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Denmark’s Health System Suffering Familiar EMR Woes

Posted on February 21, 2017 I Written By

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

If you’re trying to navigate the US healthcare system – or worse, trying to pay for your care — Denmark’s alternative may sound pretty sweet. The Danish health system, which is funded through income taxes, offers free care to all Danish residents and EU citizens, as well as free emergency treatment to visitors from all other countries. And the Danes manage to deliver high-quality healthcare while keeping costs at 10.5% of its GDP (as opposed the US, which spends nearly 18% of the GDP on healthcare).

That being said, when it comes to health IT, Denmark is going through some struggles which should be familiar to us all. Starting in 2014, the Danish government began modernizing its healthcare system, an effort which includes developing both new hospitals and a modern health IT infrastructure. One of the linchpins of its efforts is a focus on directing care to fewer, more specialized hospitals – cutting beds by 20% and hopefully reducing average lengths of hospital stays from five to three days – supported by its HIT expansion.

You probably won’t be surprised to learn, meanwhile, that Epic has inserted itself into this effort, winning a $1B project to put its systems in place across 20 hospitals with 44,000 concurrent users. Unfortunately for the Danes, who are starting with a few hospitals in one of the country’s five regions, the effort has run into some early snags. Apparently, the Epic installs at these initial test hospitals aren’t going according to plan.

According to one publication, initial hospital go-lives in May and June of last year have seen  major problems, including errors that have put patients at risk, as well as creating erroneous test reports, results and prescriptions. The Epic systems were also having trouble communicating with the Danish health card, which stores patient information on a magnetic stripe.

The questionable rollout has since caused some controversy. As of August 2016, the local doctors’ union was demanding that a planned deployment in Copenhagen, at Denmark’s busiest hospital, be put off until authorities had figured out what was going wrong at the other two.

At first, I was surprised to hear about about Denmark’s IT woes, as I’d blithely assumed that a government-run health system would have a “central planning” advantage in EMR implementations. But as it turns out, that’s clearly not the case. It seems some frustrations are universal.

I got some insight into this yesterday, when I took a call from an earnest Danish journalist who was trying to understand what the heck was going on with Epic. “Things are going badly here,” she said. “There are lots of complaints from the first two hospitals. And the systems can’t talk to each other.”

I told her not to be surprised by all of this, given how complex Epic rollouts can be. I also warned that given the high cost of Epic software and support, it would not be astonishing if the project ended up over budget. I then predicted that without pulling Epic-trained (and perhaps Epic certified) experts into the project, things might get worse before they get better. “Just hire a boatload of American Epic consultants and you’ll be fine,” I told her, perhaps a bit insensitively. “Maybe.”

When I said that, she was clearly taken aback. Even from thousands of miles away, I could tell she was unhappy. “I was hoping you had a solution,” she finally said. “I wish,” I replied. And I had to laugh so I wouldn’t cry.

Reinventing Claims Management for the Value-Based Era

Posted on February 16, 2017 I Written By

Provider claims management as we once knew it is not enough to thrive in a value-based era. Here’s what you need to know about taking claims management to a higher level.

The following is a guest blog post by Carmen Deguzman Sessoms, FHFMA, AVP of Product Management at RelayAssurance Plus RelayHealth Financial.

Provider claims management as we know it can no longer exist as a silo. With the rapid transformation from fee-for-service to value-based models, denial rates remain high–nearly 1 in 5 claims–despite advances in technology and automation. The complexity of value-based payment models almost guarantees an increase in denials, simply because there’s so much to get wrong.

For provider CFOs and their organizations to be effective–and thrive–in this environment, the touchpoints across the revenue cycle continuum must be re-examined to see if there are opportunities for improvement that have not presented themselves in the fee-for-service era. One such area is claims management, which is ripe to be elevated into an integral part of a denials management strategy.

What are the implications for providers? Well, for perspective, consider the savings realized through electronic claims submission.  CAQH research reveals that submitting a claim manually costs $1.98, compared to just $0.44 per electronic transaction. Likewise, a manual claims status inquiry costs $7.20 versus $0.94 for processing electronically.

This paper outlines the features and benefits of a technology platform that is geared toward elevating traditional claims management into the realm of strategic denial prevention and management, along with some recommended denial management best practices.

