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The Challenge of FDA Clearance

Posted on March 16, 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.

As I’ve talked to 100s of companies creating devices for healthcare, there’s inevitably the question: “Are you FDA cleared?” There answer usually tells me a lot about the company and what their goals are for the product. Generally, it’s a question of if they’re going to go after the consumer space (ie. no FDA clearance) or after the medical market (ie. FDA clearance preferred).

In a few cases, I’ve talked to companies like EarlySense that have an FDA cleared product for hospital beds and a non-FDA cleared product for consumers. It was interesting to hear the reasons why they chose to release a non-FDA cleared product for consumers since they already knew they had the capability to go through the FDA clearance process. Their answer to me was instructive.

The core of their response was that FDA clearance is not a one time event and so this limits their ability to iterate and release product updates.

For anyone working in the startup world, it runs completely counter to the startup culture. The idea of iterating quickly and often is part of the mantra of most startup companies in silicon valley and now around the world. The FDA’s clearance process runs almost completely counter to this idea.

With this type of restriction, it makes sense why so many companies would avoid FDA clearance and just create a direct to consumer product that doesn’t require FDA clearance. The ongoing FDA clearance requirements can be a bear. What company wouldn’t want to bypass it and just iterate as they please?

The challenge with this approach is that there are reasons that FDA clearance is so challenging. First, it searches to provide a level of safety as far as what’s being implemented and the results of the device actually being tested and confirmed. Second, it creates a trust that most doctors (and their malpractice and insurance companies) want to see before using it.

Certainly, we could argue about how effective the FDA clearance is about ensuring safety and results, but that’s a topic for another day. If nothing else, it requires many organizations to think deeply about what the safety of the patients that are impacted by the device and consider the promises they make to customers. Those are two things that are missing in my consumer health devices and apps.

It’s a tough balance and I don’t think we’ve fully figured it out. How do you ensure safety and efficacy while still allowing the entrepreneurial spirit of innovation to thrive?

Is Quality Mutually Exclusive with Profitability?

Posted on March 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.

I was browsing through some old notes today from past conferences and stumbled upon a really intriguing question from when I met with Infor back at ANI 2014. Thanks to technology I know that I met with Beth Meyers, Healthcare Industry Strategy Director, and Prakash Kadamba, Director of Healthcare Product Management at Infor. The question I jotted down from our discussion is the title for the blog post:

Is Quality Mutually Exclusive with Profitability?

In most industries, the company with the better quality often wins. There are a few exceptions, but for the most part, quality matters a lot in the choices we make. However, if I dive a little deeper I think that value wins out over quality in many industries as well. You know you have a breakout product which provides amazing quality and amazing value.

Unfortunately, I’m sad to say that this isn’t always the case in healthcare. The reason I think it isn’t the case is that patients don’t have a good way to measure quality and I’m not sure we’ll ever get to where we can measure quality. I’d be excited if we could, but I don’t see it in the foreseeable future. We have vague representations and indicators of quality, but none of them effectively represent quality.

The best measure of quality a patient can see is “I got better.” The irony of this statement is that just because you got better doesn’t mean you got quality care. You might have gotten better based on something other than the care you received.

Back to the original question, I think you can provide amazing quality healthcare and still be profitable. Those two ideas aren’t mutually exclusive. However, I also don’t think that all those doctors providing quality care are going to be profitable. Quality care does not directly determine how profitable your organization will be. What makes the difference then?

The big difference I see is how well an organization is run. How effective is your billing department? How effective is your documentation? Do you have tools that engage patients in their billing and in their care? Have you automated many patient experiences to free up time for your staff to work on the things that matter most?

Those clinics that are profitable and providing quality care are usually the ones that are looking beyond the EHR. They realize where the EHR fits into their larger strategy, but the EHR isn’t their entire strategy. That’s a big shift in mindset for many that were so myopically focused on implementing EHR as they chased after government handouts.

