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Ten-year Vision from ONC for Health IT Brings in Data Gradually

Posted on August 25, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

This is the summer of reformulation for national U.S. health efforts. In June, the Office of the National Coordinator (ONC) released its 10-year vision for achieving interoperability. The S&I Framework, a cooperative body set up by ONC, recently announced work on the vision’s goals and set up a comment forum. A phone call by the Health IT Standards Committeem (HITSC) on August 20, 2014 also took up the vision statement.

It’s no news to readers of this blog that interoperability is central to delivering better health care, both for individual patients who move from one facility to another and for institutions trying to accumulate the data that can reduce costs and improve treatment. But the state of data exchange among providers, as reported at these meetings, is pretty abysmal. Despite notable advances such as Blue Button and the Direct Project, only a minority of transitions are accompanied by electronic documents.

One can’t entirely blame the technology, because many providers report having data exchange available but using it on only a fraction of their patients. But an intensive study of representative documents generated by EHRs show that they make an uphill climb into a struggle for Everest. A Congressional request for ideas to improve health care has turned up similar complaints about inadequate databases and data exchange.

This is also a critical turning point for government efforts at health reform. The money appropriated by Congress for Meaningful Use is time-limited, and it’s hard to tell how the ONC and CMS can keep up their reform efforts without that considerable bribe to providers. (On the HITSC call, Beth Israel CIO John Halamka advised the callers to think about moving beyond Meaningful Use.) The ONC also has a new National Coordinator, who has announced a major reorganization and “streamlining” of its offices.

Read more..

Could Population Health Be Considered Discrimination?

Posted on August 19, 2014 I Written By

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

Long time reader of my site, Lou Galterio with the SunCoast RHIO, sent me a really great email with a fascinating question:

Are only the big hospitals who can afford the very expensive analytics pop health programs going to be allowed to play because only they can afford to and what does that do to the small hospital and clinic market?

I think this is a really challenging question. Let’s assume for a moment that population health programs are indeed a great way to improve the healthcare we provide a patient and also are an effective way to lower the cost of healthcare. Unfortunately, Lou is right that many of these population health programs require a big investment in technology and processes to make them a reality. Does that mean that as these population health programs progress, that by their nature these programs discriminate against the smaller hospitals who don’t have the money to invest in such programs?

I think the simple answer is that it depends. We’re quickly moving to a reimbursement model (ACOs) which I consider to be a form of population health management. Depending on how those programs evolve it could make it almost impossible for the small hospital or small practice to survive. Although, the laws could take this into account and make room for the smaller hospitals. Plus, most smaller hospitals and healthcare organizations can see this coming and realize that they need to align themselves to survive.

The other side of the discrimination coin comes when you start talking about the patient populations that organizations want to include as one of their “covered lives.” When the government talks about population health, they mean the entire population. When you start paying organizations based on the health of their patient population, it changes the dynamic of who you want to include in your patient population. Another possible opportunity for discrimination.

Certainly there are ways to avoid this discrimination. However, if we’re not thoughtful in our approach to how we design these population health and ACO programs, we could run into these problems. The first step is to realize the potential issues. Now, hopefully we can think about them going forward.

Hospital M&A Cost Boosted Significantly By Health IT Integration

Posted on August 18, 2014 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 @annezieger on Twitter.

Most of the time, hospital M&A is sold as an exercise in saving money by reducing overhead and leveraging shared strengths. But new data from PricewaterhouseCoopers suggests that IT integration costs can undercut that goal substantially. (It also makes one wonder how ACOs can afford to merge their health IT infrastructure well enough to share risk, but that’s a story for another day.)

In any event, the cost of integrating the IT systems of hospitals that merge can add up to 2% to the annual operating costs of the facilities during the integration period, according to PricewaterhouseCoopers. That figure, which comes to $70,000 to $100,000 per bed over three to five years, is enough to reduce or even completely negate benefits of doing some deals. And it clearly forces merging hospitals to think through their respective IT strategies far more thoroughly than they might anticipated.