From Claim Scrubbing to Strategic Denial Management

Simple claims management as we know it is becoming obsolete. By “simple” we mean a claims process with a basic set of capabilities: creating claims, making limited edits, and ensuring that procedures are medically necessary. Today, a new class of integrated claim and denials management solutions augment this traditional approach to include pre- and post-filing activities that help automate and streamline claim submission, proactively monitor status, and expedite the appeals process for those that are denied.

In its simplest form, denials management can be defined as a process that leads to cleaner submitted claims and fewer denials from payers. But there are a lot of interim steps and variables that lead to “clean” claims, and a growing number of factors that influence denials. With the shift to alternative payment models and increasing consumerism, it’s more important than ever for providers to process claims properly the first time and to keep staff intervention to a minimum.

A big part of denials management is to improve the quality of patient data at registration, the source of many errors that lead to denials. Nonetheless, integrated claim and denial management processes span the entire revenue cycle, and technology brings new opportunities to manage costs and improve efficiencies. For example, having the ability to manage claims within a unified platform that can share and integrate data with the organization’s EHR prevents the need to toggle back and forth between systems to determine the status of a patient encounter.

A comprehensive claims management platform that advances denials management efforts integrates the following capabilities:

  • Eligibility verification prior to claim submission. It sounds pretty basic, but eligibility and registration errors on claims continue to be the top reason for denials. Automating the real-time verification of eligibility data helps identify avoidable denials and alert staff to claims needing attention before submission.
  • Maintenance of and compliance with oftenchanging payer business rules and regulatory requirements, including Medicare and state-specific updates, so that claims go out as cleanly as possible on the front end. With multiple payers and a growing roster of alternative payment models, manual in-house maintenance of edits is becoming an overwhelming task.
  • Digitization of attachments for Medicare pre- and post-payment audits, commercial claims adjudication and integrity audits, and workers compensation billing support. Integrating digital data exchange into the claims management workflow can help providers better control administrative costs, ensure regulatory compliance, and help automate and streamline claims processing and reimbursement.
  • Visibility into claim status lifecycle, with guidance for proactive follow-up. This lets providers only focus on those potential “problem” claims, and address any issues, before they are denied or delayed.
  • Automation of repetitive and labor-intensive tasks such as checking payer portals or placing phone calls to determine the status of pended or denied claims. This helps drastically reduce the amount of staff time spent perusing payer sites, and sitting on the phone on hold when an answer can’t be found.
  • Predictive intelligence to determine timing of payer acknowledgements and requests for additional information, as well as when payment will be provided. Analytics-driven claims management provides insight into how long responses should take, alerting providers when follow-up is required.
  • Management of remittances from all sources. Automated management of transaction formats, adjudication information, remittance translation and posting can help reduce A/R days, boost staff productivity, and accelerate cash flow.
  • Denial management and data analysis to guide corrective action and prevent future denials. Revenue cycle analytics can monitor the number of claims per physician, payer, or facility, enabling the health system to be proactive in interventions.
  • Creation and tracking of appeals for denied claims, including pre-population and assembly of appropriate forms. This not only helps cut down on resource-intensive manual work and paper attachments, but streamlines the appeals process.

Tying these capabilities together within an exception-based workflow helps address the challenge by providing visibility into problem claims. At-a-glance access to claim status helps cut down on the back-and-forth between billing departments and payers, and allows staff to focus only on those claims that require attention.

Pulling it all Together

Once you’ve integrated these capabilities, what are some of the claims management best practices to improve denial management and prevention? Consider the following actions:

