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The Time Has Finally Come for MU, It Really Is Now or Never

The following is a guest blog post by Lea Chatham.
Lea Chatham

The healthcare industry has been talking about Meaningful Use (MU) for years now. The program started in 2011, but there were discussions and planning going on years before that. It’s become a ubiquitous topic in healthcare publications and blogs. So much so that many providers probably still think that they have time to decide if they are really going to attest or not.

The truth is that 2014 is last year to initiate participation for Medicare to receive incentive payments. To avoid the first adjustment of 1%, providers must attest for Stage 1, Year 1 no later than the third quarter of 2014 (July 1 – September 30, 2014). You can still start MU in future years to avoid additional penalties, but you won’t get any incentives and you will still have the 1% deduction on your Medicare Part B Claims starting in 2015. That penalty doesn’t go away if you start MU in 2015 or 2016.

What this means is that the estimated 40% of America’s physicians who don’t’ have an EHR and haven’t yet begun to attest for MU have a decision to make—now. And there are essentially three options:

  1. Choose an EHR and attest in 2014
  2. Accept the penalty (which increases each year)
  3. Request a hardship exception.

Here is what you need to know about each of these options so you can make the right choice for your practice.

Choose an EHR & Attest

Over $16 billion in incentives has been paid out to providers who have been attesting for MU. If you start in 2014, you’ll still get $24,000 over three years for your efforts. You’ll also avoid the penalties, which start with 1% in 2015 and increase each year for a minimum of three years. The larger your Medicare pool of patients, the more sense this makes financially.

If you are going to adopt an EHR now, be sure to choose the right solution for your needs. Many of the providers who have not yet implemented an EHR, are small practices (10 or fewer providers). According to a survey conducted in January by SK&A, the smaller the practice, the lower the adoption rate. Small, independent practices don’t have staff, time, or money to waste. So it has to be right the first time. Take these factors into consideration:

  1. Cost: There are now free and low cost EHRs that can offer almost any specialty the tools they need to reap the benefits of an EHR.
  2. Cloud-based and Mobile: Its 2014, don’t choose an EHR unless it offers anytime, anywhere access and true mobile connectivity.
  3. 2014 Edition Certified for MU: As of January 1, 2014, you need a 2014 Edition certified EHR to attest for MU. Only about 12% of complete EHRs have this certification, which narrows the field.
  4. Total Integration: You can get more from your EHR if it is fully integrated with your practice management and billing system. You can meet MU and streamline many other functions. As a bonus it can actually increase both charges and collections. A UBM white paper showed that the average increase in revenue was $33,000 per FTE provider per year!

Accept the Penalty

So you are thinking you’ll just take the penalty. This may be because you don’t serve Medicare patients or at least not that many. It could also be that you are planning to retire soon and don’t think you’ll be around in another couple of years. But consider this, with MU, PQRS, and eRx penalties, it reaches over 10% in total adjustments to your Medicare Part B claims in five years. If you do start seeing more Medicare patients (as your patients age) or you don’t retire, 10% is nothing to sneeze at. If you are a solo doc and you generate an average of $30,000 a month and about 30% of your patients have Medicare, that’s $10,000 a month. A 10% cut adds up to $12,000 a year. To make that up, you would have to conduct about 100-120 more patient visits a year (if your average visit reimbursement is around $100-150).

And here is something else to consider. Perhaps you are willing to take that hit, and you are sure that you don’t want to attest for MU. But does that mean you don’t need to implement an EHR? Not these days. Patient expectations are changing, and to stay competitive you need to meet those expectations. A study conducted by the Optum Institute showed that 62% of patients want to correspond with their physician online and 75% are willing to view their medical records online. Another survey conducted by Deloitte showed that two-thirds of patient would consider switching to a physician who offers secure access to medical records online. You need patients to stay in business so take their changing needs seriously or you may struggle to stay competitive in changing times.

Request a Hardship Exception

The first thing that needs to be said here is that not everyone can apply for a hardship exception. If you’d like to attest for MU, but need more time AND you meet one or more of the criteria, then you should definitely consider this option. This is a summary, check the CMS tipsheet to find out more:

  1. Your area lacks the necessary infrastructure (i.e., no broadband)
  2. You’re a new provider
  3. Natural disaster or other unforeseen barrier
  4. Lack of face-to-face interaction with patients
  5. Practice in multiple locations
  6. EHR vendor issues (i.e., your current vendor was unable to certify for 2014 edition)

For most providers who are practicing full time in a single location and have not yet chosen an EHR, these exceptions won’t apply. This leaves you with choices and one and two above. You will still need to decide if you want to attest or not.

