a series of “20 Questions for Health IT” with responses from a variety of health IT professional. Check out an example tweet and question that was answered by Mandi Bishop (better known as @MandiBPro):

I love the work their doing and I love hearing perspectives from across the industry. I’m going to think about ways I can do something like they’re doing to bring and amplify more of the interesting voices in healthcare IT. Nice work HL7 Standards.

What Are You Doing for #NHIT Week? Does It Matter?

Posted on September 15, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

Today is the official start of National Healthcare IT Week (#NHITWeek). Do you have any plans for #NHITWeek? Are you doing anything special? I personally don’t have any huge plans, but I do have one post for #NHITWeek that I hope people will enjoy. Watch for that coming later this week on one of the Healthcare Scene blogs.

If you want a full run down of official #NHITWeek activities, EHR Intelligence has put that together. HIMSS seems to be the real driver behind the week from what I can tell. I’ve never been to Washington during #NHIT Week, so maybe that’s why I haven’t ever seen the impact of the week. I guess I’m skeptical about what it really accomplishes.

What I have enjoyed is following the #NHITWeek hashtag on Twitter. There’s a lot of activity on the hashtag. You just have to filter through the #NHITWeek fluff and marketing. From the looks of Regina Holliday’s tweet, there are quite a few people attending the event she’s attending:

Plus, you get to see other craziness like this QR code connected to Casey Quinlan’s health record that she had tattooed on her chest:

Not to mention, you get links to great resources like this one from Steve Sisko:

I think that Steve has the right spirit for what #NHITWeek is for me. It’s about connecting people in the space. It’s always great when we can share the work that’s being done across the spectrum of health IT. I’m always amazed at how many people are working so hard day in and day out to make healthcare IT work.

If I Were AHIMA and Wanted to Ensure ICD-10 Wasn’t Delayed Again

Posted on September 12, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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’ve been working on my schedule for the AHIMA conference happening at the end of the month (officially I think they call it the AHIMA Convention). As I’ve looked over the various meetings and topics that will be discussed, I’m once again faced with the ICD-10 discussion.

I’ll admit that the ICD-10 discussion feels a little bit like the movie Groundhog Day. A little reminder of the movie (man I need to rewatch it):

Much like Bill Murray, I think we’re entering the same ICD-10 cycle that we were in last year. People warning about the impending implementation of ICD-10. People talking about the need to train on ICD-10. The impact of ICD-10 on revenue, productivity, software, etc etc etc. If it feels like we’ve been through these topics before, it’s because we have.

I previously posted an important question, “What Would Make Us Not Delay ICD-10 in 2015?” Unfortunately, I think the answer to that question is that right now nothing has changed. All of the reasons that someone would want ICD-10 to go forward and all of the reasons that ICD-10 should be delayed are exactly the same. I’d love to hear from people that disagree with me. Although, so far people have only come up with the same reasons that were the same last year.

That doesn’t mean it’s a lost cause for organizations like AHIMA that really want ICD-10 to go forward. They could do something that would change the environment and help ensure that ICD-10 actually happens in 2015. (Note: When we’re talking about DC and congress, nothing is certain, but I think this strategy would change the discussion.)

If I were AHIMA and wanted to push forward the ICD-10 agenda, I’d leverage your passionate community and be sure that the story of ICD-10 was told far and wide. The goal would have to be to create the narrative that delaying ICD-10 would cause irreparable harm to healthcare and to millions of people.

I imagine a series of videos with HIM people telling their stories on the impact of ICD-10 delays. These stories aren’t hard to find. Just start by looking at the AHIMA LinkedIn thread about the 2014 ICD-10 delay. Then engage the AHIMA community in social media and provide them the tools to spread these videos, their own stories, and other pro ICD-10 messages far and wide. Don’t underestimate the power of storytelling.

Also, you have to change the conversation about the impact of ICD-10. Far too many proponents of ICD-10 just talk about how it’s going to impact them individually. These individual stories are powerful when creating a movement, but the people in Washington hear those stories all day every day. They don’t usually change decisions based on a few heartbreaking stories. So, you have to illustrate to those in Washington that the impact of another ICD-10 delay is going to cause some harm to the healthcare system. This is not an easy task.