  • Embed denial management within the entire workflow–Strong edits lead to clean claims, whether they pertain to Medicare, commercial payers or state-specific regulations. Edits should be constantly refined and seamlessly implemented, and pushed out to providers as often as possible–at minimum on a twice-weekly basis.
  • Adopt analytics-driven claims management–Claims management systems and connectivity channels to payers (i.e. clearinghouse) produce a wealth of operational information, most importantly data evidencing the speed of the payment path and claim status. Analyzed and served up in meaningful formats, this data becomes targeted business intelligence that can help providers better see obstacles and identify the root cause of denials and payment slowdowns.
  • Resolve issues before they result in denials–Providers should know claims location and status at all times. For example, has the claim been released by the EHR system? Has it been received and approved by the payer—or does a problem need to be addressed? Has a problem been rectified? Has the claim been released to a clearinghouse? Historical trends establish guidelines for the timing of events (e.g., whether claim status or payment should have been received from a particular payer by a certain date).
  • Be ready to identify claims denials and submit appeals. Nationwide revenue cycle statistics show that 1 in 5 claims are denied / delayed and can be avoided with the right software and better business processes.  In addition 67% of these denied claims are recoverable Identifying denials and submitting appeals to supply information not included on the initial claim can recoup lost revenue. To help streamline the process, additional claims information, such as medical records or lab results, should be supported by structured electronic attachments rather than faxed paper records or uploaded files to payer portals.

An Ounce of Prevention = Big Returns

Reducing and managing denials will have a significant impact on any healthcare organization’s bottom line. First, it costs $25 to rework a claim, and success rates vary widely. Additionally, when denials must be written off, the drop in patient revenue may total several million dollars for a medium-sized hospital, according to Advisory Board estimates.

The new look and feel of claims management is moving quickly toward analytics-driven, exception-based processing. By implementing and leveraging these capabilities and best practices in a cloud environment, providers can look forward to accelerated cash flow, reduced denials, increased automation with less staff involvement, and lower IT overhead.

About Carmen Sessoms
With over 20 years of progressive strategic leadership and healthcare experience in product management, business development, strategic planning and consulting, Carmen Sessoms has worked with all organizational levels in the ambulatory and acute care markets for patient access and reimbursement.

Prior to joining RelayHealth, Carmen was the regional vice president of operations for an outsourcing firm, where she led the eligibility side of the business and was instrumental in many process improvements that brought efficiencies to the company, its provider customers and their patients. Additionally, she has 10 years’ previous experience with McKesson in Product Management roles in which she directed projects related to the design and development of revenue cycle solutions, including initiatives with internal and external partners.

Carmen is a past president of the Georgia HFMA chapter, a recipient of HFMA’s Medal of Honor, and holds the designations of CHFP (Certified Healthcare Financial Professional) and FHFMA (Fellow in HFMA).

“We’re All Patients”

Posted on February 15, 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.

Ever since the first #HITsm Chat of the year, I’ve been rolling around the idea of “We’re All Patients.” It was kicked off by what I think was probably a well-intentioned tweet by Andrey Ostrovsky, MD who asked to hear from patients:

This led someone to say “Aren’t we all patients at some point?” which got this response from Erin Gilmer along with a whole firestorm of other comments:

First, let’s applaud Dr. Ostrovsky for asking for the patient perspective and let’s not let the firestorm of defining patients overwhelm the fact that he wanted to hear from patients. That’s a dramatic shift from the past where patients might have been an afterthought. Dr. Ostrovsky was asking for patient input 11 minutes into a 1 hour chat. That’s a big improvement.

Second, if you look at the literal definition of patient, it says “a person receiving or registered to receive medical treatment.” By pure technical definition, it’s true that we’re all patients. Hard to imagine an adult that hasn’t received medical treatment at some point. However, when we say that “We’re all patients” it misses the point of why I think Erin Gilmer and Carolyn Thomas, who wrote the post that Erin linked to, said that we’re not all patients.

The reality is that even if we’ve all been to a doctor before, it doesn’t mean that we’re talking from our view as a patient. Many times when you go to a conference or are participating on a Twitter chat, you’re not having a discussion from your view as a patient. Often you’re talking from a work perspective or from a provider perspective and not from a patient perspective.

We know this happens a lot because you’ll often hear at conferences “This isn’t what I want personally, but this is my perspective on it.” Just because you have been a patient at one point doesn’t mean you’re speaking from that perspective at a conference, Twitter chat, blog post, etc. That’s true for me too when writing these blog posts. I’ll write from a wide variety of perspectives depending on the topic and post. It’s often not from the patient perspective.

Along with not necessarily speaking from your own patient perspective, it’s fair to say that just because you were a patient for some “injury or episode of illness”, it doesn’t mean you can share the perspective of a patient with a chronic condition. That’s a very different situation and one that largely has to be lived to fully comprehend.