If you know you’re providing high quality care, but you’re not profitable, take a step back and evaluate your business. I’m sure you’ll find a lot of shortcomings on the business side that if you addressed would make you more profitable. Just don’t expect your EHR vendor to give you all the answers. They’re an important piece of the puzzle, but just one piece.

Paper Records Are Dead

Posted on March 14, 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.

Here’s an argument that’s likely to upset some, but resonate with others. After kicking the idea around in my head, I’ve concluded that given broad cultural trends, that the healthcare industry as a whole has outgrown the use of paper records once and for all. I know that this notion is implicit in what health IT leaders do, but I wanted to state this directly nonetheless.

Let me start out by noting that I’m not coming down on the minority of practices (and the even smaller percentage of hospitals) which still run on old-fashioned paper charts. No solution is right for absolutely everyone, and particularly in the case of small, rural medical practices, paper charts may be just the ticket.

Also, there are obviously countless reasons why some physicians dislike or even hate current EMRs. I don’t have space to go into them here, but far too many, they’re hard to use, expensive, time-consuming monsters. I’m certainly not trying to suggest that doctors that have managed to cling to paper are just being contrary.

Still, for all but the most isolated and small providers, over the longer term there’s no viable argument left for shuffling paper around. Of course, the healthcare industry won’t realize most of the benefits of EMRs and digital health until they’re physician-friendly, and progress in that direction has been extremely slow, but if we can create platforms that physicians like, there will be no going back. In fact, for most their isn’t any going back even if they don’t become more physician firendly. If we’re going to address population-wide health concerns, coordinate care across communities and share health information effectively, going full-on digital is the only solution, for reasons that include the following:

  • Millennial and Gen Y patients won’t settle for less. These consumers are growing up in a world which has gone almost completely digital, and telling them that, for example they have to get in line to get copies of a paper record would not go down well with them.
  • Healthcare organizations will never be able to scale up services effectively, or engage with patients sufficiently, without using EMRs and digital health tools. If you doubt this, consider the financial services industry, which was sharing information with consumers decades before providers began to do so. If you can’t imagine a non-digital relationship with your bank at this point, or picture how banks could do their jobs without web-based information sharing, you’ve made my point for me.
  • Without digital healthcare, it may be impossible for hospitals, health systems, medical practices and other healthcare stakeholders to manage population health needs. Yes, public health organizations have conducted research on community health trends using paper charts, and done some effective interventions, but nothing on the scale of what providers hope (and need) to achieve. Paper records simply don’t support community-based behavioral change nearly as well.
  • Even small healthcare operations – like a two-doctor practice – will ultimately need to go digital to meet quality demands effectively. Though some have tried valiantly, largely by auditing paper charts, it’s unlikely that they’d ever build patient engagement, track trends and see that predictable needs are met (like diabetic eye exams) as effectively without EMRs and digital health data.

Of course, as noted above, the countervailing argument to all of this is the first few generations of EMRs have done more to burden clinicians than help them achieve their goals, sometimes by a very large margin. That seems to be largely because most have been designed — and sadly, continue to be designed — more to support billing processes than improve care. But if EMRs are redesigned to support patient care first and foremost, things will change drastically. Someday our grandchildren, carrying their lifetime medical history in a chip on their fingernail, will wonder how providers ever managed during our barbaric age.

 

What Do Doctors Need to Know About MACRA and MIPS? – MACRA Monday

Posted on March 13, 2017 I Written By

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

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

While at the HIMSS 2017 conference, I had a chance to do a video interview with MACRA expert, Alexandria (Alex) J. Goulding, Public Policy Manager at iHealth. We cover a broad range of MACRA topics focused on the practical things that doctors should know about MACRA and MIPS.

