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Patient Self Management

Posted on August 25, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I always find stats like this interesting, but misleading. The fallacy that most people apply to a stat like this is saying that because people want something they will actually do it. In this case, just because 90% of people want to self-manage their care, that doesn’t mean that 90% of patients will actually self-manage their care.

90% of people want to stop smoking, but they don’t. 100% of people want to be more fit and healthy, but we don’t. There are a lot of things that we want, but that doesn’t mean we actually want it enough to do something about it.

The reality is that most of us don’t think about our health until we have a problem. If you ask us if we care about our health, we’d all say that we do. However, our actions tell a very different story. Our actions say that most of us don’t really care about our health. Or at least that we don’t care about it enough to give up things that are harming our health.

In many ways our health system reflects this fact. Our doctor doesn’t really worry about our overall health. Our doctor mostly treats our chief complaint. In many cases, they don’t even dig down past our chief complaint. They certainly don’t proactively look for ways our lifestyle or environment are impacting our health. Should that change?

The question I keep asking is if the doctor is the right person to address this type of change in perspective when it comes to health. Should the doctor be the one to understand our overall health and address our health risks? Should we do it ourselves? Should a health app do it for us in a way that it motivates us enough to actually care about the unhealthy choices we make?

The last option seems like the most likely option to me. Doctors aren’t trained to treat you when you’re healthy. It would take a sea change for them to switch roles. Health apps, the health sensors that inform these apps, and the baseline health knowledge are all progressing so quickly that it’s not hard to see a day when a health app could better help us understand how the choices we make influence our health.

What do you think? Is there anything that will really help us understand the health impact from the choices we make? Do patients really want to self-manage their care?

A Look at the Olympic EHR

Posted on August 23, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve always been interested in the United States Olympic Committee’s choice of GE as their EHR software. As part of the Olympics, GE put out this video where a bunch of the USOC support staff talk about how they use the GE Centricity Practice Solutions EHR with olympic athletes. Pretty cool to hear about some of the stuff they’re doing and the unique challenges they face as the doctors of these athletes.

My favorite part of the video is that they’re able to use the EHR to coordinate care of the athletes across 1000 doctors. Shows you that if there’s a desire to do so, it’s possible. Also, pretty interesting that they note that they take 45 minutes to get someone up to speed on the Centricity EHR.

Who’s Eligible for MIPS? – MACRA Monday

Posted on August 22, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of MACRA.

In years 1 and 2 of MACRA, those that are eligible to participate are going to be very similar to past programs. However, the secretary does have the option in year 3 to look at expanding the program to include other healthcare providers that don’t meet the initial requirements. You can see this illustrated in the graphic below.
MIPS Eligibility

There are three exceptions to the above graphic. The first exception is if you’re a first year partipant in Medicare Part B. This gives these doctors time to get up to speed before they’re required to participate in MIPS. They will have to participate in year two. There is also a MIPS exception for low volume providers. If you’re a provider that has Medicare billing charges that are less than or equal to $10,000 and providers care to 100 or fewer Medicare patients in a year, then you are not required to participate in MIPS. The third exception is those providers that are already participating as an advanced APM (see what we wrote about Advanced APM eligibility for more details) are not allowed to participate in MIPS. Here’s a summary of these exceptions:
Not Eligible for MIPS

If all of this Advanced APM and MIPS eligibility is confusing to you, here’s a flow chart which will walk you through the process of knowing whether you’re an advanced APM, whether you must participate in MIPS or whether you’re not subject to MIPS:
APM or MIPS - Where Do You Fit Into MACRA

Next up, we dive into the details of MIPS and the 4 MIPS categories.

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

Should Clinical Research Options Be Integrated Into Every EHR?

Posted on August 19, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the amazing things of the internet and technology is the democratization of information. I recently heard that it’s not that the world is getting worse, but that our information is getting better (ie. we hear about all the bad things happening in the world). That really resonated with me. Although, it annoys me when information that could be useful still isn’t making it to the right people at the right place and the right time. The point being that our information could still be better.

This tweet and infographic illustrated how this is true in the world of clinical trials and research:

Clinical Research and Doctor Referrals

How often do research studies not get done because they don’t have the right patients? Far too many. How many patients don’t get treatment from clinical trials that could save their lives because they don’t know about it? Far too many.

