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Non-Profit Achieves Meaningful Use For In-House EMR

Most organizations hoping to achieve Meaningful Use milestones buy their way in, by acquiring certified technology from an established EMR vendor. However, there are still some organizations that are working to create in-house technology that meets Meaningful Use standards.

One such organization, the Massachusetts eHealth Collaborative (MAeHC), recently achieved a nice win by meeting all three Meaningful Use Stage 2 requirements for its in-house-built EMR module, according to a report in Information Week. To meet certification criteria, modular EMRs must use the Quality Reporting Document Architecture Type 1 document to capture and input the data electronically.

MAeHC, a not-for-profit health IT organization, has created a modular EMR for clinical quality measurements (CQM) reporting, which the CCHIT certified to support Meaningful Use Stage 2, IW reports. The MAeHC product, which is hosted in the cloud, integrates with stand-alone EMRs and can span across multiple EMR platforms.

Getting certified was partly a matter of interpreting the criteria for Stage 2, which include capture and export, import and calculate and electronic submission, MAeHC execs told IW.

From the get-go, for example, the first criterion was problematic, as “capture and export” require EMRs to electronically record data and export it using established standards. MAeHC’s EMR has no user interface to manually key in data.

But the group’s leaders were determined to meet all three criteria, and they managed to get all of their issues sorted out. The MAeHC system is now certified for eligible providers and should be certified for eligible hospitals within the next few weeks, according to IW.

Looking at the challenges faced by those that blaze their own EMR trail, it’s interesting to note that two years ago, Beth Israel Deaconess Medical Center became the first hospital to have its entire home-brewed EMR certified as “complete” by the CCHIT. Considering the resources required, and the tough problems a group like MAeHC faced just to create one module, I’m not surprised that most of its hospital brethren have gone with packaged solutions instead.

October 23, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Building — But Not Overbuilding — Next Gen HIEs

Today I’m delighted to bring you some thoughts from Micky Tripathi, founding president and CEO of the Massachusetts eHealth Collaborative.  In a write-up for the useful iHealthBeat.org blog, Tripathi argues that the HIT world is in danger of seriously overbuilding the next generation of HIEs.

As he notes, a generation of private HIEs (known as CHINs at the time) failed or struggled in the early to mid-1990s. He also reminds us that the failures — such as the demise of Tennessee’s CareSpark and the Minnesota Health Information Exchange — are far from over. In his mind, this is mostly because these groups tried to create over-architected HIEs.

Now, we’re at the heart of the matter. What is an over-architected HIE?  I’ll let Tripathi speak:

Put simply, it’s one that tries to do too much for too many with not enough money and time. It tries to establish an all-encompassing infrastructure and service to meet multiple, heterogeneous current and future requirements of multiple, heterogeneous current and future customers. It tries to do all of this with a shoestring budget and staff. And worst of all, it focuses more on long-term potential “big-bang” value at the expense of short-term, realizable, incremental value. Or as one HIE organization’s promotional material put it, the value proposition is to be a “one-stop shop for Clinical and Administrative Information.”  (Editor’s note: They actually made that claim? Wow.)

What’s wrong with trying to build a Holy Grail of HIEs that solves everyone’s problems?  His analysis:

1.   HIEs can only develop so fast no matter how much money and people you throw at them, given that moving clinical documents around, searching and retrieving clinical info and getting everything into a big database requires a lot of manual labor, legal and technical judgement, cultural and clinical change.

2. While HIEs can only move so fast, business and technology can move at breathtaking speed. Building out an infrastructure which is supposed to work five years from now may turn out to be a massive waste of resources. As he points out, remember that the game-changing iPad is only two years old.

3. CIOs are, let us say, a little overwhelmed at the moment. Asking them to build out a huge infrastructure for the HIE doesn’t exactly make things better. “Better to proceed with achievable steps that deliver incremental value along the way,” he says.

Well, all I can say is that I agree with him completely. Incremental moves and technologies like the Direct Project seem infinitely smarter than a “Big Bang” approach. HIEs are going to be part of our future like it or not, for many reasons, so why not get it right a little bit at a time?