As if that stat isn’t bad enough, other experts feel that PwC is understating the case. According to Dwayne Gunter, president of Parallon Technology Solutions — who spoke to Hospitals & Health Networks magazine — IT integration costs can be much higher than those predicted by PwC’s estimate. “I think 2% being very generous,” Gunter told the magazine, “For example, if the purchased hospital’s IT infrastructure is in bad shape, the expense of replacing it will raise costs significantly.”

Of course, hospitals have always struggled to integrate systems when they merge, but as PwC research notes, there’s a lot more integrate these days, including not only core clinical and business operating systems but also EMRs, population health management tools and data analytics. (Given be extremely shaky state of cybersecurity in hospitals these days, merging partners had best feel out each others’ security systems very thoroughly as well, which obviously adds additional expenses.) And what if the merging hospitals use different enterprise EMR systems? Do you rip and replace, integrate and pray, or do some mix of the above?

On top of all that, working hospital systems have to make sure they have enough IT staffers available, or can contract with enough, to do a good job of the integration process. Given that in many hospitals, IT leaders barely have enough staff members to get the minimum done, the merger partners are likely costly consultants if they want to finish the process for the next millennium.

My best guess is that many mergers have failed to take this massive expense into account. The aftermath has got to be pretty ugly.

Population Health Polls

Posted on August 11, 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 was thinking about population health today. It’s become a hot topic of discussion now that a lot more healthcare data is available for population health management thanks to EHR adoption. Although, in many ways, the various value based reimbursement and ACO programs are a form of population health. I guess, for me I classify all of these efforts to improve the health of a population as population health.

I just wonder how many organizations are really working on these types of solutions and how much of the population health is just talk. Let’s find out in the poll below.

I’ll be interested to hear how organizations are approaching population health. Also, let’s do another poll to see how much people will be working on population health in the future.

I’d love to hear more details to your responses in the comments. If you are working on population health, what programs are you doing and what IT solutions are you using to support it?

Patient Engagement Strategies Must Start with the Patient

Posted on December 18, 2013 I Written By

The following is a guest blog post by Matt Adamson, vice president of product management for ACO and value-based health at ZeOmega

Healthcare providers are preparing to engage patients at a deeper level than ever before as they strive to achieve quality and savings metrics required of accountable care models being implemented across the country. However, a critical, lingering question remains – will patients participate? Patients have grown accustomed to seeking out healthcare information on their own, with the top five healthcare websites logging more than 78 million unique visitors monthly.[i] While this is clearly a positive sign that must be leveraged to move the needle even further, the answer could lie with the addition of the care coordinator that exists in most accountable care and medical homes.

A patient portal is seen as the most likely way that care providers will interact with patients outside of resource intensive office visits or telephone conversations, but any technology adoption must be accompanied by monumental shifts in attitudes among both physicians and patients in order to be successful. Physicians already are strapped for time and few are reimbursed for patient engagement beyond the traditional face-to-face interaction. Likewise, patients may hesitate to “bother” their doctors with questions or access their personal healthcare information online.

Care coordinators could serve as the bridge that connects physicians and patients, bringing them together at a clinical connection point. Relatively new in the healthcare system, care coordinators generally are nurses with care management experience who can help put conditions and diagnoses into the appropriate clinical context while speaking with patients on their level. The patient portal would provide another avenue for patients to communicate with the care coordinator, who would serve as the liaison to the physician when appropriate.

