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We’re Hosting the #KareoChat and Discussing Value Based Care and ACOs – Join Us!

Posted on June 23, 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.

ACO and Value Based Reimbursement Twitter Chat
We’re excited to be hosting this week’s #KareoChat on Thursday, 6/25 at 9 AM PT (Noon ET) where we’ll be diving into the details around Value Based Care and ACOs. We’ll be hosting the chat from @ehrandhit and chiming in on occasion from @techguy and @healthcarescene as well.

The topic of value based care and ACOs is extremely important to small practice physicians since understanding and participating in it will be key to their survival. At least that’s my take. I look forward to hearing other people’s thoughts on these changes on Thursday’s Twitter chat. Here are the questions we’ll be discussing over the hour:

  1. What’s the latest trends in value based reimbursement that we should know or watch? #KareoChat
  2. Why or why aren’t you participating in an ACO? #KareoChat
  3. Describe the pros and cons you see with the change to value based reimbursement. #KareoChat
  4. What are you doing to prepare your practice for value based reimbursement and ACOs? #KareoChat
  5. Which technologies and applications will we need in a value based reimbursement and ACO world? #KareoChat
  6. What’s the role of small practices in a value based reimbursement world? Can they survive? #KareoChat

For those of you not familiar with a Twitter chat, you can follow the discussion on Twitter by watching the hashtag #KareoChat. You can also take part in the Twitter chat by including the #KareoChat hashtag in any tweets you send.

I look forward to “seeing” and learning from many of you on Twitter on Thursday. Feel free to start the conversation in the comments below as well.

Full Disclosure: Kareo is a sponsor of EMR and EHR.

The Tower of EMR Babel

Posted on May 28, 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.

It’s the sad state of interoperability. This week when I was teaching an EHR workshop I asked for those attending to define what an Electronic Health Record was in their own words. I’d say 90% of them said something about making the healthcare data available to be shared or some variation on that idea. This wasn’t surprising for me since I’ve heard hundreds and possibly thousands of doctors say the same thing. EHR is suppose to make it so we can share data.

While people pay lip service to this idea and just assume that somehow EHR would make data sharing possible, that’s far from the reality today. This is true even in some organizations where they own both the hospital and the ambulatory provider. How sad is this? Extremely sad in my book.

I’ve often wondered what would change the tide. I’ve been long hopeful that ACOs and value based care would help to push the data sharing forward, but that’s going to be a long process. The private HIEs are working the best of any HIEs I’ve seen, so maybe the trend of hospitals acquiring small practices and hospital systems acquiring hospital systems will get us to EHR data sharing nirvana. Although, I don’t think it’s going to make it there in most communities. Instead it’s just going to have a number of large organizations not wanting to share data as opposed to some large and some small ones.

Do people really have much hope for true EHR data sharing? Does FHIR give you this hope? I’m personally not all that optimistic. We all know it’s the right thing to do, but there are some powerful forces fighting against us.

Annual Evaluation of Health IT: Are We Stuck in a Holding Pattern? (Part 2 of 3)

Posted on April 14, 2015 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.

The previous installment of this article was devoted to the various controversies whirling around Meaningful Use. But there are lots of other areas of technology and regulation affecting the progress (or stasis) of health IT.

FHIR: Great Promise, But So Far Just a Promise

After a decade or so of trying to make incompatible formats based on obsolete technology serve modern needs such as seamless data exchange, the health IT industry made a sudden turn to a standard invented by a few entrepreneurial developers. With FHIR they pulled on a thread that will unravel the whole garment of current practices and standards, while forming the basis for a beautiful new tapestry. FHIR will support modern data exchange (through a RESTful API), modern security, modern health practices such as using patient-generated data, and common standards that can be extended in a structured manner by different disciplines and communities.

When it’s done, that is. FHIR is still at version 0.82. Any version number less than 1, in the computer field, signals that all sorts of unanticipated changes may still be made and that anyone coding around the standard risks having to rip out their work and starting over. Furthermore, FHIR is a garment deliberately designed with big holes to be filled by others:

  • Many fields are defined precisely, but elements of the contents are left open, such as the units in which medicine is measured. This is obviously a pretty important detail to tie down.

  • Security relies on standards in the OpenID/OAuth area, which are dependable and well known by developers through their popularity on the Web. Still, somebody has to build this security in to health IT products.

  • Because countries and medical disciplines vary so greatly, the final word on FHIR data is left to “profiles” to be worked out by those communities.