You can find the full MACRA video interview at the bottom or click any of the links below to skip to a specific answer:

Do you have other perspectives and insights that you’d add to what Alex Goulding offered above? Please share them in the comments.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

First Time HIMSS: Parker Redding, Banyan Social

Posted on March 10, 2017 I Written By

Janae builds inbound social media sales and marketing plans for healthcare IT companies. Healthcare as a human right. Physician Suicide Loss Survivor. twitter: @coherencemed

One of the main themes of HIMSS was using digital tools to manage your patient engagement and social engagement online. Banyan Social was there for their first conference introducing their digital solution for storing patient permissions to post reviews or photos online. I spoke with Parker Redding from Banyan Social. They were a first time Exhibitor at HIMSS and I wanted to hear what their impressions were from the conference.  Banyan Social is a platform with marketing tools for providers including digital storage of HIPAA forms and integration with Google reviews. From their website:  “Extend your reach and grow your practice with real-time reviews, HIPAA-compliant social media posts and automated practice listings.”

What was your first health IT conference like?

“Honestly, I thought it was pretty cool. It was almost overwhelming how many people were there. It was the biggest event I’ve ever been to. It was cool to see how many people are in the Health IT space. We were constantly busy at our booth and with how many people came to our booth we didn’t really have the opportunity to explore in depth. We are unique in the Health IT space and aren’t always the perfect fit for these database guys and those kinds of people but they were always willing to refer us to the right people and who to talk to.

One thing that I liked about this event is that even if they don’t think it’s a good fit everyone is willing to be open and have a conversation. Everyone there is trying to learn more and share knowledge it’s not just “I’m trying to get my CE credits and leave.”  It’s about learning something new – about gaining knowledge.

A lot of the people who were first time exhibitors that we talked to told us how it was crazy how big it was and how many people were there. The conference was really diverse in terms of experts from different countries.  It was cool to see the big EMR or the IBM booth and to see how much effort they put into their space.

What were your goals?

Our main goal was to create partnerships with other companies in the healthcare industry and to learn more about the healthcare IT industry and how our business fits in with this. We wanted to share our HIPAA approved social media app and how doctors/clinics can use social media and reviews to engage patients.

What was your favorite part of HIMSS?

Honestly, speaking with a pediatrician that owns multiple practices the last day and learning about why he’s been in the medical industry.  Learning about how much he cared about his patients and how he knew he could make more money in another industry. It’s amazing to see how passionate people are about healthcare and being positive. He gives up money because he’s passionate about helping with children.

What did you learn about Health IT?

Bunch of nerds.  Just kidding.  I love the nerds and the developers those are my people.

What do you wish you could do differently?

I would bring more people to have at our booth. We had a consistent flow of people stopping to talk with us that we didn’t get to spend the time we wanted to connect with other companies and learn more about the IT healthcare world. You can’t complain about having a busy booth.  I would take an Uber to the conference. Trying to find a parking spot and walking a mile to get to your booth was difficult.

Make Your Medical Practice Website Patient-Friendly

Posted on March 9, 2017 I Written By

The following is a guest blog post by Yasmin Khan from Bonafide.

It’s a sad truth that many websites are simply not effective at being a resource for visitors, including most medical practice and healthcare service websites. The key element to a service-oriented business website is accessibility or ease of use.

Unfortunately, accessibility is the element most lacking in websites for healthcare organizations.

  • The content is written at the graduate school level.
  • There is too much jargon, unfamiliar acronyms, and unfamiliar words.
  • Too much in-depth medical knowledge is required to understand what is presented on the website.

An example of writing above the audience is using the term nosocomial infection instead of the self-explanatory hospital-acquired infection.

Optimizing your website requires you to look at it from the intended user’s point of view and using proven techniques to increase the probability your website will be found. The entire goal of your website is to attract and convert leads into patients.

Below are three areas of optimization you can use to improve your medical practice’s website to be more patient-friendly.

Provide Relevant, Well-Written Content, and Attractively Presented Content

Does your present website look just like the brochure at your front desk? If so, you are not leveraging the power of your website. You have at your fingers a tool that can be designed to appeal to a wide variety of information needs that is easily navigated.

