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Key Processes and Functions to Meet the Aims of ACOs

Posted on July 2, 2015 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.

In the last Kareo Twitter chat I hosted, we dug into the topic of ACOs and value based reimbursement. I learned a lot in the discussion. In case you missed the chat, you can review the transcript of the chat here.

One of the tweets in the chat came from Steve Sisko (@shimcode) and included the following image (click on the image to see a larger version):
Key Processes and Functions in an ACO

When you see the beautiful complexity of that chart, is it any wonder why we have a hard time understanding and implementing ACOs?

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 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.

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.

ACO Tire Change Analogy

Posted on March 25, 2013 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 at an ACO conference a while back and one of the speakers compared the idea of ACOs to a tire change. Although, he suggested in an ACO world, you’d get your tire changed and then a mile down the road the tire goes flat and the tire company will say they couldn’t predict that to happen.

It’s an interesting comparison to consider. I know many doctors are concerned with ACOs for situations like the one described. This is particularly true because they only have so much control over the health of a patient. Using the car analogy, they don’t know if the person is going to go off roading with their car (risky behavior), run over a nail (get in an accident), or slash the tire themselves (smoking or other unhealthy behavior). Yet, in an ACO world, the doctor is held accountable for all of these things.

I don’t pretend to be the foremost authority on ACOs. I’m still learning (and so is everyone at this point). However, there are some real challenges associated with reimbursing based on improving the health of a patient so they don’t return to the office.

Certainly technology can play a major role in making this happen. In fact, without technology this is a really hard thing to do. Mobile devices can help patients be more accountable for the choices they make. They can help a doctor influence healthy behavior in ways that weren’t possible before.

Big data can help a healthcare organization know which patient populations need the most attention to be able to increase the overall health of a population. Plus, this is only going to get more powerful as patients start tracking their health data more and more and healthcare can address those who have the most need before they even know they need it.

I like the direction that we’re headed in healthcare where we try and reimburse for the right things, but it’s going to be a really long, hard road. In fact, as I look into the future of ACOs I don’t really see a road at all. Instead, I see the ACO movement as trailblazing its way to an unknown future.

The Intersection of EMRs and Health Information Management

Posted on July 26, 2012 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.

It was with great regret that I canceled my trip to Healthport’s first HIM Educational Summit earlier this week. (A rampant stomach bug claimed me as the last victim in our family of four, and so I thought my healthcare conference colleagues would, in fact, appreciate my absence.) I had been scheduled to moderate a discussion on the exchange of personal health information within an accountable care organization (ACO) – a topic that I thought I knew a lot about, until I began researching the subject. Turns out that to truly grasp this topic from a health information management (HIM) perspective, you need to be well versed in the current state of ACOs, Office of Civil Rights audits, HIPAA rules and regulations, privacy and security breach prevention strategies, the bring-your-own-device movement …. Needless to say, HIM professionals seem to have their hands full at the moment, as they will likely interact with a few if not all of the aforementioned areas in the coming months.

I especially had been eager to see if this cartoon from Imprivata got a few chuckles from my audience. Pretty timely, no?

Courtesy of Imprivata

I was also looking forward to attending a number of sessions, including:
“The Effects of EHR on HIM”
“Where HIM & MU Intersect, and What’s in it for You”
“Meaningful Use: Countdown to Attestation”
“Is Your PHI Protected? Security Measures you Need to Know About”
“The Brave New World of HIEs”

In prepping for the event, I came across a great list of “The Top 10 Trends Impacting HIM in 2016.” Note that EHR and related technologies top the list. I guess it’s safe to say that concerns around them aren’t going away any time soon.

Courtesy of Precyse

I’d love to have readers weigh in on what relationship HIM professionals have with their EMR counterparts in the hospital setting. How do they impact your workflow? Is Meaningful Use making your lives easier or harder? And how in the world are you going to find the time to worry about 2016, when it seems you’ve got enough on your plate in 2012?

Please share your thoughts in the comments below.

EHR Vendor Consolidation

Posted on June 15, 2012 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.

Katherine Rourke recently did a post on EMR and HIPAA entitled, “Major EMR Vendor Consolidation On The Verge.” This is an incredibly important topic, and so I’m glad that she’s writing about it. However, I have a number of differing views on EHR consolidation.

Probably the two biggest differences of opinion is how quickly she believes we’re going to see EHR consolidation and how much EHR consolidation will happen. Sure, we all know that the current mass of EHR companies isn’t sustainable (I personally put us at about 600 EHR vendors, versus her 1000+ EHR company projection).

In my EHR Company Funding Risks series I looked at all the various type of EHR companies. In that analysis, I realized that each type of company seems to be really well funded through at least the next stage of meaningful use stage 2. Sure, there might not be a few that make it that far, but I believe that most of them will. So, yes EHR consolidation has got to happen, but I don’t see EHR companies falling like flies until at least after meaningful use stage 2 and possibly after meaningful use completely.

I also don’t believe that we’ll ever see the MASS EHR consolidation that many predict. The reason I believe this is that healthcare is very regionalized and so I think there could be many regional EHR companies that are quite successful. Plus, there are such a wide variety of practices including things like: specialty, practice size, billing method, etc on top of local that I believe each of these factors are likely to make it that each factor could have its on EMR market.