The reality is that we need to involve as many different patient voices in our discussions as possible if we want to create solutions that benefit patients the most. On that, I think almost everyone agrees. Studies have shown that having a wide diversity of viewpoints, opinions, and perspectives provides a much better solution.

At the end of the day, we can all only share our own personal experience. I don’t want chronic patients talking for me. Chronic patients don’t want non-chronic patients talking for them. In fact, many chronic patients don’t want other chronic patients talking for them. etc etc etc

Instead, we should do everything we can to incorporate multiple perspectives into all the work we do. That’s where we’ll get the best results. We shouldn’t be so arrogant that we try to speak for someone else. However, we also shouldn’t demonize someone that tries to show empathy and raises the voice of another’s perspective either. The reality of complex problems is that we can all be right depending on perspective. So, let’s embrace as many perspectives as possible. We are all humans and most of us want healthcare to be better.

UPDATE: In a great discussion on Twitter with Erin Gilmer that was prompted by this post, Erin highlights a point that I didn’t cover well in the above commentary. She pointed out that many chronic patients’ voices have been marginalized in the past. I’d take it even a step further and say they’ve not only been marginalized but often ignored.

The reality is that the “healthy” patients have more voices making sure their (my) needs are heard. Chronic patients are smaller in number and so it’s more challenging to have their voices heard. Not to mention the last thing you want to do when you’re dealing with chronic illness is make your voice heard. However, in an impressive manner, many patients with debilitating illnesses do just that.

Erin also made a good point that we shouldn’t use “We are all patients” as an excuse to not involve expert patients at the table. We should definitely elevate their voices. As an advisor to many health IT startup companies and having written about thousands of companies, the challenge of incorporating all these voices and perspectives into a product is impossible. There are always gives and takes with limited resources. However, far too many don’t even make a sincere effort. That’s what’s sad.

This post is about elevating more patient voices from a wide variety of perspectives. That produces the best outcomes and discussions.

Are the Independent Doctors that Remain the Disruptors, the Tough Ones?

Posted on February 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.

We’ve seen a dramatic shift in healthcare over the past 3-5 years. More and more small group and independent practices have been selling to much larger health systems. Plus, we’ve seen a consolidation of health systems as well. The move to larger and larger health organizations has happened and I’ve heard many predict that we’ll never go back.

While I know there are pressures that indicate this might be the case, I also wonder if the independent doctors and small group practices that remain are the real industry disruptors. Are they the tough ones that survived through the challenging healthcare environment?

With this thought in mind, I looked up the definition of “survival of the fittest”:

the continued existence of organisms that are best adapted to their environment, with the extinction of others, as a concept in the Darwinian theory of evolution.

Sounds a bit like the independent practice to me. Those independent practices that still exist have had to adapt to the changing healthcare world. The ones that remain are likely the most “fit”. We’ve also seen a lot of other independent practices go “extinct.”

Does this give us hope? On the one hand, I can see how those independent practices that remain are strong and can adapt well. I hope that they do it so well that they disrupt the whole healthcare system in a good way. I think that the health system is generally better with more independent practices. There are a certain ownership and patient kinship that happens with independent practices that is often missing in larger health systems that treat doctors like machines that need to produce certain numbers. It’s unfortunate for healthcare that this is being lost.

The thing that scares me most about this trend is that most of the independent doctors seem to be older doctors. Most of the younger doctors I know are just fine going to the large health systems. They don’t want to take on the risk of starting their own practice. If the younger generation isn’t willing to fight the independent practice fight, then independent practices will die.

How many doctors at large health systems have created real disruptive innovation? Not very many. That’s a scary thought that should all have us worried about the future of the independent doctor. Once it’s gone. It will be hard to see how it could come back.

If you don’t think this is a big deal. Think back to the last time you called your cable provider. There’s a reason they’re ranked the lowest in customer service. They have very little competition to force their hand. The loss of independent practices will mean very little competition for the big healthcare organizations. That’s a bad thing for all of us.

What do you think about independent practices? Are the ones that remain the strong ones? Will the independent practices survive in healthcare? I look forward to reading your thoughts on social media and in the comments.

E-Patient Update: Hey Government, Train Patients Too!

Posted on February 10, 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.

