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4 Things Your Patient Portal Should Include

Posted on May 30, 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.

Karen Gallagher Grant has a great blog post up on the MRA Health Information Services blog that talks about the ideal patient portal. She breaks it down into 4 things that a patient portal should provide:

  1. Information that is meaningful
  2. Easy access for patient review for data integrity
  3. Dashboard information about prescriptions that combine pharmacy information and clinical information
  4. Appointment scheduling

And 5 things she’d ideally like to see in a patient portal:

  1. Details about my next appointment
  2. Wellness tips
  3. Access to home health through telemedicine solutions
  4. Customized decision support via nationwide clinical data repositories
  5. Patient exchange of information

I found these lists really interesting, but I asked myself “Is this what we really want in a patient portal?

I think the number thing people want in a patient portal is access to a provider. Sure, it’s great to be able to access your paper records, your prescription history, your appointment list, and even some health information. Although the health information is never going to be as good as what Dr. Google can provide.

I was surprised that almost nothing (except the Telemedicine solution) talks about the patient portal being used to connect with the doctor. This is the most compelling reason for a patient to use the portal. They want to connect with someone. Notice the emphasis on the one, that means with an actual person. Yes, in many cases this can be the front desk, the biller, or the nurse, but patient portals see the most value when the portal is a way for a patient to connect to a person. Then, the rest of the resources become more valuable and used as well.

The problem is that most of the patient portals out there don’t do a good job connecting people. Although, maybe I’m just biased because of the Physia Connect messaging product we’ve developed and the docBeat messaging company I advise. However, seeing these two products helps me realize how beneficial it can be to make healthcare communication simple. Once we do that, it opens up whole new windows of opportunities.

How the Meaningful Use Stage 2 Timeline Affects Your Medical Practice

Posted on 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.

The following is a guest blog post by Dana Deardorff.
D. Deardorff pic
The year of 2014 will be a year of great transition for most medical practices. You may be in the beginning stages of using EHR/EMR software, or you may be installing Medical Practice (MP) software for the first time. Perhaps you have been using a software program, but you’ve realized you need to upgrade to software that is certified for Meaningful Use. Or, if you’ve purchased certified software, you may need help proving the “meaningful use” of that software, meeting the requirements of Stage 2.

What does Stage 2 Meaningful Use mean for your medical practice? In addition to more recording and reporting measures, Stage 2 of Meaningful Use emphasizes care coordination and HIPAA-compliant engagement with patients.

Meaningful Use Stage Requirements

Stage 1

Beginning in 2011, the focus was on data capturing and sharing. Eligible providers and hospitals were required to show meaningful use of software by meeting a set number of objectives. These objectives were broken down into core objectives and menu set objectives. To be eligible for incentive payments, eligible providers and hospitals needed to prove they met the requirements for a 90-day period in the first year of participation and the entire second year of participation.

In a nutshell, during Stage 1, you are expected to:

  • Capture health information in a standardized electronic format
  • Use EHR/EMR or MP software to track clinical conditions
  • Report clinical quality measures and public health information
  • Begin engaging electronically with patients via HIPAA-compliant software

Your EHR/EMR or MP software vendor should be able to explain the practical applications of these requirements to you, training your staff how to prove and report compliance.

Stage 2

Once you’ve met the requirements for Stage 1 of Meaningful Use, you will need to widen your focus to include clinical processes.

In shorthand, during Stage 2, you will be expected to:

  • Engage in more rigorous health information exchange
  • Engage in e-prescribing
  • Deliver lab results electronically
  • Offer increased patient-controlled data and engagement with patient through electronic means
  • Transmit patient care summaries securely and compliantly through approved electronic methods

On a practical level, this means your office will need to use software that provides the following features, amongst others:

  • Patient engagement portal, including mobile device access to messages and records
  • Electronic recording of and communication of immunization records
  • E-prescribing capabilities and communication

You can begin meeting Meaningful Use Stage 2 requirements now (2014), assuming you have already met Meaningful Use Stage 1 requirements for the minimum time frame. (Ninety consecutive days one year, and an entire year the following year. Be sure to learn more about the possible Meaningful Use Stage 2 delay.) You will need to do the same with Meaningful Use Stage 2 before you can proceed to Stage 3.

Stage 3

Beginning in 2016, eligible providers and hospitals can take on a third set of requirements, focused on improving quality of care, safety and efficiency. The end goal is to provide improved health outcomes.