If you are still on the fence, consider this… Beyond MU, practices are facing the ICD-10 transition and a changing reimbursement landscape with ongoing reform from of the Affordable Care Act (ACA). Technology can be a very effective tool to help you manage these changes and turn this set of challenges into an opportunity to optimize your practice and position your business for success no matter what comes your way.


About Lea Chatham

Lea Chatham is the Content Expert at Kareo, responsible for developing educational resources to help small medical practices improve their businesses. She joined Kareo after working at a small integrated health system for over five years developing marketing and educational tools and events for patients. Prior to that, Lea was a marketing coordinator for Medical Manager Health Systems, WebMD Practice Services, Emdeon, and Sage Software. She specializes in simplifying information about healthcare and healthcare technology for physicians, practice staff, and patients.

March 27, 2014 I Written By

Meaningful Use Changes Focus to a To-Do List and Away from Patient Care

I was reading a message from a doctor recently that really struck me. He commented about the impact of meaningful use on his EHR use and said that he’s now “trying to figure out what to do next instead of trying to figure out what is wrong with a patient.”

I’m sure some doctors will come on here and argue why the person experiencing this is a bad doctor and why they should always be focused on patient care and not checking the next box. While there’s always a balance in everything we do, the comment from this doctor really struck me because it describes really well the way so many doctors are being trained to use their EHR. They literally have people auditing and tracking them to make sure that they’re checking the right check boxes so they can meet meaningful use. This type of hyper focus on checking the right boxes and punishment when you don’t changes the way someone practices medicine.

I always love when people comment that many doctors didn’t like the stethoscope when it came out. They use that story to explain that many doctors don’t like EHR software, but that they’ll come around the way they did with the stethoscope.

While there’s some merit in this analogy, I can’t imagine there was anyone watching how a doctor used the stethoscope to ensure that it was used in a specific manner. That’s what we have going on in the EHR world today. Meaningful use is so prescriptive in its requirements that it overwhelms a doctor to the point of affecting the quality of care they provide.

Think about the efforts that are being made by EHR vendors and EHR consultants to take the meaningful use load off of a doctor’s back. Everything from changing the design to meet the MU requirements without a major change to workflow to offloading as much of the meaningful use requirements to someone other than the doctor. If meaningful use really was of value for doctors, why would they have to go to all this effort to avoid doing it?

March 4, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

#HIMSS14 Highlights: the Snail’s Pace of Interoperability

Ah, HIMSS. The frenetic pace. The ridiculously long exhibit hall. The aching feet. The Google Glass-ers. As I write this, day three for me is in full swing and I’ve finally managed to find some time to reflect on what I’ve seen, which includes a ridiculously long taxi queue at the airport, more pedicabs than I can count, beautiful weather and lots of familiar faces, which is what makes HIMSS so much fun. I’ve heard lots of buzzwords and sales talk, and seen only about an eighth of the exhibit hall, barely scratching the surface of what’s out there on the show floor.

Several common themes stand out based on the sessions and events I’ve been to, and the passions of those I’ve encountered. Whether it’s vendor breakfasts, social networking functions, exhibit elevator pitches or educational sessions, interoperability and engagement are still the buzzwords to beat. This particular HIMSS has given me a different perspective on each, and offered new insight into what’s happening with the Blue Button Connector. I’ll cover each of these in HIMSS Highlights posts over the next several weeks, starting with interoperability.

The industry seems far more realistic this year regarding interoperability – downright frustrated by the slow pace at which such a lofty goal is proceeding. Industry experts Brian Ahier and Shahid Shah perhaps expressed it best during a lively panel discussion at the Surescripts booth:

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Putting vendors’ feet to the fire will certainly initiate a quick and painful reaction, but probably not a sustainable one. True momentum will occur only when providers get singed a bit, too. Panelist comments at a Dell / Intel breakfast on analytics for accountable care brought this into sharper focus for me. The fact that too many disparate EMRs (and thus too many vendors poised to cause inertia) are making it hard for analytics to successfully be adopted and utilized at an enterprise level, highlights a bigger problem related to hindsight and strategy.