Every piece of content on your website should be targeted to your ideal patient profile. You must also have content that speaks to each segment of the patient journey, written in the patient’s language and at their level of education.

Your content should be written to no more than the 11th-grade level to be accessible to most of your visitors. Communicate urgency without scaring or pressuring the reader. Above all, do not patronize.

Create clear calls to action to guide people where you want them to go and provide something of value that encourages them to share their contact information to obtain it.

Practice Search Engine Optimization (SEO)

You need to address two areas of SEO:

  • On-page: refers to everything within the website
  • Off-page: refers to SEO opportunities, not on your website

On-page SEO refers to the building and optimization of your website.

  • Indexable content, including images, videos, and plug-ins
  • Crawl-able link structures
  • Search engine friendly URL structures
  • Optimized pages, title tags, and meta-descriptions

Avoid duplicate content to avoid being penalized by Google and other search engines. Each page of your website should have unique content that adds value to the user while achieving a clear marketing goal for your practice.

Off-page SEO includes ways to attract attention to your website through link-building, sharing and promoting content, and optimizing for local and mobile search.

Building quality links is the first principle of successful SEO. The key is to build quality links, relevant links from authoritative websites, blogs, and other areas of the web back to your site. High-quality links are what Google uses to judge trust and confer higher search engine rankings.

Optimize for Localization

As a geographically based service, you need to optimize for local search. When patients search for a medical practice, they typically add the city name to the search:

Primary Care Physicians in Kansas City

Each of your location pages should be optimized with your city and other identifying information such as the name of the medical center your office is in.

If your website is not responsive, meaning it will display appropriately regardless of the device, you need to convert it. Mobile devices have blanketed the globe, and most are used to search for local businesses as well as serving as a primary device for online activity.

The mobile version of your site should have:

  • Large, legible fonts
  • A fast load speed
  • Bullet lists and less text
  • Simple navigation with few internal links
  • Fewer images

Don’t lose opportunities because you cannot be found via smartphone or tablet.

A Quick Summary

Your website is your marketing engine. Take full advantage of online technology to develop a patient-friendly website that:

  • Contains relevant, well-written content
  • Is optimized for search engines
  • Has high-quality sites linking to it
  • Is optimized for local search and mobile devices.

Building a medical practice is a business, just like any other. Today’s patients expect to be able to find you online and engage with you when they are ready. Make sure you give them the information they need to put you at the top of their list.

About Yasmin Khan
Yasmin Khan is the marketing manager for Bonafide, a digital marketing agency in Houston, Texas. She loves writing, tweeting, and positive change. She’s all about the big picture and the greater good.

International Women’s Day – Women in HIT Wish List

Posted on March 8, 2017 I Written By

Janae builds inbound social media sales and marketing plans for healthcare IT companies. Healthcare as a human right. Physician Suicide Loss Survivor. twitter: @coherencemed


Inequality in healthcare IT can get discouraging. Simplistic articles and advice for organizations on support from other women isn’t helping decrease the wage gap. (According to the 2016 report from HIMSS.) This year while attending HIMSS I asked women what advice they had for other women in Health IT.  I wanted to write life changing advice about what women in healthcare can learn from knowing women in tech and from each other.  I wanted to convince my good friend that left Health IT to move to other parts of Tech to come back. Many activists encouraging documenting your experiences negative and positive within the healthcare IT system. Some of the things I could share I judged too damaging for my personal goals to write about. As I spoke with Sarah Lacy and Cindy Gallop they directly said- if no one shares their story nothing will change.

Women’s issues in technology and the workplace make me livid. Here’s a list of some of them.

