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Patient Billing Experience is Tied to HCAHP Scores

Posted on October 22, 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 first heard about this earlier this year when I met with ZirMed at ANI. Since then, I keep hearing this concept over and over and so it’s finally time for me to create a blog post on the topic. How you bill a patient has a tremendous impact on patient satisfaction and therefor your HCAHP scores.

When you read that, I’m sure you’re thinking “Well duh! Of course it does.” While it’s obvious once it’s stated, I don’t know many organizations that are working to improve their HCAHP scores by improving their patient billing processes. I have seen a lot of programs that look at the patient experience getting checked in, while their in the hospital, and how their discharge goes. Unfortunately, many organizations seem to stop one step short of the finish line. It’s like running 25 miles of a 26 mile marathon. The patient bill is the last mile of that journey.

The final experience a patient has with a hospital is usually when they get the bill from the hospital. There are so many ways this can be a terrible experience for the patient. If the charges are a lot more than what the patient expects, they’ll have a bad experience. If it’s not clear what charges they owe and whether insurance has paid their portion or not, they’ll have a bad experience. If they see the $5 aspirin (yes, that’s representative of charges that don’t make logical sense to the average patient), then it can damage their experience. If there’s no way to pay the bill online, it can leave a bad taste in the mouth for many. If it’s not clear what the bill is charging for, it can cause a bad experience. I could go on, but you get the idea.

All of these issues (and no doubt there are plenty more) have no impact on the care the patient received. In fact, your doctors and nurses could have provided an amazing customer service and literally worked miracles to save the patients life. However, if the billing experience is bad, it can leave a bad taste in their mouth and that will show up when they’re rating your hospital.

No doubt there are plenty of edge cases that we’ll never be able to satisfy. However, there’s a lot more we can do with our medical billing processes to ensure that the experience is a lot better than what it is today. Your HCAHP scores shouldn’t suffer because you didn’t take the time to make your billing process as beautiful as your clinical care.

ICD-10 Ebola Infographic

Posted on October 21, 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 my post on funny ICD-10 codes ruining the ICD-10 brand, I briefly commented how there’s no ICD-9 code for Ebola, but that there is one for ICD-10.

Beth Friedman from Agency Ten22 shared a link to this ICD-10 Ebola Infographic that I thought readers would find really interesting.

Ebola ICD-10 Infographic

One more reason to finally implement ICD-10 in the US.

Insights from Dr. Eric Topol at #SHSMD14

Posted on October 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.


Patient care will eventually win, but sacred cows still have a lot of fight in them.


I’m still chewing on this one. I definitely love the idea of remote visits. Not sure it’s the smartest patient room.


This trend is definitely happening. Although, if you sound out Iwwiwwiwi, it sounds a lot like whining. I’m not sure that’s a good thing. Either way, I think the market is going to push towards on demand medicine.


I’d love to hear more about this topic. I think the first step is identifying the real cost problem. Seems like these top drugs could provide a really good start.

Are We Moving from Passive Patients to Active Consumers?

Posted on October 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.


This were the questions I was asking myself when I sat in on a presentation by Intermountain’s revenue cycle manager at the Craneware Summit in Las Vegas. I think the clear answer to the first question is that patients are becoming more active. Patients are shouldering a larger portion of the cost of their healthcare and so now they’re move involved in the care they receive. Plus, the internet and mobile applications have made it much easier for a patient to be informed on their health.

The later question is much harder. What impact will this change have on healthcare?

I certainly don’t have all the answers, but it’s going to take a dramatic shift by the current healthcare system to adapt to this changing consumer. The days of the omniscient doctor (at least perceived) are gone and there’s now a shift to a more collaborative care model.

Of course, many doctors fear that this shift is going too far. They usually point to the overbearing patient who thinks they know better than the doctor. Certainly these patients exist, but they are the minority and aren’t a huge shift from the patients who didn’t listen to their doctor before the shift happened. The problem is that 1 rotten apple spoils the bunch.

Overall, I think this change will be a good thing for the healthcare system. There are a lot of things you can’t change in healthcare if you don’t have an active patient that’s engaged and cares about their health. Hopefully this will be the start of that movement to helping patients care more about their health.