From my perspective – that of an industry observer and commentator – it seems many providers felt compelled to purchase EMRs because the federal government offered them money to do so, and hopefully just as many were optimistic about the role technology would play in positively affecting patient outcomes. Vendors saw a great business opportunity and moved quickly to develop systems that met Meaningful Use criteria (not necessarily going for best-fit as related to workflow needs and usability). Neither group truly knew what they were in store for, especially regarding longer term plans for health information exchange.

Providers now find themselves wanting to move forward with health information exchange and greater interoperability, but slowed down by the very IT systems they were so insistent on purchasing just a few years ago. Vendors (some more than others) are hesitant to crack open their products to allow data to truly flow from one system to another, and who can blame them? The EMR market, in particular, is poised to shrink, which begs the question, who will survive? What companies will be around at HIMSS 15 and 16? Those who keep their systems siloed, like Epic? Or those who are trying to break down the silos, such as Common Well Alliance members like athenahealth and Greenway?

It makes me wonder if providers wouldn’t have been better served with just had a handful of EMRs to choose from around the time of HITECH, all guaranteed to evolve as needed and play nicely with each other in the interest of health information exchange. Too many options have caused too many barriers. That’s not just my opinion, by the way. I’m willing to bet that a sizeable chunk of the 37,537 HIMSS 14 attendees would agree with me.

Do you disagree? Are providers (and patients) better served by more IT options than less? Let me know your thoughts, and impressions of interoperability advancement at HIMSS, in the comments below.

February 26, 2014 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.

The State of the Meaningful Use

UPDATE:
If meaningful use were gone (ie. no more EHR incentive money or penalties requiring meaningful use), which parts of meaningful use would you remove from EHR immediately and which parts would you keep?
Responses:
*Michael Sherling, MD – Modernizing Medicine
*Shahid Shah – Influential Networks
*Joel Kanick – interfaceMD
*Michael Brozino – simplifyMD
*Dr. Michael Koriwchak
*Karen Knecht – Encore Health Resources

I recently wrote what’s been a really popular article on EMR and HIPAA called “Meaningful Use Program a Success…Depending on How You Measure Success.” I think we’re at an interesting point in the meaningful use program and it’s worth taking a step back and seeing where we’re at with meaningful use.

As I state in the other article, there’s no doubt that the EHR incentive money has moved the needle on EHR adoption. Those of us who believe that EHR holds lots of potential benefit to healthcare have to be happy about the amazing EHR adoption rate that has occurred thanks largely to $36 billion of EHR incentive money (we’ll save the question of whether we’ve gotten our money’s worth for another post).

While we could Monday Morning quarterback (appropriate football reference the week of the Super Bowl) the EHR incentive program and meaningful use, that won’t change the fact that it’s here and it’s not going anywhere. So, instead of asking whether we should have spent the money on EHR and whether we should have done meaningful use, I decided to take a deeper look at meaningful use and how we could improve the program. Which elements of meaningful use are really adding value and which parts of meaningful use should be removed? Or maybe it’s all great and we should just continue on the path we’re on.

I decided to use a simple approach to identify what’s good and what’s bad with meaningful use. I reached out to EHR vendors, doctors, practice managers, hospital executives, and other EHR experts and asked them a simple question. The answers to this question should provide a solid understanding of what’s meaningful in meaningful use and what’s not.

Here’s the question I asked:
If meaningful use were gone (ie. no more EHR incentive money or penalties requiring meaningful use), which parts of meaningful use would you remove from EHR immediately and which parts would you keep?

The concept is simple. If there wasn’t some outside influence (ie. government money) influencing the requirement to do meaningful use, which elements of MU actually provide value to the users of an EHR. Those that provide value will continue to be embraced by an EHR vendor and those that don’t will be removed. Plus, this is the reality of what’s going to happen once the EHR incentive money runs out, so let’s find this info out now.

I originally thought that this question would lead to a blog post with quotes from a variety of people offering their unique perspectives. However, every person who’s answered so far had so much to say on the topic, that each of their responses was worthy of a blog post of its own.

With that in mind, over the next couple of weeks, I’ll be posting all of the responses as separate posts across the network of Healthcare Scene blogs. I’ll link each of these blog posts at the bottom of this post as they are published.