One health data expert I talked to expressed the hope that market forces would compel the vendors to cooperate and make sure these various patches are interoperable as they are pieced into the garment. I would rather design a standard with firm support for these things.

Some of the missing pieces can be supplied relatively painlessly through SMART, an open API that predates FHIR but has been ported to it. An impressive set of major vendors and provider organizations have formed the Argonaut project to carry out some tasks with quick pay-offs, like making security work and implementing some high-value profiles. Let’s hope that FHIR and its accompanying projects start to have an impact soon.

The ONC has repeatedly expressed enthusiasm for FHIR, and CMS has alerted vendors that they need to start working on implementations. Interestingly, the Meaningful Use Stage 3 recommendation from CMS announces the opinion that health care providers shouldn’t charge their patients for access to their data through an API. An end to this scandalous exploitation of patients by both vendors and health care providers might have an impact on providers’ income.

Accountable Care Organizations: Walls Still Up

CMS created ACOs as a regulatory package delivering the gifts of coordinated care and pay-for-value. This was risky. ACOs require data exchange to effect smooth transfers of care, but data exchange was a rare occurrence as late as 2013, and the technical conditions have not changed since then so I can’t imagine it’s much better.

Pay-for-value also calls for analytics so providers can stratify populations and make rational choices. Finally, the degree of risk that CMS has asked ACOs to take on is pretty low, so they are not being pushed too hard to make the necessary culture changes to benefit from pay-for-value.

All that said, ACOs aren’t doing too badly. New ones are coming on board, albeit slowly, and cost savings have been demonstrated. An article titled “Poor interoperability, exchange hinders ACOs” actually reports much more positive results than the title suggests. There may be good grounds for ONC’s pronouncement that they will push more providers to form ACOs.

Still, ACOs are making a slow tack toward interoperability and coordinated care. The walls between health care settings are gradually lowering, but providers still huddle behind the larger walls of incompatible software that has trouble handling analytics.

I’ll wrap up this look at progress and its adversaries in the next installment of this article.

Farzad Mostashari Launches New Startup Company Aledade – A Physician-Led ACO in a Box

Posted on June 18, 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.

I know when I first heard that Farzad Mostashari landed at the Brookings Institution after leaving his position as National Coordinator, I couldn’t imagine it being Farzad’s long time home. However, it was a really smart short term landing spot that would give him the opportunity to prepare for his next adventure.

We just learned that Farzad is now entering the startup world with the launch of a new company called Aledade which partners with primary care doctors to form ACOs. In a blog post introducing the startup, Farzad said “The world of start-ups may not be the usual path for those leaving a senior federal post, but it’s the right decision.” I’m not sure the career path of former senior federal employees, but I think the startup world is going to fit Farzad really well. Plus, who would you rather have leading your ACO efforts than Farzad?

Maybe we should have been able to predict this move if we’d listened closely to Neil Versel’s interview with Farzad Mostashari at HIMSS. As Neil comments, “Always the champion of the little guy in healthcare, Mostashari also brought up the notion of physician-led ACOs, or, as he called it, the “Davids going up against the Goliaths.””

Aledade has received $4.5 million in investment from Venrock and the company is targeting four areas of the country: Delaware, Arkansas, Maryland and the metro New York area (not surprising considering Farzad’s past connection to NYC).

What’s also interesting is that Aledade is building their financial model on a performance model. They aren’t requiring any up-front cost to physicians and instead are opting to make money when the physicians realize savings. I’ll be really interested to see how this works out in practice. Many of the savings that ACOs have realized could be considered fuzzy math. Although, maybe Aledade will just take a percentage of the additional ACO payments the physician ACO receives.

I’ll be interested to see what technologies come out of Aledade. I can’t imagine them launching a full EHR and so they’ll have to integrate whatever they do with dozens of EHR companies. This will be a tremendous challenge. Will they build the technology in house or just partner with an outside vendor?

I’ve heard Farzad say that the move towards value based reimbursement was happening quicker than most of us realize and that the fee for service and value based reimbursement models can’t happen at the same time. The launch of Aledade is a great example that he’s not just paying lip service, but he’s fully committed to this change.

Must-See Sessions, Exhibitors at HFMA #ANI2013

Posted on June 13, 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.