  1. Being casually hit on by married men in a professional setting. Or lack of professionalism. I’ve heard shocking stories from doctors and CEOs. Recent legal action has highlighted some systemic sexism in technology companies.
  2. Women who discredit each other in public and in private.
  3. At one meeting a woman mentioned “It must be hard to be in a room with so much estrogen.”
  4. Being afraid of mentioning anything for fear of losing credibility or hurting people I value.
  5. Feeling unsupported by men when I have greater fallout from relationships than they ever will. Do not forget that some of the fear is actually founded. Women who speak up do not always have support at work.
  6. Balancing positive and negative experiences can be exhausting. I am a mother like Sarah Lacy- I loved her comment that becoming a mother changed everything.  While I want to be a good example and provide for my three children I haven’t had the moment when I call out sexism and inequality in my personal experience.

Double standards scare me. In chatting with Sarah Lacy about being unafraid of sharing I was impressed by her candor about real personal losses.  Her comment that standing up for women has made her enemies reminded me that gender parity isn’t free.  It takes fearlessness. Through losing someone to suicide a year and a half ago I saw some fallout of people and realized that not everyone is for us. People disappeared that I never expected to leave my life and not everyone knew how to interact with me anymore. The advice I give to people from that experience is- When you don’t fit into the same mold you will lose people. Not everyone will want to work with you. Take people where they are. Always be where you are. Let go of some people so your professional life has room for true allies. For my friend that meant leaving Healthcare tech for another software industry. For me it meant a higher paying job after John’s death and only working with people I chose to connect with. It was a huge financial adjustment for personal reasons. I was also one of 4 women with a team of approximately 70 men at the time. In a very real way the women at that company had different expectations than the men. For one woman I spoke to at HIMSS it has meant losing her job at 55 and experiencing wage discrimination despite extensive experience. Have the courage to be where you are.

Systemically the culture of women in technology has to change. The loss of potential innovation and revenue and talent is a major cost to companies and the industry. There are educators teaching the economics of gender equality and trying to balance the equation. Thank you.

I have an amazing group of women in my life. I’ve had the honor to be part of Doyenne Connections this year. They are a group of women dedicated to grassroots support and mentoring. I was able to attend the Women in Tech Luncheon hosted by Disruptive Women in Healthcare.   I’m still pretty sure that Ceci Connolly and I are going to lunch next year.  I sat next to Dr. Wen Dombrowski at the luncheon and she reminded me to make my own opportunities.

Statistics about women in healthcare IT are discouraging. The wage gap is alive and well in healthcare especially at the executive level. Some of the theories about why this might be true seem apologist to me. HIMSS Vice President Loren Pettit was quoted in regards to the for profit gender pay divide shortly before HIMSS. “To be perfectly honest, we can’t explain that,” he said. “It’s just how the data came out.”

WE CAN’T EXPLAIN IT!?

Expletive?  There is probably an informatics specialist out there that has a digital solution to this problem. Can we gamify equality for corporations? This year has seen some new initiatives encouraging women to be involved in technology, including Melinda Gates announcing she was planning to invest in programs.  The 2017 report about Gender Barriers from ISACA.org reported that “a lack of female mentors (48 percent), a  lack of female role models (42 percent) and limited networking opportunities (27 percent) are the top three” barriers to women advancing in technology.   I went to some great women’s networking events at HIMSS. Can we make women specific events free? Many women’s events at HIMSS have an additional registration and cost. Companies that asked about helping women – I’ll give you an idea about what you can do. Sponsor a women’s event.

As Cindy Gallop reminded me- “If nobody speaks up, nothing changes.”

Here’s my wish list for Women’s Day this year.

  1. I want the gender gap in Health IT to get narrower this year.
  2. I would love to see support of female counterparts for gender differences without fanfare or expectations. Show up for women. Show up because it is what people do.
  3. I would love a health IT solution for gender parity in tech. If it already exists, please contact me so I can write about it.
  4. I wish we could all be as brave as female leaders that aren’t afraid of making enemies.  I wish I could be as brave as they are.
  5. I would love to see Melinda Gates as a mentor. My mentor.  Actually as my sponsor.