Recently I got a most interesting email from the ONC and A-list healthcare educator Columbia University. In the message, it offered me a free online course taught by Columbia’s Department of Biomedical Informatics, apparently paid for by ONC funding. (Unfortunately, they aren’t giving away free toasters to students, or I definitely would have signed up. No wait, I’m sorry, I did register, but I would have done it faster for the toaster.)

The course, which is named Health Informatics For Innovation, Value and Enrichment) or HI-FIVE, is designed to serve just about anyone in healthcare, including administrators, managers, physicians, nurses, social workers an care coordinators. Subjects covered by the course include all of the usual favorites, including healthcare data analytics, population health, care coordination and interoperability, value-based care and patient-centered care.

If I seem somewhat flippant, it’s just because the marketing material seemed a little…uh…breathlessly cheery and cute given the subject. I can certainly see the benefits of offering such a course at no cost, especially for those professionals (such as social workers) unlikely to be offered a broader look at health IT issues.

On the other hand, I’d argue that there’s another group which needs this kind of training more – and that’s consumers like myself. While I might be well-informed on these subjects, due to my geeky HIT obsession, my friends and family aren’t. And while most of the professionals served by the course will get at least some exposure to these topics on the job, my mother, my sister and my best girlfriend have essentially zero chance of finding consumer-friendly information on using health IT.

Go where the need is

As those who follow this column know, I’ve previously argued hard for hospitals and medical groups to offer patients training on health IT basics, particularly on how to take advantage of their portal. But given that my advice seems to be falling on deaf ears – imagine that! – it occurs to me that a government agency like ONC should step in and help. If closing important knowledge gaps is important to our industry, why not this particular gap. Hey, go where the need is greatest.

After all, as I’ve noted time and again, we do want patients to understand consumer health IT and how to reap its benefits, as this may help them improve their health. But if you want engagement, folks, people have to understand what you’re talking about and why it matters. As things stand, my sense is that few people outside the #healthit bubble have the faintest idea of what we’re talking about (and wouldn’t really want to know either).

What would a consumer-oriented ONC course cover? Well, I’m sure the authorities can figure that out, but I’m sure education on portal use, reading medical data, telemedicine, remote monitoring, mobile apps and wearables wouldn’t come amiss. Honestly, it almost doesn’t matter how much the course would cover – the key here would be to get people interested and comfortable.

The biggest problem I can see here is getting consumers to actually show up for these courses, which will probably seem threatening to some. It may not be easy to provoke their interest, particularly if they’re technophobic generally. But there’s plenty of consumer marketing techniques that course creators could use to get the job done, particularly if you’re giving your product away. (If all else fails, the toaster giveaway might work.)

If providers don’t feel equipped to educate patients, I hope that someone does, sometime soon, preferably a neutral body like ONC rather than a self-interested vendor. It’s more than time.

Physician EHR Burnout Infographic

Posted on February 9, 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.

Physician burnout is a hot topic and one that’s not likely to go away anytime soon. There are a lot of elements to physician burnout and I was impressed with how well eMedApps captured the issue of physician burnout in the infographic below.

I think the question of the next decade is going to be, “How do we decrease the administrative tasks the doctors perform?” If we don’t find a satisfactory answer, our healthcare system will be permanently damaged. What’s even scarier is that this seems to be trending worse and not better.

What would you propose to help solve the problem of physician burnout?

Physician EHR Burnout and Administration Tasks - eMedApps

Switching Out EMRs For Broad-Based HIT Platforms

Posted on February 8, 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.

I’ve always enjoyed reading HISTalk, and today was no exception. This time, I came across a piece by a vendor-affiliated physician arguing that it’s time for providers to shift from isolated EMRs to broader, componentized health IT platforms. The piece, by Excelicare chief medical officer Toby Samo, MD, clearly serves his employer’s interests, but I still found the points he made to be worth discussing.

In his column, he notes that broad technical platforms, like those managed by Uber and Airbnb, have played a unique role in the industries they serve. And he contends that healthcare players would benefit from this approach. He envisions a kind of exchange allowing the use of multiple components by varied healthcare organizations, which could bring new relationships and possibilities.

“A platform is not just a technology,” he writes, “but also ‘a new business model that uses technology to connect people, organizations and resources in an interactive ecosystem.’”

