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Doctors without Planets – Doc Vader

Posted on June 23, 2017 I Written By

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

The incomparable ZDoggMD has been creating a whole series of videos for his alter ego’s alter ego, Doc Vader and has even launched a website for Doc Vader. There are some really funny videos and a lot of them touch on healthcare IT.

The latest Doc Vader video is called Doctors Without Planets:

What’s amazing is that the Doc Vader character actually came out of a sponsored video that ZDoggMD did with Dr First. Here’s the Doc Vader, Episode 1: The Pager Menace video that started the character:

Happy Friday everyone and thanks to ZDoggMD for putting out such funny content.

Is Your Health Data Unstructured? – Enabling an AI Powered Healthcare Future

Posted on June 22, 2017 I Written By

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

If you asked a hospital IT executive how much of their data is unstructured data, most of them would reasonably respond that a lot or most of their data was unstructured. If you asked a practice manager or doctor how much of health data is unstructured, they’d likely respond “What do you mean?”

The reality is that most doctors, nurses, practice managers, etc don’t really care if their data is structured data or not. However, they should care about it and more importantly they should care about how they’re going to extract value out of the structured and unstructured data in their organizations.

The reality in healthcare, as the above tweet and image point out, is that much of the data we have and are going to get is going to be unstructured data. Our systems and software need to handle unstructured data in order to facilitate the AI powered healthcare future. That’s right. An AI powered healthcare future is coming and it’s going to be built on the back of structured and unstructured healthcare data.

I think the reason so many healthcare providers are concerned with this AI powered future is that they know the data they currently have is not very good. That’s going to be a problem for many organizations. Bad data is going to produce bad AI powered support.

We shouldn’t expect technology to solve our problems of bad data but, technology will amplify the state of your organization. If your organization is doing an amazing job creating high quality health data, then the AI powered future will propel you in amazing ways to be an even better organization. However, the opposite is also true. If your health data is poor, then these new AI powered systems are going to highlight how poorly your organization is being run. I get why that’s scary for many people.

This should be one of the big lessons we take away from the EHR experience. Healthcare organizations with poor workflows hoped that implementation of an EHR would help them fix their workflows. Instead of EHR fixing the workflows it just highlighted the poor workflows. Technology accentuates and accelerates your current state. It doesn’t usually fix it. You have to fix your organization and workflows first and then use technology to accelerate your organization.

The next step after that is what Rasu Shrestha highlighted when he said, “How can we move from ‘doing digital’ to ‘being digital’. Let’s not replicate analog workflows. Let’s rethink!”

5 Stages of Provider Dissatisfaction and Happiness

Posted on June 21, 2017 I Written By

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

A couple weeks ago I posted an infographic on the 5 stages of patient frustration and the 5 stages of patient satisfaction. This week SCI Solutions came out with a new infographic which looks at the 5 stages of provider dissatisfaction and the 5 stages of provider happiness.

It was interesting that the infographic focused so much on the pains of prior auths. I agree that this is extremely painful for doctors and definitely leads to a lot of dissatisfaction. However, I’m surprised that they didn’t include the EHR and other regulations related to the EHR in their list of provider dissatisfaction. I’m sure EHR and prior auths would fight a good fight as to which is more annoying to doctors.

As for the provider satisfaction, the infographic focused so much on easy access to the right information. I agree that’s a valuable thing, but the most valuable thing is doctors getting quality time that helps their patients. We need to facilitate more of that in healthcare.

A Tribute to Larry Weed

Posted on June 20, 2017 I Written By

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

I must admit that I didn’t really know about Larry Weed until in 2013 I saw Neil Versel interviewing him at HIMSS. I’d been getting to know Neil Versel pretty well at this point and I saw him hit the press room full of energy and totally engaged with a man who was 89 years of age. I was new to the press room then, but I now know well the look Neil gets when he has a good interview. It’s how he looked at HIMSS 2013 when I saw him interviewing the 89 year old Larry Weed.

After the interview, I was talking with Neil and he recounted to me that he’d just been able to interview Larry Weed. I could tell that this was a real highlight for him and that he was honored by the opportunity. This month, Larry Weed passed away and Neil Versel offered up this great tribute to Larry Weed’s work.

I love this Larry Weed quote that Neil shared in his tribute:

“The worst, the most corrupting of all lies is to misstate the problem. Patients get run off into the most unbelievable, expensive procedures … and they’re not even on the right problem,” Weed said during that memorable presentation in New Orleans.

“We all live in our own little cave. We see the world out of our own little cave, and no two of us see it the same way,” he continued, explaining the wide deviation from standards of care. “What you see is a function of who you are.”

We should all take a week or so to think about the most corrupting lie of misstating the problem and how our own experiences corrupt our views.