Open Call for Participation
As I considered this, I realized that hundreds of other people might want to participate as well. As a health IT community I think we can make a real impact. So, I encourage everyone who reads this to publish their response to the question above.

If you have your own blog, publish it there and link back to this post so we can add your post to our list below. If you don’t have a blog, wish to remain anonymous, or would just rather have us publish it, we’re happy to publish it for you. Drop us a note on our contact us page and we can work out the details.

I believe this will become an incredible resource of information to better understand how to improve meaningful use. Once I’ve gathered a good number of responses, I’ll be reaching out to ONC and CMS to make sure they take in the body of contributed work as well. Hopefully this simple approach will be effective at gathering a response from more people than the convoluted rule making process was able to do.

Meaningful Use will go down as one of the most impactful things to hit healthcare IT and EHR in my lifetime. It behooves us to do what we can to make the most of meaningful use.

January 30, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Should Doctors Say Goodbye To Meaningful Use?

Of late there’s been a lot of concern about doctors exiting the Meaningful Use program, with many saying the financial reward was simply not worth the trouble. This trend, of course, has the medical world abuzz with discussion as to what will happen if doctors drop Meaningful Use like a stone.

Meanwhile, a few months ago, an EMR vendor brought the discussion more heat when it announced that it would no longer be Meaningful Use certified. ComChart Medical Software said, in a letter to the EMR community, “unfortunately, will not be able to meet the Stage 2 (or greater) Meaningful Use certification requirements as its requirements are technically extremely difficult to implement.”

If I were running a medical practice, and my vendor took away from me the choice of complying with Meaningful Use or not, I might be angry, but I might breathe a sigh of relief.  After all, complying with Stage 2 will be a major accomplishment for virtually any practice, and if my vendor takes the choice of complying or not complying with Meaningful Use out of my hands, I won’t have people breathing down my neck saying I’m not a team player.

But even if my vendor continues to support a certified EMR for now and into the future, it’s still worth wondering whether it’s worth the trouble for doctors, half of whom are in smallish practices that don’t have much of an IT budget.  After all, if my practice has completed Stage 1 I’ve already realized most of the financial benefits the program offers, notes Modern Healthcare.

So what do you think readers? Do the next stages of Meaningful Use pay off in other ways that make the struggle for compliance worth the trouble?

January 7, 2014 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.

Mulling Over EMR Market Consolidation

I had the pleasure of attending a Technology Association of Georgia Health Society event last week on mobile health. It offered me a chance to chat with colleagues, and hear from a panel of payers, providers, startups and vendors on the current state of and predictions for mobile health. While networking beforehand, I found myself trying to succinctly answer a colleague’s question of, “Where do you see the EMR market heading in the next few years?”

My short answer was, “It is consolidating and will continue to consolidate.” I had more details and theories on the tip of my tongue, but didn’t get the chance to back up my statements before we were ushered in to the evening’s presentation. It was a big question – one that I think has only one correct answer, but also one that potentially has a variety of explanations behind that answer. Needless to say, I mulled it over that night and into the next day, when, coincidentally, I awoke to news of the Vitera/Greenway Medical deal.

If I had the chance to do it over again, I’d break my response down like this: Meaningful Use obviously provided incentive for businesses to get into the EMR game. Some were already in healthcare, while others were on the fringes. Combine those new industry entrants with companies that have provided EMRs since before HITECH, and you’re left with a crowded market.

Implementations and go lives coinciding with Stage 1 left many providers dissatisfied with the EMR experience thus far, but still willing to forge ahead. As they look to Stage 2, some realize their vendors – whom many are already disenchanted with – will not be up to the task of helping hospitals meet digital patient engagement quotas, among other Meaningful Use guidelines. And so began the rip and replace movement.

Vendors deemed not up to par looked at their options. Many took a step back and reassessed product development and strategy, deciding to either: get out of the healthcare game, close up shop altogether, merge with a competitor, or make themselves available for possible acquisition.

That’s one wave of consolidation. I’m fairly confident we’ll see another wave in the next 12 to 18 months, if it hasn’t already started. (I don’t think we’ll see too many Phoenix-type situations like Google.) As providers dive deeper into using technologies around Stage 2 engagement requirements, they’ll experience a second wave of acceptance or denial. At some point, the EMR replacement market will die down, providers will settle into the technology they’ve settled on, and purchases of new systems will stagnate. EMR sales will thus dry up a bit, forcing vendors to again look at their options. I would think that many will turn into consulting services once the demand for new software has died down.