July 2, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Business Intelligence Gets a Boost from popHealth and the MAeHC

I’ve been inundated with two things as of late – HIMSS12 planning and all things business intelligence. I’ve spent the last few weeks helping prepare the Porter Research team for a webinar on providers’ perceptions of business intelligence, which I’m sure will be a big theme at HIMSS. As I’ve been looking over data from the latest Porter Research survey on BI, I’ve realized that providers know they need it but many aren’t quite sure how to define it, what they need out of it, how to implement it, or how to go about making it meaningful for their organization’s particular needs. And vendors in the healthcare space seem to be (or so I thought) just getting into the game of developing these sorts of tools – be they on a departmental or enterprise level.

Micky Tripathi, President and CEO of the Massachusetts eHealth Collaborative (MAeHC) – a nonprofit healthcare IT advisory and consultancy firm – alerted me to an interesting business intelligence tool called popHealth during my recent interview with him for a Porter Research feature on that state’s developing health information exchange. The MAeHC team, which includes among its services the MAeHC Quality Data Center, will be part of the Interoperability Showcase at HIMSS12, and will help to highlight the functionality and accuracy of the popHealth tool.

“popHealth was originally created as an open-source quality measurement tool by the Primary Care Information Project in New York City,” explained Tripathi, “which was headed at the time by Dr. Farzad Mostashari. Now that he’s the national coordinator for health IT, he’s been promoting it at a national level as a free, open-source tool that any organization in the country can use to send their clinical data to and get Meaningful Use clinical quality measures out of.”

Since then, the ONC has contracted with the Mitre Corporation to further develop the platform for a national user base.

You can of course check out the popHealth website for more info, but in a nutshell, the tool is “an open source reference implementation software service that automates the reporting of Meaningful Use quality measures. popHealth integrates with a healthcare provider’s electronic health record (EHR) system using continuity of care records. popHealth streamlines the automated generation of summary quality measure reports on the provider’s patient population.

“popHealth supports healthcare providers and EHR vendors by reporting clinical quality measures from electronic health record continuity of care files. Providers are empowered to better understand, and analyze the health of their patient population, and meet Meaningful Use reporting objectives, through reports of clinical quality measures. EHR vendors and healthcare providers are free to download, use, and integrate the popHealth software in their systems.”

The popHealth team will at HIMSS also to announce the winner of their tool development challenge. Announced last fall, the competition challenges participants to “develop an application that leverages the popHealth open source framework, existing functionality, standards and sample datasets to improve patient care and provide greater insight into patient populations.”

As the need for business intelligence tools and demand for open source solutions grow, I’ll be interested to see if popHealth ushers in a new era of reporting – one that everyone can take advantage of thanks to its non-existent price tag.

February 9, 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.

When Physicians Own Practice, EMR Implementation Feels Tougher

Here’s an EMR adoption study which interested me largely because it runs counter to what I would have predicted.  The study, which surveyed physicians pre- and post- EMR implementation, found that doctors who owned a stake in their practice found their rollout to be tougher than physicians who didn’t have a stake.

I don’t know about you, but I would have assumed that the folks with more control — the owners — would have found it easier than those who have to adapt to the decisions others make.  But it seems that physician-owners simply feel the pain of change more acutely.

To conduct the study, which was published last week in the Journal of the American Medical Informatics Association,  researchers surveyed 156 physicians working with the Massachusetts eHealth Collaborative.  The surveys included a pre-implementation questionnaire  in 2005 and a post-implementation questionnaire in 2009.

Thirty-five percent of doctors who responded reported that implementation was very difficult, 54 percent said it was somewhat difficult and 12 percent not difficult. Those numbers square pretty well with what I’ve seen elsewhere. The twist here was that 38 percent of physicians with full or partial ownership stakes in their practices voted “very difficult,” versus 27 percent of non-owners. That surprised me. After all, aren’t most of the complaints coming from doctors who try to use the new systems?

According to Marshall Fleurant, MD, one of the study’s authors, the owners “probably experienced more underlying challenges associated with EHR implementation and workflow transformation” given their broader operational responsibilities.

While this study is interesting, it’s hardly the last word. Teasing out just which factors predict how doctors will react to EMR implementation, much less what it takes to support them, is still a new science.  But it never hurts to bear in mind that physicians making critical management decisions get support, too.

January 30, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.