Meaningful Use Timeline

Eligible hospitals are held to a fiscal-year timeline, but eligible providers are held to the calendar year. This means you will need to ask your EHR/EMR or MP software vendor to help you figure out what your practice’s deadline is and how to meet it for each stage. A good vendor should be able to help you overcome obstacles like:

  • Employee resistance to using new software or processes
  • Software implementation and integration challenges
  • Office procedure modifications and work flow changes

Participation in Stage 1 opened in 2011. Practices that were early participants are now moving into Stage 2 here in 2014. Those who participate soon will be eligible for Stage 3 participation as soon as 2016, taking advantage of years of incentive payments.

Medical Practice Participation

According to the Centers for Medicare and Medicaid Services, more than 355,000 health care providers have received incentive payments for their participation in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs (as of February 2014).  Over $13.6 billion has been paid out through the Medicare EHR Incentive Program thus far, and over $7.5 billion has been paid out through the Medicaid EHR Incentive Program.

Incentive payments aren’t the only reason to upgrade your MP software. Medicaid and Medicare eligible providers and hospitals that do not meet Meaningful Use requirements will be subjected to penalties starting in 2015. These penalties will come in the form of payment reductions, starting at one percent, capped at five percent for each year eligible providers don’t demonstrate meaningful use.

If you haven’t tackled this challenge yet, you’ll want to take it on now, before you miss out on the incentive payments and lose out on a percentage of your Medicaid and Medicare payments.With the right guidance, you’ll find that the upgrade and training will result in an improved experience for everyone, staff and patients alike.

About Dana Deardorff of MediPro

MediPro, Inc. is a full-service medical billing software company offering practice management (PM) software, electronic health records (EHR) and electronic medical records (EMR) from IMS and McKesson. As of April 2014, IMS is certified for Meaningful Use Stage 2, and McKesson, which is certified for Stage 1, will soon also be certified for Stage 2. (McKesson is certified for Stage 2 now, they just haven’t made the formal announcement).

The Meaningful Use Revolution

Posted on May 29, 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.

Meaningful Use change is afoot in the world of EHR software. Many doctors, hospitals and EHR vendors were set up to step away from meaningful use stage 2. Many would have filed for an exception, others would have opted out of Medicare, and others would have just taken the penalties on the chin. It wouldn’t have been pretty and the people at CMS/ONC/HHS realized this was happening and had to do something to avoid the meaningful use stage 2 fall out. It wouldn’t have looked good to have billions of dollars of EHR incentive money sitting on the table with no one wanting it.

CMS decided to cover this wound with a bandaid fix that essentially delays meaningful use stage 2. There are still a lot of details of the proposed rule that are unclear. For example, can anyone attest to meaningful use stage 1 or is that option only available to those EHR vendors who aren’t ready for meaningful use stage 2? I’ve sent that question to CMS, but still haven’t gotten an answer.

Can you imagine the fallout if this is indeed the case? Basically they’d be saying, “All of you EHR vendors and organizations that were good and stayed up with the latest regulations are going to have to do more work and attest to the stricter MU2 criteria while we reward those EHR vendors and organizations that weren’t ready for MU2 with a simpler option.” Can you imagine the backlash that would occur if this is indeed what they decide to do? For that reason alone, I can’t imagine them keeping it that way. I think they have to just open up all the stages/certifications to anyone and everyone regardless of your EHR vendor’s readiness for MU2. (Note: I haven’t dug in to see if this is really a viable option or if a 2014 Certified EHR required changes to the software which make it so it can’t do both MU2 and MU1, but I think it should work out fine. For example, CQMs are tied to certification year and not MU stage. Update: Lynn Scheps from SRSSoft sent me the following update “Prior to the publication of the proposed rule, 2014 CEHRT was required for everyone who wanted to earn an incentive in 2014, so part of the certification requirements was that the EHR could be used for stage 1 or stage 2.”)

What’s even more important is that this is really just the start of the meaningful use revolution. I’ve pointed out my article to “blow up meaningful use” a few times before and that message is starting to be shared by other healthcare IT influencers. For example, the title of this post came from a post by EHR certification and Meaningful Use expert, Jim Tate’s post “You Say You Want a Meaningful Use Revolution” which was a great follow up to his “Meaningful Use Zombie Land” post.

It has become really clear that there’s a lot of confusion afoot. The thing people want most from government regulation is clarity and ICD-10 and now meaningful use are suffering from a lack of clarity. John Halamka summarizes this issue really well:

at some point we need to recognize that layering fixes on top of existing Meaningful Use regulation, some of which was written by CMS and some of which was written by ONC creates too much complexity. I have direct access to the authors of the regulations and email them on a daily basis. It’s getting to the point that even the authors cannot answer questions about the regulations because there are too many layers. I realize that we are reaching the end of the stimulus dollars, but as we head into Stage 3, I wonder if we can radically simplify the program, focusing on a few key policy goals such as interoperability, eliminating most of the existing certification requirements, and giving very clear direction to hospitals and professionals as to what must be done when.