Now that I’ve put pen to paper and laid out my thoughts, I wonder what readers predict. I encourage you to let me know whether I’m on the mark, totally off base, or somewhere in between.

September 27, 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.

Connecting the Dots Between S2MU and #HCSM

I gave myself a pat on the back last week for attending Friday’s #HITsm chat. Moderator Brian Ahier (@ahier) and the usual suspects did a great job of zeroing in on the positives and negatives of what not only a delay to Stage 2 of Meaningful Use could look like, but what modifications to the requirements could look like as well.

As I mentioned during the chat, I feel that delaying it further would only delay the ultimate benefits we are all hoping healthcare IT like EMRs will bring to patient care. It will also add copious amounts of fuel to the already burning fire of provider discontent. Modification, however, might actually ease the burden on both providers and vendors. I’ll defer to the chat commentary, which you can view via the transcript.

If a recent CMS presentation on providers likely to incur Meaningful Use penalties is any indication, modifications might just let them breathe a small sigh of relief and focus a bit more on their patients, rather than hurriedly struggling to meet IT deadlines with ill-fitting or non-certified products.

Concurrently with all of this Stage 2 coverage has been a rise in commentary on providers’ use of social media. I have to assume that physicians and hospitals are becoming more attuned to the benefits of social networking in light of the industry’s push towards more patient engagement. While hospital social media strategies may be considered an offshoot of engagement initiatives tied to Stage 2, I have a feeling providers are beginning to realize such strategies are a valuable means of marketing and education outreach in their own right.

It would be interesting to see if there is a correlation between the types of doctors and hospitals CMS has identified as being most likely to incur Meaningful Use penalties and the social networking activity of that same group. I’d venture to say that providers at penalty risk don’t have social strategies in place, and face more systemic problems related to lower reimbursements, fewer resources, not enough qualified IT staff available, too many patients and not enough physicians, etc. It’s also probably safe to assume that providers that do have a social networking strategy have more resources, and have been able to devote those resources to preparation for Meaningful Use well before their less fortunate colleagues.

What do you think? Feel free to play devil’s advocate by leaving a comment below.

September 5, 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.

MU Requirements Make a Decent EMR Suffer

If you’ve been missing the deep conversation we’re having in the “Develop Your Own EMR – You’re Still Crazy” thread, you’re missing some good conversation. Here’s one of the comments from Andrew Schechtman, M.D.

I’ve found the MU requirements can make an otherwise decent EMR suffer. For example, I previously used a web-based EMR that implemented an allergy documentation component that met MU requirements but was impossible to use in real-world clinical care. It didn’t allow one to enter a class of drugs (“I’m allergic to sulfas”) only specific agents. It didn’t allow an allergy entry without specifying the type of reaction. As any practicing doc knows, a good chunk of allergies come in as “I don’t know what reaction but my mom told me I’ve been allergic since I was a kid.” It met MU requirements but it was truly unusable. It continued in this unusable state for more than a year. I think it’s fixed now although I no longer use that product.

I’ve seen this from EHR vendors many times I’ve done demos. I’ll ask why something is there and then I’ll realize that it’s to satisfy meaningful use. I’ve often said something very similar about the healthcare billing requirements. EMR software could be so beautiful if it weren’t for insane healthcare billing and other government regulations like meaningful use.

I realize that it’s kind of water under a bridge at this point. Meaningful use is here to stay and the EHR incentive money is too tasty for most doctors and hospitals to ignore. However, I think the meaningful use requirements will eventually create an amazing opportunity for disruption. It will take a number of years for the billions of dollars of EHR incentive money to be spent. Plus, I think we’ll need some sort of healthcare collapse, possibly similar to the real estate collapse, to awaken people to the insane healthcare reimbursement. Both of those could create a tremendous opportunity for an entrepreneur to do something amazing for healthcare.

July 22, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Big Data Impacting Healthcare

The following is a guest post by Sarah E. Fletcher, BS, BSN, RN-BC, MedSys Group Consultant.
Sarah Fletcher
It is generally agreed that bigger is better.  When it comes to data, big data can be a challenge as well as a boon for healthcare.  As Meaningful Use drives electronic documentation and technologies grow to support it, big data is a reality that has to be managed to be meaningful.