I also didn’t know that Larry Weed was possibly one fo the founding father’s of patient empowerment. As Neil notes:

Indeed, it could be argued that Weed was a founding father of patient empowerment. Back in 1969, Weed wrote a book called “Medical Records, Medical Education, and Patient Care.” In that, he said, “patients are the largest untapped resource in medical care today.”

Larry Weed also co-developed an early EMR and the SOAP note was his idea.

I often don’t think that those of us who take healthcare IT and EHR for granted today realize the rich history and evolution of technology in healthcare. Thanks Neil for sharing a small glimpse into that history and honoring a man who was an important part in it.

Everyone should take 2 minutes and go and read Neil Versel’s full tribute to Larry Weed.

MACRA Video Training – MACRA Monday

Posted on June 19, 2017 I Written By

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

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

I did a quick search on YouTube for the term MACRA and it found 23,300 search results. It’s not surprising to find so much MACRA content. It seems to me that healthcare has an insatiable appetite for MACRA information.

While it’s great that so many organizations are producing MACRA content, no doubt some of it is not all that valuable and a bunch of it isn’t accurate. Case in point, the first video returned in the YouTube search for MACRA was a video from eClinicalWorks (eCW). Is there anyone that would want eCW to train them on government regulations after the recent eCW settlement that revolved around their decision to not properly certify their EHR and the meaningful use program? Maybe all the information is accurate, but that’s not where I’d go to for my source of MACRA information.

If you wanted a really brief, high level overview of MACRA, I found this 2 minute cartoon video from MediSync to be a nice intro to the intent of MACRA:

If you want a much more in depth look into MACRA’s MIPS program, you’ll want to check out Answers Media’s 25 videos in their The ABCs of MIPS series:

We all know that the government MACRA website is the first place to go for really high quality MACRA information. Do you have another go to source for your MACRA information that we should know about? Let us know in the comments.

Sorting Through HIT’s Cultural Revolutions

Posted on June 15, 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.

HIT is a small ship in the large IT sea. Whether we like it or not whatever stirs IT will rock HIT’s boat – to stretch an analogy. Sometimes it’s a tidal change in how we do business. Dial up modems, for example, gave way to high speed lines revolutionizing all that they touched.

Sometimes these revolutions – to switch analogies are much welcome and undeniable. No one is going back to MS-DOS or parallel interfaced printers. Sometimes, though, IT gets caught up in cultural revolutions (CRs) that eventually fade and disappear, but take a toll before their done and gone.

Chinese Cultural Revolution Poster

Chinese Cultural Revolution Poster. Source: chineseposters.net

By cultural revolutions I don’t mean the extremes of Chairman Mao’s creation, with Red Guards who destroyed everything and everyone in their path. We’re far more kinder and gentler than that. The CRs I’m talking about are organizational or technical fads noted for their promoters’ evangelical zeal. Heavily promoted they soak up organizational time and effort often with little to show.

To be sure IT’s not the only organizational sphere with fads. DOD’s Program, Performance Budgeting System (PPBS) is a famous 1960s example. It promised an almost mechanical solution to DOD’s major logistical, operational and performance review problems. It didn’t. Little changed. That doesn’t mean PPBS didn’t have some practical aspects, or that it didn’t leave behind some improvements. However, little justified its over blown hype and massive organizational disruption.

IT and HIT have had their share. Six Sigma, CMMI, and ISO 9000 quickly come to mind. I would add XML and Big Data. Advocates pushed these in the name of curing many woes or reaching new heights by adopting a new way of thinking or doing. However, CRs almost always just put old beer in new bottles.

Spotting a Cultural Revolution

Each day brings something new in IT/HIT. Here some ways to determine if what you’re facing is a fad or not:

  • Advocates. Who’s promoting it? Who certified them and what did that entail?
  • Analogues. Who’s implemented the CR and can you speak to them freely?
  • Client Demand. What do your clients think? Do they want you to adopt the new ways?
  • Effort. What effort will it take to adopt the CR? What are the opportunity costs?
  • Focus. Does the CR require your staff to stop what it’s doing and attend lengthy, expensive seminars?
  • Jargon. Do the advocates speak terms you know, or do they promote a whole new language you’ll have to master?
  • Organizational Fit. How well does the CR fit into your current way of doing things?
  • Payoff. What are the CR’s specific, definable advantages?
  • Segments. Does the CR give you a menu of choices or is it an all or nothing approach?
  • Sponsors. Who’s the CR author? Is it a standards organization, a movement by knowledgeable users or a self referencing group?

CRs aren’t a simple matter of useful or not. Sometimes even fads can bring a useful approach wrapped up in hyperbole.  For example, XML advocates claimed it would change everything. After that promotional tide receded, XML became another tool. The challenge, then, is being able to see if the current CR really offers anything new and what it really is.