He offers a long list of characteristics such a platform might have, including that it:

* Relies on apps and modules which can be reused to support varied projects and workflows
* Allows users to access workflows on smartphones and tablets as well as traditional PCs
* Presents the results of big data analytics processes in an accessible manner
* Includes an engine which allows clients to change workflows easily
* Lets users with proper security authorization to change templates and workflows on the fly
* Helps users identify, prioritize and address tasks
* Offers access to high-end clinical decision support tools, including artificial intelligence
* Provides a clean, easy-to-use interface validated by user experience experts

Now, the idea of shared, component-friendly platforms is not new. One example comes from the Healthcare Services Platform Consortium, which as of last August was working on a services-oriented architecture platform which will support a marketplace for interoperable healthcare applications. The HSPC offering will allow multiple providers to deliver different parts of a solution set rather than each having to develop their own complete solution. This is just one of what seem like scores of similar initiatives.

Excelicare, for its part, offers a cloud-based platform housing a clinical data repository. The company says its platform lets providers construct a patient-specific longitudinal health record on the fly by mining existing EHRs claims repositories and other data. This certainly seems like an interesting idea.

In all candor, my instinct is that these platforms need to be created by a neutral third party – such as travel information network SABRE – rather than connecting providers via a proprietary platform created by companies like Excelicare. Admittedly, I don’t have a deep understanding of Excelicare’s technology works, or how open its platform is, but I doubt it would be viable financially if it didn’t attempt to lock providers into its proprietary technology.

On the other hand, with no one interoperability approach having gained an unbeatable lead, one never knows what’s possible. Kudos to Samo and his colleagues for making an effort to advance the conversation around data sharing and collaboration.

EMR Data Use For Medical Research Sparks Demand For Intermediaries

Posted on February 7, 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.

Over the last couple of years, it’s become increasingly common for clinical studies to draw on data gathered from EMRs — so common, in fact, that last year the FDA issued official guidance on how researchers should use such data.

Intermingling research observations and EMR-based clinical data poses different problems than provider-to-provider data exchanges. Specifically, the FDA recommends that when studies use EMR data in clinical investigations, researchers make sure that the source data are attributable, legible, contemporaneous, original and accurate, a formulation known as ALCOA by the feds.

It seems unlikely that most EMR data could meet the ALCOA standard at present. However, apparently the pharmas are working to solve this problem, according to a nice note I got from PR rep Jamie Adler-Palter of Bayleaf Communications.

For a number of reasons, clinical research has been somewhat paper-bound in the past. But that’s changing. In fact, a consortium of leading pharma companies known as TransCelerate Biopharma has been driving an initiative promoting “eSourcing,” the practice of using appropriate electronic sources of data for clinical trials.

eSourcing certainly sounds sensible, as it must speed up what has traditionally been the very long process of biopharma innovation. Also, I have to agree with my source that working with an electronic source beats paper any day (or as she notes, “paper does not have interactive features such as pop-up help.”) More importantly, I doubt pharmas will meet ALCOA objectives any other way.

According to Adler-Palter, thirteen companies have been launched to provide eSource solutions since 2014, including Clinical Research IO (presumably a Bayleaf client). I couldn’t find a neat and tidy list of these companies, as such solutions seem to overlap with other technologies. (But my sense is that this is a growing area for companies like Veeva, which offers cloud-based life science solutions.)

For its part CRIO, which has signed up 50 research sites in North America to date, offers some of the tools EMR users have come to expect. These include pre-configured templates which let researchers build in rules, alerts and calculations to prevent deviations from the standards they set.

CRIO also offers remote monitoring, allowing the monitor to view a research visit as soon as it’s finished and post virtual “sticky notes” for review by the research coordinator. Of course, remote monitoring is nothing new to readers, but my sense is that pharmas are just getting the hang of it, so this was interesting.

I’m not sure yet what the growth of this technology means for providers. But overall, anything that makes biopharma research more efficient is probably a net gain for patients, no?

The Quality Disconnect in Healthcare

Posted on February 2, 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.

There’s a big problem with the current healthcare model. There’s no real financial incentive to make sure you’re practicing the highest quality care possible. Doctors don’t get paid for quality. Patients don’t select a doctor based on the clinical quality of the doctor since the patient has no way of measuring a doctor’s clinical quality. The clinical quality a doctor provides doesn’t move the needle on her business.