It’s that time of year again. The Healthcare Finance Management Association’s annual ANI conference is just days away. I’ve come to associate the month of June with all things revenue cycle and the anticipation of learning more than I ever wanted to know about financial risk, reimbursement strategies, RACs, coding … the list could go on and on. I do enjoy the show, almost more than HIMSS, because it is smaller, shorter and so much more manageable from a logistics standpoint. HFMA puts out a great mobile app each year, and this year marks the first time I’ll be able to take advantage of it thanks to a (finally) upgraded phone.

Last year in Las Vegas, the show floor and educational sessions were largely focused on ICD-10 and ACOs. Flipping through this year’s brochure, I see that health insurance exchanges, Stage 2 of Meaningful Use and payer relationship strategies will also see a bit of the limelight. Personally, I’m looking forward to learning what healthcare finance folks think of this surge in healthcare consumer cries for price transparency. Are they paying attention? Will charge masters ever change (for the better)?

I thought I’d share some of the sessions I’m most looking forward to attending. I admit that I’m a big fan of panel discussions. Solo presenters can turn into sleep-inducing monologues far too quickly.

To Merge or Not to Merge: Hospital Executive Panel Discussion (Monday, 6/17)
What are the advantages and challenges of maintaining stand-alone status? What factors could influence a decision to see affiliation partners? What various affiliation strategies have worked for others?

Living in Atlanta, which has seen its fair share of hospital mergers and partnerships, I’ve often wondered why some facilities choose to go it alone and some choose to affiliate. I’m looking forward to hearing some inside scoop from the four scheduled hospital executives.

Transitioning to Value: Barriers, Solutions and Opportunities (Tuesday, 6/18)
Former CMS administrator Don Berwick will give this keynote address, which promises to “identify the barriers that must be overcome to reform the delivery system, the outcomes of successful delivery models, and the signals of progress within provider organizations.”

I can’t help but wonder how his stage presence will compare to Farzad Mostashari’s, and what sort of neck attire he’ll don.

Physician/Hospital Revenue Cycle Integration: a Panel Discussion (Tuesday, 6/18)
This session will cover the “opportunities and challenges of unifying the revenue cycle to reduce overall costs while increasing collections and patient satisfaction.”

I think it will be interesting to hear from providers just how important patient satisfaction (and presumably referrals) are to a provider’s bottom line. I expect at least one of the panelists will bring up Stage 2, as I’m learning that patient engagement and satisfaction are closely intertwined.

Women as Leaders: Charting the Course (Tuesday, 6/18)
As I mentioned in a recent post, I’m looking forward to learning how the HFMA board members (dare I call them #RevCycleChicks?) on this panel manage careers, families and communities.

Quiet: Harnessing the Strengths of Introverts to Change How We Work, Lead and Innovate (Wednesday, 6/19)
This keynote from author Susan Cain seems tailor-made just for me. Until social media came into my life, I’d always considered myself an introvert. But social networks have turned that idea on its head in unexpected ways, and so I wonder if Cain will touch on digital media in her presentation.

Best Practices for Managing Consumer Payments in the Current Environment (Wednesday, 6/19)
This “late-breaking session” promises to share best practices on improving collections and patient satisfaction.

I hope they’ll touch on the “future” environment, as it seems reasonable to assume that 2014 will likely make a number of current best practices out of date.

Then, of course, there is the exhibit hall, which I always enjoy roaming around without plan or purpose. A few recent postcards have piqued my interest in several companies:

sock

I’m not even sure what the name of this company is, but the idea of a singing sock intrigues me.

emdeon

I fared poorly at Emdeon’s Cash Stacker games last year, and am determined to do better this time around. Plus, the company always seems to be doing interesting things in the revenue cycle space, so I look forward to catching up with several of their team members to get the inside scoop.

relayhealth

I’m very intrigued by the idea of provider benchmarking at the moment, so I’m planning to learn more about what RelayHealth is doing in this area.

athenahealth

While this postcard doesn’t allude to athenahealth’s recent claims of guaranteed ICD-10 compliance, it will definitely be my main talking point when I stop by their booth.

Good works are always a good idea, and several companies are making charitable contributions in lieu of giveaways:

optum

jpmorganbnymellon

What sessions and exhibitors are you looking forward to? Let me know what I shouldn’t miss via the comments below.

Patient Accountability and Responsibility

Posted on February 22, 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 think you can add this post to my series of posts on the Physician Revolt that I talked about earlier. The following message is from a doctor who emailed me. Obviously, they didn’t realize it would be published, so ignore some of the grammar errors, but the message is a good one that we should be discussing.