Meaningful Use Drives Push for Patient Engagement

Patient engagement will be a critical consideration in achieving Stage 2 Meaningful Use. Now extended through 2016, Stage 2 includes objectives to improve patient care through better clinical decision support, care coordination and patient engagement. Patient engagement metrics will require that more than 5% of a practice’s patients send secure messages to the provider and more than 5% of the patients access their health information online.[ii]

The Medicare Shared Savings Programs (MSSP) and the Partnership for Patients community-based care transitions program both have measures related directly to demonstrating an enhanced communication experience between patients and physicians that can lead to recognition and additional revenue for practices and hospitals. The NCQA Patient-Centered Medical Home certification also includes elements related to patient engagement. One of the critical certification factors requires contact with at least 50% of patients to develop and document self-management plans and goals.[iii]

Beyond regulations and certifications, patient engagement is also being shown to help meet the cost savings aspects of accountable care. Patients who are more engaged have fewer hospital stays, adhere more often to prescribed medical treatments, recover faster and are more satisfied with their care.[iv]

Engaged patients are also more successful at managing chronic illness than those who are not. More than 40% of Americans are living with at least one chronic disease, which overall cause seven in 10 deaths each year in the United States, according to the Centers for Disease Control and Prevention.

Getting Patients Involved in Their Own Health

As clinicians work more closely with patients who are trying to manage chronic illness, it is important to note that the time patients spend with physicians, nurses and other care providers represents a very small percentage of the overall time spent managing conditions or treatments. The patient and other caregivers are largely responsible for adhering to care plans and making the necessary lifestyle changes to accommodate chronic conditions. Patients who are educated about their conditions and engaged in the process will more likely succeed in keeping their chronic conditions in check.

So using a patient portal or similar technology would seem a rational, logical way for patients to learn more about their conditions and interact with care providers in a secure, HIPAA-compliant environment. Unfortunately, it isn’t as easy as that. With all of the rules, metrics and evidence that are mandated for the clinician community, there are no such rules in place that require compliance for patients.

A portal would allow patients to contact their doctor any time, day or night, to ask a question or relate treatment information. But few doctors are trained for or desire that type of high-touch interaction, especially since reimbursement for that type of interaction is rare. The United States also is facing a rather serious primary care shortage in many areas, one that will be exacerbated as up to 30 million uninsured obtain coverage under the Affordable Care Act. So what’s the best use of physician time – diagnosing and treating an increasing number of patients or answering questions by secure email?

Patient portals and other technologies that Meaningful Use is bringing into common usage will not move the needle toward smarter health choices on their own. The technology has to be helpful and interesting for patients, providing them with an easy way to connect with care providers when they need help and to get updates and reminders when needed.

This is why the idea of using care coordinators in the role of engaging patients when not in the physician office or receiving direct care is gaining traction. The goal of care coordinators would be to guide patients and help them to navigate the healthcare system so that they stay on track with their treatments between physician visits. Care coordinators would have a direct link to a patient’s physicians, bringing them in only when needed.

Secure messaging and emails could provide an easy way for patients to submit questions or take action when they are ready to do so. Platforms that can connect and share the nursing care plans between the care coordinator, caregivers and the patient could be highly effective, especially if there are issues resulting from chronic or acute conditions. This seamless connection would allow the care coordinator to pass along educational content and become part of a two-way mechanism for tracking medications in a manner that allows patients to update and print the list.

From there, embedding incentive management and gaming features into the portal would provide a reason for the patient to keep coming back to continue the engagement.

Technology platforms built to enable the connection between the patient and the care coordinator could be the missing pieces of the puzzle that would allow patients to become more involved in their health and allow the promise of patient engagement to become a reality.

EMR Analysis Detects Childrens’ Growth Disorders

Posted on September 16, 2013 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 @annezieger on Twitter.

EMRs can be used to detect growth disorders in children, according to new research published in the Journal of the American Medical Association . The study, which was written up in FierceEMR, used a special automated growth monitoring algorithm integrated into an EMR system to track childrens’ growth.

To conduct the study, researchers compared three “control” years to an “intervention” year. An annual average of 33,029 children were screened, according to FierceEMR.

Researchers found that in a control year an average of four children were diagnosed with a growth disorder. During the intervention year, however, 28 new diagnoses of growth disorders were made among 32,404 children, FierceEMR reports.