A well organized effort by AHIMA and other organizations could really gather steam. Enough calls, messages, and letters into Congress and they have to take note. It’s a feature of the way their systems are done. Although, a few responses won’t work. It has to be a real grassroots wave of people talking about how delaying ICD-10 is going to cause major issues. The biggest challenge to this is that it was delayed this year and what was the impact?

Of course, the other option is to hire a lobbyist. They’re going to tell the same story, but in a much more direct way. If AHIMA and other ICD-10 proponents don’t work hard to change the narrative of ICD-10 through a lobbyist or a grass roots campaign, then I don’t see any reason why ICD-10 won’t be delayed again. The good part is that any effort to do this will likely be supported and amplified by organizations like CMS. The bad part is that other organizations like the AMA are fighting the opposite battle. However, being quiet means that the other side wins by default.

Purpose of EHR Incentive Program According to CMS

Posted on September 9, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

When I was reading through the EHR Certification flexibility final rule, I found a really interesting part of the rule (pg.49-50) that describes what CMS sees as the purpose of the HITECH act and all the money their spending on EHR software:

The entire overarching purpose of the EHR Incentive Program is to move providers towards advanced use of health IT to support reductions in cost, increased access, and improved outcomes for patients.

It’s been one of my pet peeves lately. People always come on this site or on social media and say “that goes against the purpose of the HITECH act.” I often would reply, “what is the purpose of the HITECH act?”

My problem with people’s comments about the purpose of all this spending on EHR software is that purpose changes depending on perspective. I’ve written before about the misalignment between “incentives” and “purpose.”

While I think the purpose for something changes based on whose perspective you’re talking about, I think it’s really important to know where CMS is coming from when it comes to the EHR incentive money and meaningful use. Now we know. They made it quite clear in the final rule.

How do you think the EHR incentive money is doing at achieving CMS’ purpose?

Top 5 Most Influential People in Healthcare

Posted on September 8, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

There are a whole bunch of top 10, top 50, and top 100 lists going around right now. It’s always interesting to browse through these lists. If you’re on the list, you love seeing your name or organization’s name in lights. When someone makes a list, you can almost always disagree with something on their list, which drives a good conversation.

As I was thinking about all these lists, I saw one that listed the 100 most influential people in healthcare. As I looked through the list, I didn’t really agree with the list. I knew where they were coming from, but everyone on their list was on a macro level. While those people have influence over the healthcare system as a whole, I think there are much bigger influences over the healthcare we receive.

Here’s my list of the top 5 most influential people in healthcare:

  1. The Patient
  2. The Parent of a Child
  3. The Caregiver for a Senior
  4. The Spouse of the Patient
  5. The Patient Advocate

That’s right. The patient and the people who care about and advocate for that patient are the most influential and powerful people when it comes to the healthcare you receive. There is literally nothing more powerful in healthcare than this.

This applies to patients getting care from the existing healthcare system, but also applies to the broader terms of health and wellness. Nothing is more powerful than a patient that cares about their health and wellness. The only thing that comes close is a loved one who cares about that patient. It’s a powerful force and one that we haven’t leveraged enough in healthcare.

Sure. The big names in healthcare that make huge sums of money in high profile roles have an impact on the overall state of healthcare. However, even they aren’t stronger than an empowered patient.

An Example Where an EHR Overcharges Healthcare

Posted on September 5, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

In response to my post “Study Says Overcharging by the Hospital Might Be Overstated“, Patrick Duffy from PDA Consulting offered these added insights into the “overcharging” that exists in healthcare.

Some are overcharging thanks to EMR upgrade coding errors. How about $720 for ONE nitro tablet. Insurance company did not catch it either. About 9 months after an EPIC implementation so how many people/Insurance were overcharged and never knew?

In the meantime a gastric band operation in the UK is $7500 average. In the US it is between $15k and $30k depending on State. Is that not overcharging?

I’d never heard of an EHR software doing this, but it’s not surprising at all. In fact, it’s probably not even happening because an organization is trying to be dishonest. When you look at the complexity of an EHR implementation, it’s not surprising at all that things like this happen.