Plus, the other challenge I see is that there are a large number of EHR vendors that I know that have no interest in consolidation. In many cases they’re what I call Cash Flow Positive EHR companies and so they are in a good position to last for a long time to come and don’t have any need to sell their company to someone else. I believe they’re in a very good position to be around for a long time.

I imagine some would make the argument that there could be some market forces that could come into play that would change this situation. The most likely argument I’ve heard is the new ACO (accountable care organization) model requiring a large EHR company that can support the entire ACO. This is an important change that should be considered, but I personally don’t think this will drive EHR consolidation. We’re going to have a heterogeneous EHR environment and so ACOs will have to be possible across EHR companies. I don’t see a small set of EHR companies creating a virtually ACO monopoly and shutting out certain EHR companies from that ACO. Although we’ll see how that plays out.

I am interested to hear what other forces people see that could cause EHR market consolidation to happen faster.

I also concur with Katherine’s suggestion that practices have a plan if (and in many cases when) something happens to their EHR company. Maybe I should start seeking out and publishing experiences of practice who’ve gone through this and can share what they learned.

Are EMRs As Great For ACOs As People Say?

Posted on March 13, 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

For quite some time, talking heads have noted that EMRs will be an essential part of ACOs, so much so that most doubt you can have a successful ACO organization without one.  What I don’t see asked as often, however, is whether EMRs are shaping the future of the ACO movement, both negatively and positively.

What would an ACO look like, if it could exist at all, without an electronic record or HIE in place?

* There would even more mistakes and delays in sharing patient records, as one can hardly expect a larger group of institutions to make *less* mistakes

*  ACOs could launch without having to spend millions of dollars on EMR software, hardware, training and support

*  Clinical workflow would remain the same, generally, even if doctors were forced to include larger numbers of co-workers in their network

And how are ACOs working with EMRs in place?

*  Aside from limited case studies in individual institutions , it’s not clear whether EMRs are turning large, newly assembled care organizations into safer places to get care.

*  ACOs are forming more slowly than they might be, arguably, because a comprehensive EMR is part of t he cost of doing business

* New clinical workflow patterns are being forced upon clinicians, cutting across multiple institutions. While this might ultimately increase efficiency, it’s hard to ignore how many human hours are being invested (or wasted, depending on your position) on new technology.

As you can see, I come down on the “EMRs may not be all they’re cracked up to be for ACOs” side of things. Now, I’d concede that I haven’t been completely fair — I know EMRs have yielded great benefits for some groups of institutions– but I’d say the jury’s still out overall.

Is Revenue Cycle Management Sexy?

Posted on March 9, 2012 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.

A few months back I attended a user group meeting for a large EHR vendor. While waiting for the opening keynote speech I was talking with the EHR vendor’s PR person. During our conversation they made a really interesting comment that stuck with me. I can’t remember the exact context of the conversation, but they said something to the effect of, “We also do a lot of work in revenue cycle management (RCM) and Accountable Care Organizations (ACOs), but that’s not the sexy things that people like to write about even though that’s where a lot of the money is in our business.”

It begs the question, “Is Revenue Cycle Management (RCM) sexy?”

Her comment really has had me thinking about revenue cycle management and particularly her final point about that being where the money is in their business. I’ve always believed in business that it’s a smart thing to follow the money, whether its sexy or not. On that note, I plan to do a series of posts related to revenue cycle management here on EMR and EHR. As for ACOs, I already started a series of ACO posts on EMR and HIPAA starting with my post “ACO Model Risks and Rewards.”

While I might not try and achieve the lofty goal of making revenue cycle management sexy, I do hope to be able to dig into many of the dynamics around revenue cycle management. I hope to look at reasons why revenue cycle management is so popular and doing so well. Why do so many doctors and hospital CIO/CFOs turn to revenue cycle management for their practice and hospitals? Are all RCM options created equal? What separates the various RCM options? What will be the future of revenue cycle management going forward?

In the past week, a number of online discussions have kicked up around a post I did on EMR and HIPAA around Streamlining Revenue Cycle Automation. The discussion shows there’s a real interest in discussing this topic.

I’m also interested to hear your thoughts on revenue cycle management. Are there areas you’d like me to cover? Are there important trends in RCM that more people should know about? No, this isn’t an open invitation for revenue cycle management companies to pitch me. I’m interested in good information about what’s happening with revenue cycle management.

No doubt that managing the revenue of a hospital of physician practice is incredibly important. Hopefully we can add to that knowledge base. Plus, I think it’s likely worth exploring how adoption of EHR is impacting revenue cycle management as well. Will there be less of a need for revenue cycle management with more EHR software or more of a need for RCM?

Let’s hear your thoughts, suggestions and ideas about RCM in the comments. Hopefully I can build on them in future posts.

Just What the Doctor Ordered: Mobile Access to Your Kaiser EHR

Posted on January 26, 2012 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.