This Women’s Day I don’t have an inspirational article about moving proudly forward. I am tired. Some of the people I thought would be on my side as a woman are not. That’s not where they are. There are some safe places but it is exhausting. I’m not fearlessly calling out wrongdoing to raise awareness. I’m not sure what the complete solution is. We are all stumbling forward through darkness. We will make a way. We will make our opportunities.

Post Script- Can we never clap for men asking how they can help again?  I sort of expect men to show up. It’s a financial problem for Healthcare that women don’t stay here. The first time I saw the clapping was my first HIMSS when a man asked how men can help and everyone clapped and I didn’t know what was happening. This was clearly not like other feminist groups I know. I looked around and thought- maybe start by not making a women’s event about you. Also have you heard of a thing called Google – you can insert questions and will get some relevant data. You could type “what can I do to encourage women in tech” into the search bar. Spoiler alert – money is the answer. You can pay women the same amount you pay men. Your company will also be more profitable.

 

First Time HIMSS: Hospital CEO John Kurvink

Posted on March 7, 2017 I Written By

Janae builds inbound social media sales and marketing plans for healthcare IT companies. Healthcare as a human right. Physician Suicide Loss Survivor. twitter: @coherencemed

I met John Kurvink from Georgian Bay General Hospital at the Salesforce party at HIMSS this year. We discussed the relative value of a VIP pass vs a regular guest pass. As a hospital CEO, John was wearing a shiny VIP necklace complete with sparkling flashing lights. We found the flashing light wands together and discussed how HIMSS was going for them.

John has the ability to motivate staff and managers to develop their potential and participated in the Intermountain Healthcare video series on healthcare in November 2016.  It was immediately clear that he was there with his team, to maximize the HIMSS experience. I wanted to hear more about the decision making process and differentiating between sales pitches on the exhibitor floor and value for Hopital CFO and CEOs. I asked if I could walk the exhibit floor a bit with their team.  After the show John shared his insights about his first visit to HIMSS.

What was your first health IT conference like?

It was a good experience.  Overwhelming at first.  It took a day to get my conference legs under me.

What were your goals?

See some of the latest health IT projects.  Connect with some of the vendors we do business with.

What was your favorite part of HIMSS?

Networking with other attendees and vendors.  I met some very interesting smart people

What did you learn about Health IT?

There are so many vendors who all appear to be offering the same solutions.  Differentiating between them is a challenge.

What did you learn?

I learned that as a hospital we have lots of options as far as technology solutions.  Need to be very careful before making a commitment.

What was your least favorite part of HIMSS?

Not having a plan which meant I wasted a lot of time walking back and forth arriving late for sessions.

What do people need to know about Health IT from HIMSS?

You need to be sure to have a plan before you arrive.  Know what you want to learn about and focus on executing instead of being caught up with the “new shiny object”.

Many vendors have similar offerings or business solutions and making buying decisions for a hospital or healthcare group can be overwhelming. Brenda and Elizabeth from the Georgian Bay were intelligent and hilarious. Georgian Bay had proposals from patient security partners and other vendors and walking the exhibit floor with John helped me see how vendors interact with Hospital CEOs. They are more aggressive and less technical in their product description. There are more invited dinners with sales pitches. His consideration for his team and ability to see past the “new shiny object” were impressive.

Here’s to many more years of learning with John and his team.

A New MACRA Tools Market – MACRA Monday

Posted on March 6, 2017 I Written By

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

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

One thing we’ve realized writing MACRA Monday is that there’s an insatiable appetite for MACRA right now. Webinar signups are through the roof when it’s on the topic of MACRA and MIPS. MACRA and MIPS training courses are selling like hot cakes. Everyone is trying to get the information they need to deal with MACRA and MIPS.

After talking with many companies at HIMSS, there’s a whole new market being created for tools that help organizations track and attest for MACRA as well. Of course, every EHR vendor is creating a solution for their providers. However, there are a lot of other companies that are looking at this as a big opportunity for them to provide tools to make tracking and reporting MACRA and MIPS easy.