It’s also not surprising that the insurance company hasn’t caught it…yet. Notice how I added in the yet there. We’ll see if this comes back to bite healthcare organizations. Insurance companies do get behind on a lot of things, but they do go back and plug holes and then it hurts.

There are so many issues with the way we reimburse healthcare, that I’m honestly not sure where to start in order to fix it. It’s a complex web of overhead.

In the tech world, a software program has technical debt (also known as design debt or code debt). We see it happen across the EHR and health IT software world. Over time, you accrue a debt of issues in your software that make it easier to scrape the old software that’s encumbered by technical debt and rewrite it from scratch so that you can do it the right way.

When I look at the healthcare reimbursement system it’s got a very similar problem. There’s a healthcare reimbursement design debt that’s grown so large that there are no easy fixes to the system. I guess that’s why I asked the question, “Is Healthcare So Complex That It Can’t Be Fixed with the Existing Parts?

Why Electronic Attachments Matter in Healthcare

Posted on September 4, 2014 I Written By

The following is a guest blog post by Lindy Benton, CEO of MEA|NEA.
Lindy Benton
Receiving and responding to medical record requests continues to be one of the primary contributors to lengthy claims processing delays and denials for providers. Health plans request supporting documentation, which can delay processing the pre- and post-payment review up to 45 days, on average. Technology, however, is allowing hospitals and practices the ability to efficiently and securely capture, transmit and store electronic health record information and supporting clinical data to reduce denials and reviews by payers.

Are these solutions really important for payers and providers? At present, it does not seem top of mind for payers even with CMS’ push to (finally) move toward electronic exchange of data between providers being audited by Medicare claims auditors, for example, doesn’t mean the industry – from the payer’s perspective – is moving with gazelle intensity toward the capability of doing so. The reasons are many, and understandable, of course.

Payers have bigger priorities right now with ACA, ICD-10 and other highly complex processes that require their attention. The attachment system that’s currently being used by many payers (manual delivery) works, and the thinking that “if it ain’t broke, don’t fix it” moving attachments to an electronic environment at this point may just not be important enough to these organizations to supersede everything going on at present.

But when it comes time for providers to get paid, the use of simple electronic image files can securely change the way providers get paid and grow their businesses. There are more than a billion ambulatory care visits a year producing claims in which 13 percent of those requiring attachments to support them. Each attachment averages more than three pages that the payer must review before being able to adjudicate the claim and pay the provider, according to a 2010 National Ambulatory Medical Care Survey.

For example, the annual claim denial rate in 2013 was 2.17 percent, meaning more than 70 million attachment pages were required by payers annually. Hospitals, ambulatory care centers, surgery centers, home health agencies and long-term care facilities simply experience significant improvements in their revenue cycles by using electronic attachments for their medical documentation exchange and claim processing time can be greatly reduced – in some cases by as much 60 percent.

So, why do electronic attachments matter in healthcare? Electronic document management improves processes by enabling hospitals and practices to securely capture, transmit and store supporting documentation for medical review. They are secure and HIPAA-compliant for document transfer, require minimal time and training to implement and essentially offer integrated services with some hospital information systems.

The value proposition is simple for health systems, including increased productivity (less phone time spent tracking status of mailed or faxed claims); fewer denials; faster payment; detailed tracking reports; records of every employee who viewed the attachment; and real-time follow-up on claims with attachments.

The solutions allow providers the ability to transmit both solicited and unsolicited documents via an information exchange to all participating health plans. The claim attachments are then able to be viewed and acted upon in a timely manner. According to the American Medical Association, automating the claims process can cut costs, helping organizations save thousands a year while relieving staff members of some of their most tedious and time-consuming tasks. Additionally, automating the claims submission process can:

  • Minimize claim rejections and resubmissions
  • Deliver claims to health insurers in real time
  • Expedite payer responses and boost cash flow
  • Free up time for other revenue-enhancing tasks
  • Reduce claims submission costs

An evidence of savings realized can be seen as published by Milliman from 2006. For example, the cost to submit manual claims is $6.63 x 6,200 (6,200 is based on an average of claims submitted for a single physician) equals $41,106 per year. Compare that to the cost to submit electronic claims, which is $2.90 per claim x 6,200 = $17,980. Thus, the average annual savings per physician from automating claims submission: ≈$23,126.

