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Providers In Underserved Areas Lagging On EMR Implementation

Providers in large metros are less likely to have implemented EMRs than those in smaller metro areas and rural areas, according to a study written up by Healthcare Informatics.

The study, which appeared in Health Services Research, set out to determine whether EMR adoption was lower in traditionally underserved areas. To look at this issue, in 2011 researchers gathered data from 261,973 ambulatory healthcare sites with 716,160 providers, covering 50 states and the District of Columbia. Provider sites ranged from one-physician practices to large multi-physician groups, Healthcare Informatics reports.

Researchers found that areas with high concentrations of minority and low income populations, as well as those in large metropolitan areas were more likely to be in the lowest quartile of EMR adoption nationally, as compared with rural areas. The study also found that 43 percent of providers working in ambulatory healthcare sites had EMRs with e-prescribing capabilities, Healthcare Informatics reports.

Clearly, if researchers were expecting to find a lack of EMR adoption in these metro practices, they hit the nail on the head. I’d like to know, however, why things fell out this way.

Are metro practices lacking the resources to adopt EMRs in a more pronounced way than rural practices? Is there some phenomenon in the works in which underserved populations aren’t expecting EMRs, and therefore aren’t pressuring providers to implement them?

It’s worth noting that according to HIMSS data for Q1 2013, about 50 percent of ambulatory providers were still paper-based, and that nearly half of remaining practices were still stuck at Level 3 of adoption (CDR, access to results from outside facilities) or lower.

I’d argue that the gap between practices with mature implementations and those who are barely crawling is of equal importance and worth a study of its own. In the meantime, it is worth considering what can be done — beyond Meaningful Use incentives, clearly, or the gap wouldn’t exist — to be sure that EMR uptake doesn’t hit a snag with metro providers.

July 11, 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.

Frontline Female Veterans Likely to Benefit from New VA Telemedicine Project

As anyone in healthcare will tell you, the U.S. government has an interesting sense of timing. A day after the Pentagon announces it plans to end its ban on women in frontline combat, the VA announces that it has awarded grants to VA facilities that are launching women’s health projects, including establishing telehealth services for female veterans living in rural areas. Coincidence, or well-timed marketing/public relations strategy?

According to the VA’s press release announcing the grants, “Women serve in every branch of the military, representing 15 percent of today’s active duty military and nearly 18 percent of National Guard and Reserve forces. By 2020, VA estimates women Veterans will constitute 10 percent of the Veteran population.”

No mention was made in the release, of course, of the 237,000 jobs that will be available to women in the armed forces now that the combat ban has been lifted. I wonder if that 10-percent figure might jump a little once 2016 rolls around and arguments amongst government agencies regarding combat roles that should remain closed to women are laid to rest.

Telehealth grants were awarded to 10 facilities, and, according to the VA, will be used to provide services including tele-mental health, tele-gynecology, tele-pharmacy and telephone maternity care coordination.

While I applaud Secretary of Veterans Affairs Eric K. Shinseki’s statement that “[t]hese new projects will improve access and quality of critical health care services for women,” I’m not quite sure where I stand on the underlying issue – why aren’t female veterans already given 100 percent access to care at VA facilities, and why does the government seem to be planning for an increased need for healthcare services? But that speaks to a bigger problem that is probably best addressed elsewhere.

January 30, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Regional Extension Centers (Finally) Help Docs Get Incentives

For a while there, it seemed like the RECs didn’t have their act together, particularly when it came to reaching out to and closing the deal with doctors. Getting the right person on the phone wasn’t that easy, in fact. Well, times change. A new report suggests that the RECs have gotten on top of things.

The new study, which was issued by the General Accounting Office, concludes that healthcare providers who partnered with a REC — a step which involves a modest fee — were more than twice as likely to get an incentive payment under the Medicare incentive program.  The data in the report comes from 2011, and drew on varied government sources.

On a related note, the GAO reported that 2,802 hospitals and 141,649 professionals registered for the Medicare incentive program last year. Of that group 761 hospitals and 56,585 professionals got incentive payments through Medicare.

The agency also took a look at which types of hospital were more likely to get the Medicare incentive, and got some unsurprising results (summary courtesy of EMR Daily News):

Critical access hospitals were less than half as likely to earn incentives as acute care hospitals.

Hospitals in the top third of size (measured by number of beds) were 2.4 times more likely than hospitals in the bottom third to earn an incentive payment.

Nonprofit and for-profit hospitals were 1.1 and 1.5 times more likely than government-owned hospitals, respectively, to receive an incentive payment.