If you want proof that things are changing, Intermountain has changed their mission statement. First, it’s not very often that an organization as large as Intermountain makes a major change to their mission statement. Second, think about whether this mission statement would work for your hospital or healthcare organization:

Change is in the air. What are you doing to prepare for the change?

How Quick Can We Analyze Health IT Data?

Posted on October 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.

While at the AHIMA Annual convention, I had a chance to sit down with Dr. Jon Elion, President and CEO of ChartWise, where we had a really interesting discussion about healthcare data. You might remember this video interview of Dr. Elion that I did a few years back. He’s a smart man with some interesting insights.

In our discussion, Dr. Elion led me on an oft repeated data warehouse discussion that most data warehouses have data that’s a day (or more) old since most data warehouses batch their data load function nightly. While I think this is beginning to evolve, it’s still true for many data warehouses. There’s good reason why the export to a data warehouse needs to occur. An EHR system (or other IT system) is a transactional system that’s build on a transactional database. This makes it difficult to do really good data analysis. Thus the need to move the data from a transactional system to a data store designed for crunching data. Plus, most hospitals also combine data from a wide variety of systems into their data warehouse.

Dr. Elion then told me about how they’d worked hard to change this model and that their ChartWise system had been able to update a hospital’s data warehouse (I think they may call it something different) every 5 minutes. Think about how much more you can do with 5 minute old data than you can do with day old data. It makes a huge difference.

Data that’s this fresh becomes actionable data. A hospital’s risk management department could leverage this data to identify at risk patients that need a little extra attention. Unfortunately, if that data is a day old, it might be too late for you to be able to act and prevent the issue from getting worse. That’s just one simple example of how the fresh data can be analyzed and improve the care a patient receives. I’m sure you can come up with many others.

No doubt there are a bunch of other companies that are working to solve this problem as well. Certainly, day old healthcare data is valuable as well, but fresh data in your data warehouse is so much more actionable than day old data. I’m excited to see what really smart people will be able to do with all this fresh data in their data warehouse.

Should Healthcare Institutes Perform “Rip-and-Replace” to Achieve Interoperability? Less Disruption, Please!

Posted on October 7, 2014 I Written By

The following is a guest blog post by Dr. Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
Dr Voltz
A KLAS Research Report on the EMR buying trends of 277 hospitals with at least 200 beds has identified that almost half will be making a new EMR purchase by 2016.  Of the providers considering a change, 34 percent have already selected a vendor and another 44 percent are strongly leaning toward a specific vendor. Driving factors include concerns over outdated technology and health system consolidation.

But is the technology really outdated and health system consolidation necessary, or is the real issue lack of interoperability?  And if you are a hospital looking for a new EMR, let’s not forget the history of technology before we jump to conclusions that the greatest market share means the best of breed.

When we look at EMR adoption over the past number of years, we need to be careful with the data we use. Implementations, and now rip and replace switching to other venders, has been the only choice offices, clinics, hospitals and health systems had to address the issues with interoperability.

Most of current deployed EMRs are designed as a one-size-fits-all, leading to the situation where today out-of-the-box functionalities fit none of the care providers’ requirements. Besides that, EMR vendors have been designed with proprietary data where patient medical sharing (or exchange) becomes the biggest roadblock for patient care continuum. The reason for the rip-and-replace approach by some hospitals is to reach interoperability between inpatient and outpatient data with a single integrated and consolidated database approach.

A 50 percent turnover of EMRs is an incredibly high numbers of hospitals and clinics who have either replaced or are looking to replace their current EHR’s. Being that the majority of the initial implementations were supported by the HITECH act, one would think the government would raise issue with vendors to address this high turnover of EHR’s. There seems to be a general misperception that if our current systems do not meet the demands and needs of providers, administrators, and financial arms of a healthcare delivery system, ripping out the system and implementing a new one will solve the issues.

What is the True Total Cost of Ownership of an EMR?

Healthcare management must look beyond the actual cost paid to an EHR vendor as the only cost but they must look into the total cost, much beyond the normal Total Cost of Ownership (TCO). TCO only includes the initial license cost, maintenance cost, IT support cost, but in healthcare, there is another cost – it is the disruption of the care providers’ workflow. That disruption is directly correlated to healthcare system revenue and patient care outcomes.