EHR Data – Is it Improving Healthcare?

Posted on June 14, 2017 I Written By

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

I’ve written pretty regularly about the wave of data that’s coming to the world of healthcare. It’s really something quite extraordinary. However, data in itself doesn’t solve anything. So, I was bothered by this tweet which suggested that technology was improving healthcare by illustrating that more and more health data was being collected by technology.

Here’s the tweet:

Attached to this tweet is the following image which doesn’t illustrate the above assertion at all.

No one believes that technology can help improve healthcare more than me. However, it’s not right to make that assertion on Twitter and then use the increased collection of healthcare data as proof of this fact. We can collect all the data in the world and healthcare can remain exactly as it is today.

This reminds me of when the government suggested that HITECH (Meaningful Use) was a success based on graphs that show that most organizations have adopted an EHR. I guess if EHR adoption is your goal, then it was a success. However, if your goal is to use technology to improve healthcare, then EHR adoption is a vanity metric.

We need to stop focusing on adoption and start focusing more on metrics that really matter. Are we improving care? Are we lowering the cost of healthcare? Are we improving the efficiency of our healthcare providers? If technology can’t help you in one of these areas, then we should question why we’re doing it. Let’s bring some sanity back to our approach to healthcare technology.

Embracing Quality: What’s Next in the Shift to Value-Based Care, and How to Prepare

Posted on June 13, 2017 I Written By

The following is a guest blog post by Brad Hill, Chief Revenue Officer at RemitDATA.

Whatever the future holds for the Affordable Care Act (ACA), the shift to value-based care is likely here to stay. The number of providers and payers implementing value-based reimbursement contracts has grown steadily over the past few years. A survey of 465 payers and hospitals conducted in 2016 by ORC International and McKesson revealed that 58 percent are moving forward with incorporating value-based reimbursement protocols. The study, “Journey to Value: The State of Value-Based Reimbursements in 2016” further revealed that as healthcare continues to adopt full value-based reimbursement, bundled payments are the fastest growing with projections that they will continue to grow the fastest over the next five years, and that network strategies are changing, becoming narrower and more selective, creating challenges among many payers and hospitals as they struggle to scale these complex strategies.

Given the growth of adoption of value-based care, there are certainly many hurdles to clear in the near future as policymakers decide on how they plan to repeal and replace the ACA. A January 2017 report by the Urban Institute funded by the Robert Wood Johnson Foundation revealed that some of the top concerns with some potential scenarios being floated by policymakers include concerns over an immediate repeal of the individual mandate with delayed repeal of financial subsidies; delayed repeal of the ACA without its concurrent replacement; and a cutoff of cost-sharing subsidies in 2017.

With the assumption that value-based healthcare is here to stay, what steps can you take to continue to prepare for value-based payments? The best advice would be to continue on with a “business as usual” mindset, stay focused and ensure all business processes are ready for this shift by continuing to:

  1. Help providers establish baselines and understand their true cost of conducting business as a baseline for assuming risk.
  2. Analyze your revenue cycle. Look at the big picture for your practice to analyze service costs and reimbursements for each – determine if margins are in-line with peers.  Identify internal staff processing time and turnaround times by payer. Evaluate whether there are any glaring issues or problems that need to be addressed to reduce A/R days and improve reimbursement rates.
  3. Determine whether there are reimbursement issues for specific payers or if the problem is broader in nature. Are your peers experiencing the same issues with the same payers?
  4. Capture data analysis for practice improvement. With emerging payment models, hospitals and practices will need expertise in evaluating data and knowledge in how to make business adjustments to keep the organization profitable.
  5. Determine how you can scale and grow specific payment models. Consider, for example, a provider group that maintains 4 different payment models and 10 different payers. The provider group will need to determine whether this system is sustainable once payment models shift.
  6. Break down department silos in determining cost allocation rules. Providers need a cost accounting system that can help determine exact costs needed to provide care and to identify highest cost areas. Cost accounting systems are typically managed by the finance team. There needs to be clinical and operational input from all departments to make a difference. Collaborate across all departments to determine costs, and design rules and methodologies that take each into account.
  7. Compare your financial health to that of your peers. Comparative analytics can help by giving you insights and data to determine your practice’s operational health. Determine whether you are taking longer to submit claims than your peers, have a higher percentage of denied claims for a specific service, percentage of billed to allowed amounts and more.

Though change is a part of the healthcare industry’s DNA, ensuring business processes are in line, and leveraging data to do so will help organizations adapt to anything that comes their way.