Only one in ten (12.2 percent) of eligible rural hospitals were awarded Medicare EHR incentive payments.

Taken as a whole, I  see this as a “good news/bad news” situation. One the one hand we have the welcome news that the REC program is actually delivering on its promise, something I imagine we’re all glad to see.

On the other, the critical access/rural hospital numbers are simply unacceptable. There’s no reason that people in these hospitals would be any less capable of meeting Meaningful Use standards, but they lack the staff and capital needed to push their efforts along. Ultimately, this could lead to a major disparity in care for Americans living in remote areas.

I’m not sure what the answer is here — other than perhaps a FAT load of grants for such hospitals helping them with MU efforts — but something has to be done.  I’m pretty sure that “the rich hospitals get richer” wasn’t HHS’s intent for MU.

August 3, 2012 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.

HIPAA Laws, Success of Healtchare IT, the Gap Between Large and Small Hospitals, and More — This Week in HealthCare Scene

Here is the weekly roundup of hot stories around the Healthcare Scene Blog Network:
EMR and HIPAA
HIPAA Applies To Those Who Don’t Know About It
Anyone who knows the rules of HIPAA should be held accountable for breaking them, right? According to a new appellate decision in California, even those who don’t know the rules could be punished. A recent ruling on a case did just that. Read about United States v Zhou and find out if you might be doing something illegal and not realizing it.

Meaningful Health IT News
Mark Versel, 19244-2012
With the recent death of his father, Meaningful Health IT News writer, Neil Versel, has dedicated himself to educating people about patient safety and multiple system atrophy (MSA), which ultimately claimed his father’s life. MSA is similar to Parkinson’s Disease, only more aggressive and fast-acting. During the last weeks of his life, Versel’s father, Mark, was treated at a local community hospital and Georgetown University Hospital. The differences in care between the two are startling, and the lack of appropriate care the community hospital hurt his father in his frail state. Read more about why Versel wants to educate the world about MSA and patient safety to make sure others don’t receive similar care to what his father did.

Smart Phone Health Care
Losing Weight on the Go: Keep Food Diary Easier than Ever
Recording meals and exercise have shown to increase weight loss. However, who wants to carry around a pen and paper everywhere? Luckily, there has been many apps created recently to make tracking food easier than ever. Check out the benefits of doing so and which apps top the chart.

EHR and EMR Videos
PrimeSUITE by Greenway Medical: Usability through Innovation
“When we consider usability we really take it down to a very simple philosophy, and that is, having the information always available to the users at their fingertips. . . The fewest number of clicks to get to information.” PrimeSUITE takes pride in the usability of their systems and discuss how innovation leads to more usability.

Hospital EMR and EHR
EMR Gap Grows Between Large, Small Hospitals
While Meaningful Use incentives have boosted the adoption of EMR, the gap between large and small hospitals continues to grow. Smaller hospitals may get further behind in the Meaningful Use stages because of the lack of resources for a high-volume of patient information. Discover the reasons behind the gap, and the suggestions being made to help smaller hospitals reach the requirements of Meaningful Use.

May 20, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Use Of E-Health Technologies Growing Internationally

While much of the discussion in Twitter forums and the like focuses on U.S.-based e-health use, here and there stories crop up of intriguing ways e-health technologies can help transform healthcare in developing nations.  This week, we got a more comprehensive look at the global picture.

The World Health Organization has just issued a report outlining the rapid pace at which mobile health use is expanding in low- and medium-income countries around the world.  In many of these nations, mobile health programs are emerging, in part because public use of computers and mobile phones is increasing, the WHO notes.

The WHO report focuses on privately-funded programs, as reliable government data is difficult to obtain. The private data WHO uses comes from the Center for Health Market Innovations, which has been collecting data on public health programs in developing nations since 2007.

By U.S. standards, mhealth programs in developing countries are still in their infancy. Only 176 of the 657 the public health programs WHO looked at in  Bangladesh, Bolivia, Brazil, Cambodia, Ecuador, India, Indonesia, Kenya, Pakistan, Peru, the Philippines, Rwanda, South Africa, Uganda, the United Republic of Tanzania and VietNam were using communications tech to improve healthcare.

Among the main technologies providers used were telehealth-related, given that in many cases patients were a long distance away from any form of direct care.  For example, “video chat” programs and phone hotlines offering access to doctors are emerging quickly.   Key conditions addressed by telehealth programs are emergency care, tuberculosis, mental health, malaria, general primary care, maternal and child health and HIV/AIDS.