Stop this disruption and let’s look for another solution where we integrate disparate systems since many of them are built upon databases that can address the needs of health. The cost to providers in time to learn a new system, the migration and loss of patient data that has been collected in the current systems, the capital expense of system software, the hardware, trainers, IT personnel, etc. all add to the burden, something that is currently being looked at as a necessary expense.

Interoperability Saves Resources

This need not be the case when platforms exist to connect systems and improve access for providers. Having a consistent display of data allows for more efficient and effective management of patients and when coupled with a robust collaborative platform, we close many of the open loopholes that exist in medicine today, even with EHR’s.

2.0 EMR connectors like Zoeticx and others have taken the medical information bus, middleware platform, to solve the challenges that current EHR’s have not.  This connection of systems and uniform display of information that physicians depend on for the management of patients is crucial if hospitals want their new EMRs to succeed. In addition, a middleware platform allows for patients to access their medical information between EMR’s in a single institution or across institutions, a major issue for Meaningful Use.

Fragmentation Prevents Some EMRs From Connecting With Their Own Software

Large EMR vendors’ lack of healthcare interoperability only reflects on how they compete against each other. Patient medical data and its proprietary structure is the tool for such competition where the outcome would not be necessarily beneficial for the hospital, medical professionals or patients. There are plenty of examples where healthcare facilities with EHRs even from the same vendor fail to interoperate with each other.

Such symptoms have little to do with the EMRs that have the same data structure, but about the fragmentation being put in place over the years of customization. We believe that the reason for this is to address fragmentation of the software product. Fragmentation is a case where deployments from the same software products have gone through significant amounts of customization, leading to its divergence from the product baseline.

To believe that ripping the whole infrastructure – inpatient and outpatient–as the method to reach interoperability would only cause a lot of disruption, yet the outcome would be very questionable down the road. Appreciating the backlash of calling the implementation of EMR’s a beta-release, we have much data to use in looking for the next solution to HIT.

As with much of medicine, we are constantly looking for the best way to take care of our patients. Like it or not, EMR’s have become a medical device and we need to start to evaluate them as we would any device used to manage health and disease. As we move forward, there will be an expansion in the openness of patient data, and in my prediction, a migration away from a single EHR solution to all of the requirements of healthcare, and into a system of interconnected applications and databases.

Once again, we have learned that massively engineered systems do not evolve into complex adaptive systems to respond to changing environmental pressures. Simple, interrelated and interdependent applications are more fluid and readily adaptable to the constantly changing healthcare environment. Currently, the only buffer for the stresses and changes to the healthcare system are the patients and the providers who depend on these systems to manage healthcare.

About Dr. Donald Voltz
By Dr. Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.  A board-certified anesthesiologist, researcher, medical educator, and entrepreneur. With more than 15 years of experience in healthcare, Dr. Voltz has been involved with many facets of medicine. He has performed basic science and clinical research and has experience in the translation of ideas into viable medical systems and devices.

Facebook in Healthcare

Posted on October 6, 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.

A story on Reuters reported late last week that Facebook is making an entry into the healthcare space. Here’s an excerpt from the article about Facebook’s plans for healthcare:

The company is exploring creating online “support communities” that would connect Facebook users suffering from various ailments. A small team is also considering new “preventative care” applications that would help people improve their lifestyles.

In recent months, the sources said, the social networking giant has been holding meetings with medical industry experts and entrepreneurs, and is setting up a research and development unit to test new health apps. Facebook is still in the idea-gathering stage, the people said.

This move is especially interesting when paired with the announcements of Apple Health, Samsung Health, and Google Fit (and a few other Google health initiatives like Calico). It’s not the first time that big corporations have seen an opportunity in healthcare (See Microsoft HealthVault and Google Health). However, we have yet to see any of these big corporations really make a dent on healthcare.

The reality for many of these large corporations is that they don’t realize the crazy complexities that exist in healthcare. Many like to site the healthcare privacy argument as a reason for their failure. No doubt, HIPAA and privacy are a challenge for these organizations. In fact, I can already hear the outcry of people talking about Facebook and privacy of their health data. Many don’t trust Facebook with privacy and with good reason. However, privacy is the least of the reasons why these big corporations have a challenge entering the healthcare space.