All of this happens because there’s a disconnect in the information that’s available. As someone who’s spent so much time in the EHR world, the question for me is should every clinical trial option be integrated into every EHR? Should we casually alert doctors to potential clinical trials that could benefit the patient? The EHR could already pre-qualify them in many ways so that the doctor was only seeing trials for which the patient likely could qualify for. How many more studies would get done and patients lives would be saved?

The lack of clinical trial information in the EHR is why I think the above infographic shows a disconnect between doctors presenting patients clinical trial options or not. Technology and EHRs are the way we can bridge the disconnect between patients expectations and reality. This is why I believe that EHR software can be an incredible foundation for innovation. We’re just sadly not there yet. We should be when it comes to clinical trials.

Is Interoperability Worth Paying For?

Posted on August 18, 2016 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.

A member of our extended family is a nurse practitioner. Recently, we talked about her practice providing care for several homebound, older patients. She tracks their health with her employer’s proprietary EHR, which she quickly compared to a half-dozen others she’s used. If you want a good, quick EHR eval, ask a nurse.

What concerned her most, beyond usability, etc., was piecing together their medical records. She didn’t have an interoperability problem, she had several of them. Most of her patients had moved from their old home to Florida leaving a mixed trail of practioners, hospitals, and clinics, etc. She has to plow through paper and electronic files to put together a working record. She worries about being blindsided by important omissions or doctors who hold onto records for fear of losing patients.

Interop Problems: Not Just Your Doc and Hospital

She is not alone. Our remarkably decentralized healthcare system generates these glitches, omissions, ironies and hang ups with amazing speed. However, when we talk about interoperability, we focus on mainly on hospital to hospital or PCP to PCP relations. Doing so, doesn’t fully cover the subject. For example, others who provide care include:

  • College Health Systems
  • Pharmacy and Lab Systems
  • Public Health Clinics
  • Travel and other Specialty Clinics
  • Urgent Care Clinics
  • Visiting Nurses
  • Walk in Clinics, etc., etc.

They may or may not pass their records back to a main provider, if there is one. When they do it’s usually by FAX making the recipient key in the data. None of this is particularly a new story. Indeed, the AHA did a study of interoperability that nails interoperability’s barriers:

Hospitals have tried to overcome interoperability barriers through the use of interfaces and HIEs but they are, at best, costly workarounds and, at worst, mechanisms that will never get the country to true interoperability. While standards are part of the solution, they are still not specified enough to make them truly work. Clearly, much work remains, including steps by the federal government to support advances in interoperability. Until that happens, patients across the country will be shortchanged from the benefits of truly connected care.

We’ve Tried Standards, We’ve Tried Matching, Now, Let’s Try Money

So, what do we do? Do we hope for some technical panacea that makes these problems seem like dial-up modems? Perhaps. We could also put our hopes in the industry suddenly adopting an interop standard. Again, Perhaps.

I think the answer lies not in technology or standards, but by paying for interop successes. For a long time, I’ve mulled over a conversation I had with Chandresh Shah at John’s first conference. I’d lamented to him that buying a Coke at a Las Vegas CVS, brought up my DC buying record. Why couldn’t we have EHR systems like that? Chandresh instantly answered that CVS had an economic incentive to follow me, but my medical records didn’t. He was right. There’s no money to follow, as it were.

That leads to this question, why not redirect some MU funds and pay for interoperability? Would providers make interop, that is data exchange, CCDs, etc., work if they were paid? For example, what if we paid them $50 for their first 500 transfers and $25 for their first 500 receptions? This, of course, would need rules. I’m well aware of the human ability to game just about anything from soda machines to state lotteries.

If pay incentives were tried, they’d have to start slowly and in several different settings, but start they should. Progress, such as it is, is far too slow and isn’t getting us much of anywhere. My nurse practitioner’s patients can’t wait forever.

What Do Med Students Need To Know About EMRs?

Posted on August 16, 2016 I Written By

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

Recently, I was asked to write an introduction to EMRs, focusing on what medical students needed to know in preparation for their future careers. This actually turned out to be a very interesting exercise, as it called for balancing history with the future, challenges with benefits and predictable future developments with some very interesting possibilities. Put another way, the exercise reminded me that any attempt to “explain” EMR technology calls for some fancy dancing.