While these programs show promise, there’s one roadblock which isn’t likely to go away quickly — money.  Apparently, about half of the mhealth activity tracked by the report is funded by private sources, which limits their growth. Also, text-driven programs which have worked well in the U.S. and other industrialized nations aren’t nearly as effective, as many residents of these countries are illiterate.

May 8, 2012 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.

EHR and Rural Healthcare Providers

Guest Post: Diane Matthews, MHA, is a the CEO of Laser Logics and Suitemed Solutions.  Laser Logics focuses on providing comprehensive IT services to healthcare.  SuiteMed Solutions helps doctors looking for comprehensive EHR Solutions.

Rural healthcare providers seem to be facing more obsticles with the following issues regarding EHR: cost, functionality to cost, effective training, implementation, support, IT hardware backend.

Strengthening the rural areas with technology advances in healthcare increases positive healthcare outcomes and reduces associated costly risks attributable to chronic diseases. I have lived in rural farm country side nearly all my life and I see the struggles of these rural healthcare providers. But, I also see the impact of lack of healthcare to children and elderly persons who simply have no means to travel 90 miles round trip for a doctor’s appointment. This is a crisis!

If we do not empower our rural healthcare providers with usable beneficial technology that is cost advantageous, then combined with reduced healthcare reimbursements and higher out of pocket costs that most rural families simply cannot afford, we are going to be losing our rural healthcare providers simply because they can afford to keep the doors open.

Cost is a huge factor. But a good healthcare EHR consultant not only focuses on the EHR software itself it is showing healthcare providers a wealth of avenues that can be effectively leveraged together to bring those implementation costs significantly down. Depending upon the healthcare facility this could be Section 179, American Disabilities Act, Green Tax Incentives, Federal 340B programs – it isn’t just one stimulus program – it is leveraging them all collectively and effectively together to yield the most advantageous outcome for the rural healthcare provider.

Something else I am seeing is a lot of rural healthcare providers are going with brand well known names in commercial EHR.  However, once the check is written the interest and commitment to the rural healthcare providers dwindles to non-existent. Then, what has happened is money that couldn’t afford to be thrown away in essence has possibly leaving no room to try again.

Rural healthcare providers need to invest their research into not EHR vendors but EHR consultants who look at the bigger picture of the healthcare entity and the community at large with focus on their unique needs. Organize group on-site training to reduce costs. An outstanding EHR consultant is going to view this as an opportunity to bring cutting technology to the hands of those who might not otherwise have an opportunity to receive it. Done right, while the EHR consultant may not have a high profit margin, the payoff will be seen with positive referrals from happy rural health entities, development of long term professional relationships, and being a responsible source in narrowing the gap in rural America between technology and healthcare.

What specific challenges do rural healthcare providers face with EHR?

What proposed resolutions to these challenges can be had to reduce EHR barriers for the rural healthcare providers?

July 12, 2011 I Written By

CEO of Laser Logics, Inc., serving healthcare entities in the areas of information technology, security, and authorized partner of CCHIT/ONC Certified EHR system SuiteMed IMS Electronic Health Records system. Focus on healthcare consulting nationally with focus on rural healthcare providers. EHR planning, custom return on investment calculator, project management, implementation, customization, workflow analysis, training, billing, and on-going support. Masters Degree in Healthcare Administration Bachelors Degree in Business Management Associates Degree in Paralegal Contact information: diane@laserlogics.com www.laserlogics.com www.suitemedsolutions.com

Plenty of EHR Solutions on Hand at HFMA Show

My day job as Social Marketing Director for Billian’s HealthDATA and Porter Research took me last week to the exhibit halls of the Healthcare Financial Management Association (HFMA) 2011 ANI Healthcare Finance Conference in Orlando. It was my first trip to the annual show, and to its venue, the Gaylord Palms Resort and Convention Center.

Unlike my previous tradeshow experience in Orlando, at the fun yet overwhelming HIMSS, I found the HFMA event to be extremely manageable in terms of schedule, show-floor size and booth scale. Almost everyone I ran into – whether it was at our booth, at someone else’s booth, at lunch or on the shuttle – was very approachable and seemed happy to take a few minutes out of their day to speak with me, even though, as a fellow exhibitor, I wasn’t exactly their target prospect. Perhaps it was my blue exhibitor ribbon that brought out the few bad apples in the bunch – those sales reps that either refused to get off the phone when they saw me approach or those that refused to crack a smile. My only other complaint was that exhibitors were denied entry to the majority of the educational sessions.

The Blues Brothers made an appearance at the HFMA 2011 ANI Healthcare Finance Conference.