Looked at another way, the rate of growth disorder diagnoses was 0.1 per 1000 screened children in the control years versus 0.9 per 1000 screened children in the intervention year, FierceEMR noted.

These study results are part of an emerging body of literature suggesting that EMRs to help clinicians detect and manage disease states.

For example, another study appearing in the Journal of the American Medical Association found that EMRs can be associated with a drop in emergency department visits and hospitalizations among diabetics.  That study, which analyzed all of the 169,711 records for patients enrolled in the Kaiser Permanente Northern California diabetes registry during a four-year period, found a 10.5% decline in hospitalizations for preventable ambulatory care sensitive conditions where EMRs were in use.

Another study, which recently appeared in BMJ Quality & Safety, recently concluded that EMRs can help reduce hospital readmissions of high-risk heart failure patients by sorting out high from low risk patients in the ED.

Meaningful Use Stage 3 Should Address Care Disparities

Posted on September 13, 2013 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 @annezieger on Twitter.

A consumer coalition of more than 50 consumer, patient and labor organizations has published a plan designed to thrust care disparities into center stage as part of Stage 3 of Meaningful Use, according to Healthcare IT News.

According to data from the Joint Center for Political and Economic Studies, the combined costs of premature death and health disparities in the U.S. were $1.24 trillion between 2003 and 2006. The group, the Consumer Partnership for eHealth, argues that these disparities will only increase as the country grows more diverse.

CPeH developed the plan after a year-long review of scientific literature, along with collaboration with experts on disparities in care and health IT. The plan focuses on data collection and use to identify disparities; language; literacy and communication and care coordination and planning, HIN reports.

The plan is designed to integrate disparities reduction with the other Stage 3 criteria to improve the identification and understanding of health disparities. The CPeH has submitted the plan to the Health IT Policy Committee, and has asked the committee to act on its recommendations.

Right now, the Meaningful Use program only requires basic identification of race, ethnicity and gender data collection. But the action plan would like to see Stage 3 include more stringent data collection standards designed by HHS, which would include disability status, sexual orientation and gender identity.

The group’s action plan includes recommendations that:

* EMRs have the ability to stratify patients’ specific conditions by demographic variables such as race, ethnicity, language, gender identity, sexual orientation and socio-economic status

* Providers make greater use of patient data collected and shared through mobile health applications

* Clinicians effectively communicate EMR information to patients, so patients can better make use of its benefits

While the goals outlined here are laudable, my sense is that even for doctors ready for Stage 3 Meaningful Use, requiring this level of data collection and analysis would be a difficult burden. I guess this one is a “wait and see” proposition.

HIEs Unable To Keep Up With User Demands

Posted on August 7, 2013 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 @annezieger on Twitter.

While HIEs are expanding their offerings to include analytic and care coordination functions useful for population health management, they aren’t doing it quickly enough to meet market demand, according to a piece in Information Week.

The IW story, which outlines the conclusions of a new report from Chilmark Research, notes that the focus of most HIEs is still on secure clinical messaging, which is not adequate for cross-enterprise care coordination. The Chilmark report estimates that queries of databases for patient info needed at the point of care account for just 2 percent to 10 percent of HIE transactions overall.

Information Week also drew attention to a study appearing in Health Affairs noting that the most common functions of the 119 operational public HIEs were transmitting lab results, clinical summaries and discharge summaries. While there’s been a large increase in the number of HIEs that can exchange Continuity of Care Documents, few EMRs can integrate the data components of CCDs in to structured fields, the Health Affairs piece noted.

The problem is particularly acute in ambulatory care. As Chilmark CEO John Moore told Information Week, most ambulatory EMRs haven’t been able to generate CCDs that other EMRs can consume or do queries using a record locator service. “The value that HIEs provide to the ambulatory sector, where 80 percent of care takes place, is pretty limited,” Moore told IW.