Recent news that Kaiser Permanente has made its patients’ electronic health records available via mobile devices comes as no surprise. Kaiser often seems to be at the forefront of interoperability and coordinated care, in large part due to its integrated nature and sheer volume of patients. As the company’s press release mentions, it maintains the “largest electronic medical records system in the world.” Now, 9 million of its patients can view their EHRs via a mobile site or Android app, with an iPhone app expected to launch in the near future.

On a macro level, I think this is a great step towards further empowering patients to take control of their health. By giving 9 million folks instant access to their own health information, I’d like to think that this will in turn prompt their friends and relations to ask, “Why doesn’t my doctor do that? What benefits am I missing out on?” And perhaps these same folks will then have a conversation with their provider about adopting this type of mobile access.

I’d be interested to see six months to a year from now, statistics comparing use of the mobile app/site to use of the tools found on the traditional website. Will Kaiser see a tremendous increase in the amount of emails between doctors and patients via its mobile apps? Are its doctors prepared for the potential onslaught of correspondence? I wonder if a few have balked at the possibility of being overrun by emails from particularly communicative patients.

Will they be able to tie these usage statistics to a jump in quality outcomes? Will mobile access ultimately become a criteria measured within accountable care models or patient-centered medical homes? Will mobile health truly equal better health?

On a micro level, I would certainly appreciate the effectiveness of access like this, which includes the ability to view lab results, diagnostic information, order prescription refills and the aforementioned email access to doctors. I can’t tell you how many times I’ve been on the phone with a pediatric advice nurse and drawn a blank when asked what my child’s current weight might be. It would be nice to be able to quickly pull that data up on my cell phone, especially while we’re on the go or out of town. I could eventually see patient charting apps being layered on top of this, so that in the event of a high, overnight fever, I could log temperatures via the mobile app and review them with our pediatrician – possibly alerted every time a new temp or symptom is entered – the next morning.

The possibilities seem endless. I think the big goal for Kaiser now is to get folks engaged and using these new access points.

Accountable Care Organizations Becoming Action Thanks to Pioneer ACO Awardees

Posted on December 27, 2011 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 thought this blog post on the 3M blog made a good point about ACO’s finally having some action behind them thanks to the Pioneer ACO awards that were announced recently. Until now, we’ve basically just had people talking to each other about the idea of an ACO, how an ACO should take shape, etc etc etc. It’s nice to see us starting to move beyond discussion of ACO models and now starting to see some real people and companies that have to start taking some ACO action to see what they can create.

I have a feeling that much of this initial ACO work is going to be like most startup companies: failures. In the startup world, it’s just expected that at least 9 of 10 companies will fail. That’s part of the algorithm of innovation that has worked so well in the entrepreneurial environment we know as tech startup companies. I imagine we’ll see the same with a bunch of these ACO models in healthcare as well.

One major problem I do have with this comparison is that the ACO programs that we see now aren’t entrepreneur or market driven, but instead are driven by some sort of government money. This means that those that participate have a bunch of perverse incentives.

The blog post mentioned above provides some interesting suggestions on how to improve healthcare. In response I offered these thoughts in their comment section:

The suggestions you make are reasonable and interesting, but they seem to ignore the idea that what people are really going to do with ACO legislation is find the simplest way to extract the most amount of money out of the regulation. There will be some exceptions, but this is how it works with most government programs.

I imagine some will see this as a bit cynical. I personally just see it as realistic. If we want to talk about real solutions we have to talk about the stark realities that face us and not the idealized models that could happen “IF…” ACOs are no different. Enough with the IFs and let’s talk about action.

Engaged, Connected, E-Patients – Major EHR Developments Per Halamka

Posted on November 1, 2011 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.

In my ongoing series of Major EHR Developments from John Halamka (see my previous EHR In The Cloud, Modular EHR Software and A Network of Networks posts), his fourth major EHR development from the Technology Review article is: Engaged, Connected, E-Patients.

I think this is one of the sections that Halamka makes some of the most interesting points about the future of healthcare. You should go read this whole section. One major conclusion is that patients are going to be much more involved in their healthcare. Gone are the days that patients just come into the office largely trusting what the doctors tells them. Part of that is likely do to the changing culture of question everything and the other part of it has to do with the access to healthcare information that the internet has provided.

Halamka does mention that research shows that shared decision making between doctors and patients results in better outcomes and that an engaged patient is less likely to sue. Both great reasons for doctors to want an engaged patient. Yet, there are still many of them that don’t like this change. However, most have come to realize that they really won’t have much choice going forward.

Halamka also mentions the new reimbursement models that focus on keeping patients healthy (see all the ACO talk) as opposed to paying best on services rendered (often called fee for service). I’m not sure how much this will be a driver in the engaged, connected, e-Patients. I think the patients will actually run over the doctors with their desire for engagement and their involvement in their healthcare well before any reimbursement model changes occur.

Yes, I think patients will start to demand (in the customer demand sort of way as opposed to the arrogant demands kind of way) their doctors support new forms of engagement. Certainly this will include a number of devices that monitor a patients health. Also, the teleconsultation will become very big as technology brings your doctor back into your home.

As I’ve written about before, I’m excited by the idea that a new form of doctor will be treating “healthy” patients.