Two companies that I ran into recently in this space are SA Ignite and SPH Analytics.

Both of these companies are focusing on MACRA, APM, and MIPS reporting at the higher end. We’re talking about hospital systems that have 100 medical practices and so they have a few hundred doctors who need to do MACRA reporting. Can you imagine managing that many attestations on Excel or something? That’s why I think these tools are going to become so popular.

A part of me hates that entire companies are being created around government attestation. However, the realist in me understands that these tools are needed by large health systems that have to comply with government requirements or lost a lot of money.

What do you think of this trend? Is it a microcosm of our current healthcare system? Do you know of other tools that can help organizations trying to handle MACRA reporting?

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

E-Patient Update: A Missed Opportunity For Primary Care Collaboration

Posted on March 3, 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.

Tell me if you’ve run into the following.

You call your primary care doctor to set an appointment, wading through the inevitable voice-response prompts and choosing the right number to reach a clerk. You wait on hold for a while – perhaps a LONG while – and finally get a clerk.

The clerk asks why you’re booking an appointment, and you name a problem. The clerk says she needs to consult a nurse about the problem before she books you, so you wait on hold while she calls the nurse. Of course, the nurse is too busy to answer her phone, so you leave her a voicemail message.

The next day she finally calls back and tells you a standard appointment will be fine. Yay.

This might sound like an incredibly twisty process, but this is exactly how it works at my PCP office. And the truth is that I’ve been run through a similar mill before by other primary care practices of this size.

In theory, many of these problems would go away if my PCP office simply took advantage of the scheduling tools its portal already offers. But for some reason its leaders don’t seem to value that function much; in fact, when it went offline for a while the practice didn’t seem to know.

But there are alternatives to this crazy workflow pattern that don’t require the re-invention of the lightbulb. In fact, all it would take is adding a few functions to the portal to make progress.

Gathering the threads

From what I can see, the key to streamlining this type of process is to gather these threads together. And it doesn’t take much imagination to picture how that would work.

What if my initial contact with the practice wasn’t via phone, but via more sophisticated interface than a calendaring app? This interface should ask patients what prompts their requested visit, and offer a pulldown menu providing a list of standard situations and conditions.

If a patient chooses a condition that might be hazardous, the system would automatically kick the request to a nurse, who can email or call the patient directly, possibly avoiding hit-or-miss phone tag. Or the practice could provide the nurse with a secure messaging client to use in connecting with clients on the go.  Using such an app, the nurse could even conference in the doctor as needed.

Meanwhile, if a patient wants to get a provider’s opinion on their condition – whether they should wait and see what happens, go to urgent care, make an appointment or hit the ED – the same interface could route the request to the provider on call. If the patient can be treated effectively with a basic appointment, the clinician routes the request to the front desk, with a request that the clerk schedule an appointment. The clerk reaches out to the patient, which means the patient (me!) doesn’t have to call in and wait for an age while the clerk handles other issues.

The same process would also work well for medication refill and referral requests, which my practice now handles in the same cumbersome, time-wasting manner. Not only that, automating such requests would leave an audit trail, which doesn’t exist at present.

Pursuing the obvious

What bugs me about all of this is that if I can imagine this, anyone in healthcare could — it’s a massive case of pursuing the obvious. Though I’m an HIT fan, and I follow the industry closely, I’m no programmer or engineer. I’m just somebody who wants to do my business effectively. Surely my PCP does too?

Of course, I know that just because an approach is possible, it doesn’t mean that it will be easy to implement. Not only that, only the largest and most prosperous practices have enough clout to demand that vendors develop such features. So it may not be as easy as it should be to put them in place.

Still, I see a crying need here, or perhaps one might call it an opportunity.  If we arm primary care doctors – who will play a steadily-growing role in next-gen systems – with better workflow options, every part of the system will benefit.