Certainly, I’m not saying that doctors don’t provide quality care. It is also true that over time a doctor could grow a reputation as a poor quality doctor, but those are usually only the extreme cases that end up in court with big medical class action lawsuits.

What’s amazing is that most doctors can’t event evaluate the quality of another doctor. An orthopedic surgeon has no way to evaluate how well an ENT is doing quality wise. Doctors of the same specialty could evaluate a colleague’s clinical quality, but that doesn’t happen in the current system.

In a perfect world, we could create payments based on the quality of care a doctor provides. That makes a lot of sense and it’s what we do in a lot of other industries. We pay people who provide higher quality more than we pay people who provide lower quality. The problem in healthcare is that we don’t have any good way to measure quality.

While I believe there’s no good way to measure quality, that doesn’t mean that it won’t keep organizations from trying. In fact, that’s the basis of much of MACRA and the PQRS program before it. Same goes for Accountable Care Organizations (ACOs). These are all efforts to evaluate the quality of care that’s being given and reimburse based on those quality indicators. Most doctors will tell you, that’s not a very good system if you want quality.

What’s screwed up about these quality measures is that they do nothing to actually lower the cost of healthcare. Poor quality care only represents a small portion of the massive premium we pay for healthcare in the US. The real costs come from outrageous drug pricing, pallative care, medical liability fears, and chronic conditions. Those are the four areas we should really be focusing our efforts on. The problem is that there’s not a lot of will in healthcare to address these challenging issues.

Practice Management Market To Hit $17.6B Within Seven Years

Posted on February 1, 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.

A new research report has concluded that the global practice management systems market should hit $17.6 billion by 2024, fueled in part by the growth of value-adds like integration with other healthcare IT solutions.

The report, by London-based Grand View Research, includes a list of what it regards as key players in this industry. These include Henry Schein MicroMD, Allscripts Healthcare Solutions, AdvantEdge Healthcare Solutions, athenahealth, MediTouch, GE Healthcare, Practice Fusion, Greenway Medical, McKesson Corp, Accumedic Computer Systems and NextGen Healthcare.

The report argues that as PM systems are integrated with external systems EMRs, CPOE and laboratory information systems, practice management tools will increase in popularity. It says that this is happening because the complexity of medical billing and payment has grown over the last several years.

This is particularly the case in North America, where fast economic development, plus the presence of advanced research centers, hospitals, universities and medical device manufacturers keep up the flow of new product development and commercialization, researchers suggest.

In addition, researchers concluded that while PM software has accounted for the larger share of the market a couple of years ago, that’s changing. They predict that the services side of the business should grow substantially as practices demand training, support and system upgrades.

The report also says that cloud-based delivery of PM technology should grow rapidly in coming years. As Grand View reminds us, most PM systems historically have been based on-premise, but the move to cloud-based solutions is the future. This trend took off in 2015, researchers said.

This report, while worthwhile, probably doesn’t tell the whole story. Along with growing demand for PM systems,I’d contend that vendor sales strategies are playing a role here. After all, integration of PM systems with EMRs is part of a successful effort by many vendors to capture this parallel market along with their initial sale.

This may or may not be good for providers. I don’t have any information on how the various integrated practice management systems compare, but my sense is that generally, they’re a bit underpowered compared with their standalone competitors.

Grand View doesn’t take a stand on the comparative benefits of these two models, but it does concede that emerging integrated practice management systems linking EMRs, e-prescribing, patient engagement and other software with billing are actually different than standalone systems, which focus solely on scheduling, billing and administration. That does leave room to consider the possibility that the two models aren’t equal.

Meanwhile, one thing the report doesn’t – and probably can’t – address is how these systems will evolve under value-based care in the US. While appointment scheduling and administration will probably be much the same, it’s not clear to me how billing will evolve in such models. But we’ll need to wait and see on that. The question of how PM systems will work under value-based care probably won’t be critically important for a few years yet.

(Side note:  You may want to check out John’s post from a few years ago on practice management systems trends. It seems that the industry goes back and forth as to whether independent PM systems serve groups better than integrated ones.)