Still, despite their weaknesses, public HIEs continue to hold onto life. For example, as various industry stats have shown, hospital CIOs increasingly see participation in an HIE as a key initiative, if nothing else because Meaningful Use will eventually demand interoperability.

But as the Chilmark study emphasizes, HIEs have a long way to go before they’re making a major contribution to patient care. And getting enough momentum to address these problems seems elusive. All told, while HIEs are clearly an important movement, getting them to the point of true usefulness could take years more.

Another Example Of EMR “Golden Age” Applications

Posted on July 30, 2013 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 @annezieger on Twitter.

Not long ago, John posted a piece about the “Golden Age of EMRs Being Over” and how that’s playing out from an EMR vendor perspective. Since writing that piece he’s found that while the Golden Age of EMR buyer frenzy has passed, we’re entering a new EMR Golden Age which will feature amazing applications for clinicians and public health administrators. John calls these applications Smart EMR.

Today, I came across some news which I think is a perfect example of the kind of innovative applications John is predicting will emerge as EMRs mature. At the University of Notre Dame, researchers have developed a system which uses collaborative filtering of EMR records to better guide treatment, manage disease and predict disease risks across a population.

Notre Dame computer science associate professor Nitesh Chawla and doctoral student Darcy Davis call the new system the Collaborative Assessment and Recommendation Engine (CARE). CARE uses collaborative filtering to detect similarities between patients and produce personalized disease risk profiles for individuals. It does so by looking at diseases in similar patients.

“In its most conservative use, the CARE rankings can provide reminders for conditions that busy doctors may have overlooked,” Chawla said in a prepared statement. “Utilized to its full potential, CARE can be used to explore broader disease histories, suggest previously unconsidered concerns and facilitate discussion about early testing and prevention, as well as wellness strategies that may ring a more familiar bell with an individual and are essentially doable.”

Ultimately, Chawla says, such a system can produce a host of benefits. For example, he suggests, it can reduce readmission rates, improve quality of care ratings, help demonstrate Meaningful Use and improve personal and population health. On a more micro level, it can allow patients to walk out of their doctor’s office with a list of recommendations based on predicted health risks, he notes.

This is just one example of the kind of new applications that are emerging as EMRs mature and the use of big data becomes a tool for wellness. I expect to see lots of announcements of this kind over the next year or two. It’s an exciting time.

Partners Integrates Mobile Data With EMR

Posted on June 25, 2013 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 @annezieger on Twitter.

In a move that could realize much of the promise of wireless remote monitoring, Partners HealthCare system has made it possible for providers to view remotely-collected patient health data in its EMR.  The program was launched by Partners division The Center for Connected Health, which focuses on delivering new forms of patient care outside of standard medical settings.

For years, Partners has been running programs which collect patient data through a combination of remote-monitoring technology, sensors and Web-based tools. Their focus has included management of chronic diseases such as diabetes and high blood pressure, medication adherence and improved pregnancy outcomes and cardiac care outcomes. The Center’s remote monitoring database now stores over 1.2 million  patient vital signs.

Now, Partners has linked The Center’s proprietary remote monitoring database to its EMR, a step which moves the system in the direction of offering continuous chronic disease management. If a patient is participating in a remote monitoring program, Partners physicians can can now see a patient’s day-to-day vital signs, blood glucose levels, weight and other key health indicators directly within their records in the EMR.

The ultimate notion, according to the press release at least, is to  “put the patient at the center of their care while maintaining a close watch on their condition when they are not in the hospital or doctor’s office.”

While Partners didn’t say how many patients are involved in The Center’s programs, it’s doubtless a small fraction of overall Partners patient population. So despite the general coolness of what they’re trying to do, this is still more on the order of an experiment than a population health management program via remote monitoring.

Still, what Partners is doing is a large step in the right direction, and will doubtless realize some of the long anticipated benefits of remote monitoring for patients who are involved. Good show, folks.