As it was my first time being in the thick of the healthcare finance world, I took the opportunity to chat with as many show-floor folks as I could. I learned a lot about how integral healthcare finance and information technology are to each other, and to bringing the overall costs of providing healthcare services down, so that providers can – hopefully – extend these savings on to the patient in the form of more accessible and coordinated care, and better clinical outcomes.

I kept my eyes and ears open for solutions relating to electronic medical/health records, and came across quite a few that piqued my interest. I found I have a soft spot for anything related to patient portals and mobile solutions. Here, in no particular order, are a few snippets of what those exhibiting companies had to offer:

Healthcare Management Systems Inc. (HMS)
- offers ambulatory EHR and practice management services
“HMS is uniquely positioned to provide community hospitals with an EHR in a much shorter timeframe. With ONC-ATCB certification for inpatient EHR, EDIS and Ambulatory EHR, HMS will ensure that you meet the health IT standards mandated by ARRA and reap the financial benefits that follow.”

I’d be lying if I didn’t disclose that half the reason I went to their booth was to grab one of their very cool, green water bottles.

Origin Healthcare Solutions
- offers integrated practice management software and EHR solutions
“Streamlines office redundancies and makes users more efficient.”

Walking into their booth made me realize why exhibitors spend a bit more for that cushy carpet – and I was in flats, mind you.

Patient Point
- offers a technology platform that aggregates and integrates in real-time with health plan data, pharmacy benefit management data, practice management and EMR systems
“Our patient-facing portal and mobile apps enable patients to securely communicate with their care team and report progress of their ongoing conditions. Patients have the choice to opt in for secure messaging via email, phone or text messaging, which enables us to close the loop effectively on patient compliance and care coordination.”

As a social media enthusiast, I wonder if patient portal solutions like these will one day find a way to securely (and privately) integrate with Facebook or Twitter. Heck, even location-based social networks like Foursquare could be used. I’m sure us patients could be incentivized to “check in” early to our appointment.

The White Stone Group
- offers the Trace Communication System
“The only system of its kind that captures any healthcare exchange – voice, fax, or electronic – for fast processing and easy retrieval.”

Based on the Trace literature and its graphics, I kept looking for the phrase EMR to pop up, but it was nowhere to be found. It seems like it could fall into this category, especially as “All communication records are consolidated in one central location for quick and easy retrieval.” If anyone knows different, please enlighten me. The fact that they cite Children’s Healthcare of Atlanta, which is right in my backyard, as a case study also piqued my interest. The study relates that “Trace was used to overturn $2 million in denials and prevent an estimated $4 million in denials. Productivity improvements saved 107 staff hours per month and allowed for reallocation of five FTEs.”

* Editor’s Note: Erin McCarty, Director of Marketing at The White Stone Group, Inc., was kind enough to clarify the Trace system’s relationship to the EMR: “Trace is a platform that captures communication (voice, fax & electronic), indexes the records by patient and stores them for web-based retrieval. It is primarily used to capture revenue cycle communication that occurs with payers, patients and physicians. Trace does not replace the EMR, which is documenting the patient’s clinical data. Rather, it complements the EMR by capturing communication that helps hospitals receive accurate reimbursement for care provided. Common uses include recording authorization calls to payers, out-of-pocket discussions with patients, capturing faxed physician orders, visits to payer web sites, etc.”

Healthland
- offers a certified EHR to rural hospitals
“In addition to our ONC-ATCB 2011/2012 certified EHR software, we also offer clients comprehensive services, support, training and financing to help them receive incentive dollars, and ultimately, provide the high-quality patient care their communities expect.”

I also noticed in their brochure that they offer a white paper on “10 Must-Haves to a Successful EHR Implementation.”

Phreesia

- offers an electronic patient check-in solution
“With patient payments making up $1 out of every $4 of medical practice revenue, it’s no wonder 10,000 clinicians use Phreesia as their electronic patient check-in solution.”

Patient portals and electronic check-ins were popular at the show. Phreesia’s solution stood out to me for its bright orange color. While not directly tied to EMRs, I wonder if these sorts of technologies will become interoperable with them, especially as doctors and payers begin to work more closely together in the name of more coordinated care.”

Athenahealth
- offers integrated physician billing, practice management and EHR services

Their white paper on “The HITECH Act and Your Practice: Eight Tips for Successful EHR Adoption” caught my eye. It got me wondering how they were able to whittle it down from Healthland’s 10.

A number of other companies were on hand with EHR solutions, including:
MedQuist
Healthcare Anytime
Sandlot Solutions
PatientWorks

July 6, 2011 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.