The doctors are going to be graded on the health outcomes but yet patients are going to do whatever. Nowhere in the law it states that patient is responsible for anything.

So while the ACOs are going to offer coverage…… there is going to be no immediate access due to shortage of MDs and the current MDs whose slots are overfilled are going to be dinged with penalties for not taking care of their patients completely (ie. all time coverage for all patients all the time). which means the MD has to refund the already reduced reimbursements back to the government because patients will complain about this.

Of course, the patients themselves will not tighten their belt and become personally responsible for their health so that they take up less appointment slots……..

So the significant question is Where are the patients held accountable in all these free health care reforms?

This is an important question as we shift to an ACO model. I think the above narrative places a little too much blame on the patient for the higher healthcare costs. Certainly there are things that doctors and our health system can do to lower costs that are outside of the patient. A simple example is 2 doctors ordering duplicate tests. If they just transferred the data, they’d provide the same care for a much lower cost. Plus, I think there are ways that a doctor together with a clinical care team can improve the overall quality of care of a patient population regardless of the patient’s choices. Another example of this is the hospital to PCP hand off. Doing this right can lower healthcare costs by reducing hospital readmissions.

While much can be done by doctors and the healthcare system as a whole, the doctor does raise a good question about patient responsibility. In what ways could we incentivize patients to take some accountability and responsibility for their healthcare as well?

The first thing that popped in my head was the way car insurance companies are doing it. One of the insurance companies is tapping into your car’s computer to monitor safe driving and then they provide discounts to you for being a safe driver. Are we going to have the same models in healthcare? In some ways we do, since if you’re a non-smoker your health insurance costs a lot less. Will health insurance companies start lowering a patient’s health insurance costs based on data from a wearable device that monitors your activity?

I’m honestly not sure how it’s all going to play out, but I am sure that healthcare IT is going to play a role in the process. We’ll never totally solve the issue of patient responsibility and accountability. That’s a feature of life, but I think that technology can help to hold us all more accountable for our health choices. What technologies do you see helping this?

The Story of the Colorado Beacon Consortium’s ACO Plans

Posted on January 28, 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.

There are a lot of aspects of the HITECH act that don’t get much attention. Sure, the majority of the spending is the EHR incentive money and meaningful use. So, we should focus on what’s happening with that money. However, much less attention gets paid to the other parts of the HITECH act since it’s only a few hundred million dollars (yes, I laughed when I typed that).

I do find it ironic that the “beacon” communities part of the HITECH act haven’t gotten much exposure at all. The whole idea of a beacon is to be seen by everyone, no? I’m sure each beacon community has had to submit some sort of lengthy reporting to ONC about their beacon community. I’m all about government holding people accountable for the money that they spend, but wouldn’t it be better if the beacon communities had to become true beacons in healthcare?

This rant comes on the heels of me watching this video from the Colorado Beacon Consortium. The video is professionally done and does a good job trying to capture the provider viewpoint of what they’re doing. It’s a little dry to watch, but really tries to show how the physicians and patients have benefited from technology.

Have you seen other examples of what the beacon communities are doing? I’d love to see more.

EHR Upcoding, Meaningful Use Stage 2, Interoperability, EHR Consolidation, and ACOs Video – Burning Topics with Dr. Nick

Posted on October 24, 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.

I recently sat down with Dr. Nick van Terheyden, CMIO of Nuance to talk about some of the Burning Health IT topics. In the following video Dr. Nick and I talk about EHR Upcoding, Meaningful Use Stage 2, Interoperability, EHR Consolidation, and ACOs. Enjoy and I hope you’ll extend our conversation in the comments.

Things EMR Doctors Never Say

Posted on September 20, 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.

Here’s a quick look at Things EMR Doctors Never say (maybe I’ve been watching too many late night shows):

“I’m so glad to be doing meaningful use!”

“I can’t wait until ICD-10 makes my life easier.”

“I wonder when that ACO model is finally going to kick in. I can’t wait.”

“I miss trying to read Dr. Smith’s handwriting.”

“I wish I could go and ask HIM for a chart pull.”

“I miss hiding behind the pile of paper charts on my desk.”

“I love this fax machine.”

“I miss the coffee stains on the paper charts.”

“I love the mix of EHR, EMR, HIE, ACO, ONC-ATCB, ICD-10, 5010, BI, with the RCM cherry on top.”

I’m sure I missed some. Please add more in the comments and I’ll add them to the list.

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.