Medical databases are becoming petabytes of data from any number of sources covering every aspect of a patient’s stay.  Hospitals can capture every medication, band-aid, or vital sign.  Image studies and reports are stored in imaging systems next to scanned documents and EKGs.

Each medication transaction includes drug, dose, and route details, which are sent to the dispensing cabinet.  The patient and medication can be scanned at the bedside and documentation added in real time.  Each step of the way is logged with a time stamp including provider entry, pharmacist verification, and nurse administration.  One dose of medication has dozens of individual datum.

All of this data is captured for each medication dose administered in a hospital, which can be tens of thousands of doses per month. Translate the extent of data captured to every patient transfer, surgery, or bandage, and the scope of the big data becomes clearer.

With the future of Health Information Exchanges (HIEs), hospitals will have access not just to their own patient data, but everyone else’s data as well.  Personal health records (PHRs), maintained by the patients themselves, may also lend themselves to big data and provide every mile run, blood pressure or weight measured at home, and each medication taken.

One of the primary challenges with big data is that the clinicians who use the data do not speak the same language as the programmers who design the system and analyze the data.  Determining how much data should be displayed in what format should be a partnership between the clinical and the technical teams to ensure the clinical relevance of the data is maximized to improve patient outcomes.  Big data is a relatively new event and data analysts able to manage these vast amounts of data are in short supply, especially those who can understand clinical data needs.

Especially challenging is the mapping of data across disparate systems.  Much of the data are pooled into backend tables with little to no structure.  There are many different nomenclatures and databases used for diagnoses, terminology, and medications.  Ensuring that discrete data points pulled from multiple sources match in a meaningful way when the patient data are linked together is a programmatic challenge.

Now that clinicians have the last thousand pulse measurements for a group of patients, what does one do with that?  Dashboards are useful for recent patient data, but how quickly it populates is critical for patient care. The rendering of this data requires stable wireless with significant bandwidth, processing power, and storage, all of which come with a cost, especially when privacy regulations must be met.

Likely the biggest challenge of all, and one often overlooked, is the human factor.  The average clinician does not know about technology; they know about patients.  The computer or barcode scanner is a tool to them just like an IV pump, glucometer, or chemistry analyzer.  If it does not work well for them consistently, in a timely and intuitive fashion, they will find ways around the system in order to care for their patients, not caring that it may compromise the data captured in the system.

Most people would point out that the last thousand measurements of anything is overkill for patient care, even if it were graphed to show a visual trend. There are some direct benefits of big data for the average clinician, such as being able to compare every recent vital sign, medication administration, and lab result on the fly.  That said, most of the benefit is indirect via health systems and health outcomes improvements.

The traditional paper method of auditing was to pull a certain number of random charts, often a small fraction of one percent of patient visits.  This gives an idea of whether certain data elements are being collected consistently, documentation completed, and quality goals met.  With big data and proper analytics, the ability exists to audit every single patient chart at any time.

The quality department may have reports and trending graphics to ensure their measures were met, not just for a percentage of a population, but each and every patient visit for as long as the data is stored.  This can be done by age, gender, level of care, and even by eye color, if that data is captured and the reports exist to pull it.

Researchers can use this data mining technique to develop new evidence to guide future care.  By reviewing the patients with the best outcomes in a particular group, correlations can be drawn, evaluated, and tested based on the data of a million patients.  Positive interventions discovered this way today can be turned into evidence-based practice tomorrow.

The sheer scope of big data is its own challenge, but the benefits have the potential to change healthcare in ways that have yet to be considered.  Big data comes from technology, but Meaningful Use is not about implementing technology.  It is about leveraging technology in a meaningful way to improve the care and outcomes of our patients.  This is why managing big data is so critical to the future of healthcare.

MedSys Group Consultant, Sarah E. Fletcher, BS, BSN, RN-BC has worked in technology for over fifteen years.  The last seven years have been within the nursing profession, beginning in critical care and transitioning quickly to Nursing Informatics.  She is a certified Nurse Informaticist and manages a regular Informatics Certification series for students seeking ANCC certification in Nursing Informatics.  Sarah currently works with MedSys Group Consulting supporting a multi-hospital system.

July 19, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Must-See Sessions, Exhibitors at HFMA #ANI2013

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.

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.