Will the eCW Settlement Impact MACRA? – MACRA Monday

Posted on June 12, 2017 I Written By

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

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

In case you missed it, eCW settled a whistleblower lawsuit for $155 million. At the core of the lawsuit were the Medicare meaningful use payments that were paid to eCWs customers. The lawsuit alleged that eCW had been inappropriately certified as an EHR and told their customers that they were appropriately certified.

Many in the industry including myself are suggesting that eCW isn’t the only EHR vendor that could run into these types of issues. It’s quite easy for an EHR vendor to pass the EHR certification test. It’s another thing to have actually implemented all of the EHR certification requirements. We’ll see what other lawsuits come forward.

What does this settlement mean for MACRA?

Before the eCW settlement, many in the EHR industry didn’t realize their risk profile because their customers were getting government money. Once your customers start taking government money, the legal framework really changes. This is going to be true with the MACRA program as well.

It behooves every EHR vendor to really make sure they are following the spirit of the law and not just trying to game the EHR certification process (which we all know is easily gamed). I expect that most EHR vendors will step up their game and make a good faith effort to comply. I think this is the hope of the US Attorney’s office given their press release about the settlement.

We’re still waiting to see if the eCW settlement will cause any issues for eCW users who attested with the inappropriately certified eCW software. My prediction is that they’ll be fine, but some have argued that their meaningful use incentive payments could be pulled too. If that happens, that could really impact participation in the MACRA/MIPS program.

You can be sure that healthcare organization’s compliance officers are going to spend more time verifying their EHR vendor’s certification. I wouldn’t be surprised if we saw some new contracts that include some new language to cover the healthcare organization if their EHR has issues similar to eCW.

One other thing that might be an issue is those organizations that choose to switch to a new EHR from eCW. EHR switching has always been an issue when it comes to meaningful use and now MACRA and MIPS. We’ll have to dive into EHR switching and MACRA in a future post.

What impact do you think the eCW settlement will have on MACRA?

Do We Need Stricter Scribe Standards?

Posted on June 9, 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.

As most readers will know, scribes have gone from a neat idea to a fixture in many clinical settings. Though the long-term effect of their participation has yet to be determined, so far it seems that scribes have been proven to be quite useful. Not only are they saving time, they’re helping physicians connect with patients again, rather than their computer screen.

That being said, when you hire a scribe you don’t always know what you’re getting. After all, there’s no such thing as a scribe certification accepted by the healthcare industry as a whole. There are schools which offer aspiring scribes a thorough education in the essentials of medical terminology and practice, but they don’t need to adhere to a single national standard.

This lack of standardization could turn out to be a problem, according to Dr. Jeffrey Gold. In an article for The Doctor Weighs In, Dr. Gold concedes that scribes seem to be offering real benefits, noting that researchers have found that scribes can enhance physician efficiency, boost physician satisfaction and even increase billing. And he notes that scribes may improve patient satisfaction, as they make it easier for physicians to connect with patients during visits.

But despite the benefits they offer, Dr. Gold says he’s concerned about the lack of regulation concerning how scribes participate in healthcare. For example, he notes that researchers haven’t yet assessed scribes’ ability to interface safely with the EMR.

His concerns seems to be shared by the Joint Commission, which requires that providers signed all scribe-generated orders prior to implementation, that healthcare organizations document the ability of scribes to perform their assigned tasks. These concerns arise because scribes aren’t held to a common standard, Dr. Gold contends.

“Scribes have a wide variety of backgrounds, including premed students and certified medical assistants,” he notes. “…Unfortunately, few rules or standards currently exist that designate appropriate scribe activities.”

Scribe training varies a great deal as well, he notes. To make his point, Dr. Gold cites a study by medical malpractice insurer The Doctors Company and Oregon Health and Science University which looked at scribe capabilities and backgrounds. He notes that the survey, which had 335 respondents, found that 44% of scribes had no prior experience, and that only 22% of scribes have had any form of certification.

Under these circumstances, using scribes might come with some unexpected risks, he suggests. “The combination of rapid growth in scribe use, lack of standardized training, variability in scribe experience, and variability in both EHR exposure and EHR workflows raises the concern that scribes may introduce potential negative unintended consequences to either workflow or documentation,” he writes.

It is worth noting that another of Dr. Gold’s fears is that scribes will be asked to take on more complex EMR work which, if handled badly, could also lead to problems. He’s concerned that scribes may simply accumulate such duties due to “functional creep.”

For myself, while I understand Dr. Gold’s concerns, I don’t feel the situation is as dire as he suggests. Yes, it would probably be appropriate and beneficial to standardize scribe training, as it never hurts to boost the professionalism of any party participating in the care process. At the same time, though, with many scribes being trained largely by their employers, there will be a lot of variation in outcomes anyway.

But maybe I’m wrong. What do you think? Is it important to give scribes or standardized training and ask them to meet national certification standards? Or are they working effectively as is?