However, even with a cost-savings of more than $23,000, practices saving money may not be the most important factor of the solutions. Security and safe transfer of the information to payers is the priority of all practices, and is possible. Also, the money saved may not mean as much as the efficiencies created or the comfort and reliability of being able to track, monitor and follow claims and attachments throughout the adjudication process.

Additionally, the solutions create a sense of interoperability, a concept much hyped but often difficult to achieve and often lagging in other areas of the hospital or practice. With electronic attachment solutions, information can easily be transferred across multiple systems securely and efficiently, with little effort and implementation time.

HIPAA-compliant data transfer

Even with these benefits, often overlooked is that the technology exists for HIPAA-compliant transfer of electronic data, allowing for information exchange between providers, payers and clearinghouses. Even with the oft discussed lack of exchange capabilities with current solutions, such as between competing electronic health record systems, hospitals and health systems can simply deposit required information into a secure electronic envelope to support the clinical coding on a claim, which can then be easily transmitted to a payer. Though not an exchange of data in the “traditional” sense – between electronic health record and electronic health record, for example – it is possible for hospitals to use their technology and systems to communicate with outside parties, such as payers (including CMS for Medicare/Medicaid,) clearinghouses, and other practices.

In relation to electronic attachments, with a few simple keystrokes, providers can simply upload or capture requested documents whereby a unique tracking number is then assigned to the claim, and it gets transmitted securely to the payer. Once the third party receives the claim, examiners then have the ability to view the supporting documentation. Not only is the data transferable, but the attachment is stored in a secure repository and is accessible to designated payers and providers. Attachments sent by providers can include a number of components, such as adverse drug reaction information, lab and operative reports, ER records, certificates of medical necessity and any other documentation required by a payer to adjudicate a claim. Attachments can be sent along with the initial claim submission (unsolicited) or in response to a request for additional information (solicited).

How the technology is changing healthcare

The technology is changing healthcare in a number of ways. In the near term, organizations will be able to continue achieving clinical and financial excellence as health information becomes more fluid and mobile.

Additionally, automating manual processes makes routine tasks more efficient. Clinical excellence furthered by the use of EHR and other technologies will continue to facilitate the ability for practitioners worldwide to share patient information to enable them to treat patients more efficiently. Additionally, automating billing, claims and attachment processes will reduce lengthy reimbursement periods from payers and reduce unnecessary costs associated with the redundancies in healthcare administrative processes (i.e. refilling claims/documents, manually tracking reimbursements, etc.)

Certain electronic solutions enable providers to electronically respond to RAC, MAC, CERT and ZPIC audits given certain guidelines, for example, by being able to connect through Medicare’s esMD program. The esMD program was launched by CMS to provide an electronic mechanism for providers to respond to audits. Because of these electronic solutions, responding to audits is much quicker, more secure and easier with this technology than when using traditional paper methods to manage the same process.

Additionally, with the technology, providers can import documents using a variety of acquisition methods including scanning, screen capture, file import and print capture. When used to defend against audits, these solutions typically help those in healthcare eliminate faxed or mailed audit responses, ensure timely and confirmed responses, reduce postage and fax charges, decrease administrative time spent copying, eliminate lost submissions and provide HIPAA-secure transmission and storage of files.

The benefit to providers and to health systems is clear, especially in the age of the “wireless” office. With the push toward EHRs, electronic transfer of health information and seamless interoperability, these technologies go hand-in-hand with those developments. Specifically, in regard to this case, the technology can improve acceptance rates for claims requiring supporting documentation, as well as decrease days claims spend in A/R; reduce occurrences of pended and denied claims; eliminate lost attachments; reduce postage and fax charges; eliminate paper-based claims, appeals and audit processes; improve office staff productivity and overall billing efficiency; and provide secure HIPAA-compliant transmission and storage.

All of this supports a more efficient and profitable health system driven by technology. Secure electronic claim attachments improve outdated processes with little intrusion and minimal investment – something many of healthcare’s other IT solutions can’t claim.

Lindy Benton is CEO of MEA|NEA, a provider of health information exchange and secure electronic attachments.