Here’s some of the questions I tackled:

  • Do future doctors need to know more about how EMRs function today, or how they should probably function to support increasingly important patient management approaches like population health?
  • Do med students need to understand major technical discussions – such as the benefits of FHIR or how to wrangle Big Data – to perform as doctors? If so, how much detail is helpful?
  • How important is it to prepare med students to understand the role of data generated outside of traditional patient care settings, such as wearables data, remote monitoring and telemedicine consults? What do they need to know to prepare for the gradual integration of such data?
  • What skills, attitudes and practices will help physician trainees make the best use of EMRs and ancillary systems? And how should they obtain that knowledge?

These questions are thornier than they may appear at first glance, in part because there no hard-and-fast standards in place as to how doctors who’ve never run a practice on paper charts should conduct themselves. While there have been endless discussions about how to help doctors adopt an EMR for the first time, or switch from one to the other, I’m not aware of a mature set of best practices available to med students on how next-gen, health IT-assisted practices should function.

Certainly, offering med school trainees a look at the history of EMRs makes sense, as understanding the reasons early innovators developed the first systems offers some interesting insights. And introducing soon-to-be physicians to the benefits of wearable or remote monitoring data makes sense. Physicians will almost certainly improve the care they deliver by understanding EMRs then, now and their near-term evolution as data sources.

On the other hand, I’m not sure it makes sense to indoctrinate med students in today’s take on evolving topics like population health management or interoperability via FHIR. These paradigms are evolving so rapidly that pinning down a set of teachable ideas may be a disservice to these students.

Morever, telling students how to think about EMRs, or articulating what skills are needed to manage them, might actually be a bad idea. I’m optimistic enough to think that now that the initial adoption frenzy funded by HITECH is over, EMRs will become far more usable and physician-shapeable over the next few years, allowing new docs to adapt the tool to them rather than adapt to the tool.

All that being said, educating med students on EMRs and health IT ancillary tools is a great idea. I just hope that such training encourages them to keep learning well after the training is over.

MIPS Overview – MACRA Monday

Posted on August 15, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of MACRA.

The Merit-based Incentive Payment System or MIPS as we now know it is going to be a big part of most practices future. As we mentioned previously, most practices will be participating in the MIPS program as opposed to the APM program under MACRA. Here’s a quick overview of the MIPS program. Over the next months, we’ll be diving deeper and deeper into the details of MIPS.

MIPS replaces 3 programs that will likely be familiar to most readers: PQRS, the Medicare EHR Incentive Program (Better known as meaningful use), and the Value-Based Payment Modifier (VBM). The last one might not be as familiar to people, but PQRS and Meaningful Use are likely very familiar. In future posts, we’ll dive into the changes to these programs that come as they’re rolled into MIPS.

It’s worth noting that these programs will continue to run in their current from through 2018. Plus, the Medicaid EHR Incentive Program and the Medicare EHR Incentive Program for Hospitals will continue. Along with rolling the 3 current programs into MIPS, MACRA also adds a new program to MIPS called the Clinical Practice Improvement Activities (CPIA).

The first performance period for MIPS is 2017 with MIPS adjustments happening in 2019. At least that’s the way it’s listed in the proposed rule. Many are suggesting that there’s no way that MIPS will be for all of 2017. They argue that it has to be either delayed or moved to a 90 day reporting period (which is basically a 9 month delay). We’ll see what they finally decide when the MACRA final rule finally comes out.

The potential MIPS adjustments to your Medicare Part B payment are 4% in 2019 and grow to 9% in 2022. Remember that these adjustments can be both positive and negative based on how well you participate in the MIPS program. We’ll dive into the MIPS Composite Score that determines your MIPS payment adjustment in a future post. Here’s a charge which illustrates the MIPS timeline and incentives:
MIPS Incentives and Penalties
That’s all for our MIPS overview. Next up we’ll dive into who is eligible for MIPS and who is not eligible for MIPS.

You can see how if you’re already participating in PQRS, Meaningful Use, and the Value-Based Modifier, then you are well positioned to do well in MIPS. This will become even more clear when we discuss the weighted scoring that each of these pieces of MIPS receives. Of course, if you haven’t been participating in these programs, then MIPS will definitely be a pretty big hill to climb.

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

Are Devices Distracting Doctors the Same As Devices Distracting Children?

Posted on August 12, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I came across this tweet from Howard Green, MD that really made me stop to think.