Remember that healthcare is a complex beast with the largest customer being the government (ie. Medicare and Medicaid). Healthcare is not a rational market. The government, employer owned health insurance, health insurance plans, etc etc etc all make healthcare extremely complex to navigate full of perverse incentives. Plus, how do you do an ROI on the value of saving someone’s life?

While I’m skeptical of any large corporation entering healthcare, I’m actually quite interested in what Facebook could do to help healthcare. No doubt, a lot of healthcare already exists on Facebook.

Just a few weeks ago I was running up an escalator to catch a flight and sliced my big toe from top to bottom (you should see the pics). Luckily TSA was really helpful and I made my flight. Once I got home, I assessed the damage and wasn’t sure if I should go get sutures or not. I turned to Facebook where I posted a picture of my toe and tagged a few of my doctor friends. Long story short, my doctor friends told me I should go to the doctor and quickly, because if I waited until the next day they wouldn’t be able to suture it.

This is a small example, but Facebook was really effective for me. In fact, I posted a follow up picture a few days later (you know how men always like to show off their scars) and a doctor friend told me it was healing well. Of course, many might say that it was a small flesh wound and so that’s not as big a deal to post on Facebook. Would I post me health details if I had some chronic condition?

The interesting thing is that chronic patients are more than happy to give up all privacy in search of a cure. Unfortunately, they have nothing to lose and everything to gain. It’s part of the reason why Patients Like Me has been so successful. Plus, Patients Like Me has proved that we want to take part in online support communities for our conditions.

We’ll see if Facebook can really execute on online support communities like they have on Patients Like Me. It will be a real challenge for them because it’s not the focus of the company. However, they’re obviously well connected to a lot of people that could and would benefit from these types of healthcare communities. No doubt many people on Facebook don’t visit or even know about sites like Patients Like Me.

I’ll be interested to see what Facebook does in this space. I think they’d be smart to roll it off into a separate product that focuses on things like privacy and security. Being tied to the Facebook brand is a huge liability in this case. Plus, the value of Facebook to a Facebook created healthcare community is not in the Facebook brand, but in the Facebook audience and reach.

Besides creating various healthcare communities similar to Patients Like Me, I think Facebook has a huge opportunity to use social pressure to influence healthcare decisions. Changing behavior is an extremely hard thing to accomplish. However, never underestimate the power of positive peer pressure. Peer pressure can be one of the most powerful ways to change people’s behavior. Unfortunately, it works for good and bad. Facebook has all of your peers mapped to you. Can Facebook use that to help you become healthier? If they can, they’ll be on to something.

What do you think of Facebook possibly entering healthcare?

ACO by ACO Savings and Payments Report

Posted on September 26, 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.

One of my favorite former CMS people, Travis Broome, recently shared a link to the ACO Savings and payment report. It provides an interesting view into the year 1 results of the Medicare Shared Savings Program (Medicare ACO program if you prefer).

It’s interesting to see which ACOs and other organizations got paid, but probably even more interesting to see ones that didn’t get paid at all. My guess is that many of them dropped out. If I’m reading the report properly, I could only find one organization that incurred a loss. It seems that Dean Clinic and St. Mary’s Hospital ACO in Wisconsin owes $3.96 million. Looks like they took the high risk-high reward option and lost. I’d love to talk to someone from that organization and hear what happened.

Travis Broome offered a number of other insights into the ACO report:

What do you think of the ACO program? I think it’s a bad sign that so many organizations fell out of the program. However, the trend and move towards this reimbursement is going to happen. I really don’t see how it could stop.

Celebrating Simple Solutions

Posted on September 23, 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.

Yesterday I had a chance to tour the beautiful Samford Health facility in Fargo, ND. What a thoughtful patient design and use of tracking technology. Plus their Disney like approach to front of house and back of house was fascinating. I recommend the tour if you’re ever in the area.

However, there was a really simple extra chair solution that caught my eye:
image

You often need an extra chair in the room. What a great little implementation that saves the space when you don’t need the chair, but it’s there when you need it. I love simple little design solutions.

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.