I like the juxtaposition of his comment because it makes you stop and think about the decisions we’re making. Although, I think that Dr. Green takes it too far since no one ever asked doctors to stop interacting. In fact, the chorus I’ve heard is that doctors need to interact more with patients. That said, I get his point that the EMR can get in between the patient and doctor if you let it. And many have let it get in the way.

We can certainly talk about how EHR software could be more usable. We can talk about how the onerous regulations and things like meaningful use and MACRA have made documenting in an EHR a clickfest that provides little to no value to patients. We can talk about how EHR software isn’t connected to other EHR software and we’re living in this world of healthcare data silos. All of these are a pain and a problem for doctors and we should do better. What is unfair to say is that EHRs tell doctors to stop interacting.

It’s always amazing to me how the EHR gets all sorts of undeserved blame. I’ve seen plenty of doctors who use an EHR and still spend plenty of time interacting with their patients. In fact, people like Dr. James Legan have integrated their EHR use into their patient interaction and made their patient interaction better. Yes, the EHR can be a distraction, but it doesn’t have to be. The same way devices can ruin my children, but they don’t have to ruin them. It’s how you choose to use it.

ONC’s Budget Performance Measure Dashboards Makes Goal Tracking Easy

Posted on August 9, 2016 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.

I recently wrote a post how it’s not easy to compare ONC’s spending plans with what it actually did. That’s not the case with ONC’s Budget Performance Measures. Its Performance Measure dashboard makes those comparisons easy and understandable. For example, you can look up EHR adoption among office based physicians.

Here’s how to use it. On the dashboard page, Figure I, select a general area using the radio buttons. Depending on your choice, the system will list specific issues. You select the one you want from the drop down menu on the right. You can also adjust the period covered. Right clicking a graph downloads it.

Figure I – ONC Dashboard Menu

ONC Dashboard Menu

It’s in the graph that the dashboard excels. It clearly shows targets and results. For example, Figure II shows that while office EHR adoption has grown over the years, it’s running below ONC’s goals. If you’d only saw the actual – which is the case with ONC’s budget — you’d only see adoption going up. You’d have no clue ONC’s goal wasn’t met.

Figure II – ONC Primary Care Adoption

Office Based Primary Care Doc Adoption

These dashboards give the public a way to understand what ONC wants to do and how well — or not so well — its done toward its goals. In doing so, ONC has given us a scoreboard that not only measures what it’s doing, but it also allows the public to focus on benchmarks. ONC’s fiscal reporting isn’t the clearest, but with these dashboards they’ve done themselves well.

Advanced APM Requirements and Incentives – MACRA Monday

Posted on August 8, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Last week we looked at the MIPS and APM programs within MACRA and who will be participating in which program. Today we’ll briefly cover some of the specific requirements to participate in the APM program and the incentives you’ll receive if you are qualified and participate as an APM.

As mentioned before, most people won’t participate in an APM, but will participate in MIPS. This is particularly true because even if you’re part of an ACO or other value based care program you may or may not qualify as what they call an Advanced APM. Last week we listed the various APM definitions for who could be an APM, but we didn’t include this other criteria that is required for an APM to be considered an Advanced APM.

  • Use Certified EHR
  • Base Payment on Quality
  • Bears Financial Risk or Medical Home Model

If you want to dig into the advanced APM criteria, you can do so in the APM webinars that CMS did. They dive into the nitty gritty details of each, but we’ll pass on covering them here since they’ve done a great job and it only applies to a small group of our readers.

If you do not qualify as an advanced APM, then you’ll need to participate in MIPS, but you’ll do so with some favorable MIPS scoring.

APM Incentives
For those organizations that qualify as an Advanced APM, starting in 2019 you’ll receive up to a 5% bonus. This bonus will continue through 2024. In 2026, the bonus will be replaced with a higher fee schedule update.

Worth noting is that the MACRA APM program creates extra incentives for those who are already participating in one of the value based reimbursement programs. The MACRA APM program does nothing to change the current APM functions or rewards values. The 5% bonus will be on top of what was already planned for APMs.

Plan of Action
If you think that you might be part of an organization or program that will qualify as an APM, you’ll need to figure out if you qualify as an advanced APM. You should be able to consult your ACO or other APM organization to find out if you’re considered an advanced APM or not. The key question you’ll want to ask is, Am I considered an Advanced APM or not? Only Advanced APMs are excluded from MIPS.

That’s the short overview of the APM program. Next week we’ll start talking about the MIPS program.

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