I’m glad to see that John Halamka and myself are on the same page. We need to simplify meaningful use and focus on interoperability. That’s a simple and clear message that providers will understand. I was excited that EHR vendor athenahealth offered a similar view in their post “We Should Be Pushing Interoperability Boundaries, Not EHR Certification Timelines.”

Jim Tate has a good call to action to those who care about what’s happening with meaningful use. As of last night, only 8 comments had been made during the public comment period for the meaningful use stage 2 delay NPRM. You can submit your comments on the rule incredibly easy at the following link: http://www.regulations.gov/#!documentDetail;D=CMS-2014-0064-0002 I’ll be taking this post and my “blowing up meaningful use” and modifying them as my comments. I hope you’ll take the time and share your thoughts on the delay and the future of meaningful use.

Eligible Professionals: Deadline to Submit Hardship Exception Applications Approaching

Posted on May 28, 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.

Here’s the latest email from CMS on the hardship exception deadline:

Are you a Medicare provider who was unable to successfully demonstrate meaningful use for 2013? CMS is accepting applications for hardship exceptions to avoid the upcoming Medicare payment adjustment for the 2015 reporting year.

Payment adjustments for the Medicare EHR Incentive Program will begin on January 1, 2015 for eligible professionals.

However, you can avoid the adjustment by completing a hardship exception application and providing supporting documentation that proves demonstrating meaningful use would be a significant hardship for you. CMS will review applications to determine whether or not you are granted a hardship exception.

CMS has posted hardship exception applications on the EHR website for:

Applications for the 2015 payment adjustments are due July 1, 2014 for eligible professionals.  If approved, the exception is valid for one year.

New Hardship Exception Tipsheets
You can also avoid payment adjustments by successfully demonstrating meaningful use prior to the payment adjustment. Tipsheets are available on the CMS website that outline when eligible professionals must demonstrate meaningful use in order to avoid the payment adjustments.

The Misalignment Between “Incentives” and “Purpose”

Posted on 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’m often left puzzled when I read some of the tweets and blog posts out there that talk about the “purpose” of a certain product. It might be the “purpose for the EHR” or the “purpose of meaningful use” or the “purpose of HIE.” It doesn’t really matter which product, initiative or program we’re talking about. Their comment assumes a certain “purpose” is why something is being done.

I’ve always hated when people say this unless they include plenty of modifiers (which is often not possible on things like Twitter). The problem is that the purpose for something changes completely based upon who you’re talking about. Plus, even if we’re on the same page about who we’re talking about, I often ask myself the question, “Is that the purpose of that product?”

The real purpose of any business is to make more money for its shareholders. This focus doesn’t mean that a company can’t do a tremendous amount of good along the way. This focus doesn’t mean that a higher purpose for a product might make a lot of business sense as well.

My favorite is when people say things like “meaningful use is suppose to improve patient engagement.” Is it really? This might be the purpose of meaningful use for some, but I don’t know a single doctor who looks at meaningful use and thinks “Wow, that’s a great program that I want to do because it will improve patient engagement.” For most doctors, they see the purpose of meaningful use as a way to justify the distribution of billions of dollars towards EHR software. Certainly many doctors will twist this idea a lot of ways (ie. Meaningful use is a way to get more data and pay us less.). Perspective matters when we talk about purpose.

HIE is another great example. What’s the purpose of HIE? Is it to lower costs of healthcare? Is it to provide amazing continuity of care? Is it to lock in a hospital’s relationship with outside doctors? Is it a way to do population health? I could go on, but hopefully you get the point. It depends on who you’re talking to and what they’re trying to achieve. Perspective matters when talking about purpose.

Understanding people’s true motivations or purposes is important to making sure you’re providing the proper incentive. If there’s a misaligment between the incentives and people’s true purpose, then you’re not going to see the action and results that you desire.

EHR Product Market Shares Rankings: The Envelope Please!

Posted on May 27, 2014 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com.For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manager doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst, a role he recently repeated for a Council member.

In politics, it’s the horse race, that is, who’s in front and where’s the rest of the pack. We have our own EHR version, who’s got the biggest market share and where’s everyone else.

In politics, there’s no end of polling by candidates, parties, media and all stops in between. We aren’t so lucky. You can count the reliable EHR market share estimates on one hand and not need your thumb. Of those available, I’ve found SK&A’s to be the most comprehensive and reliable free option, though they do require a registration.

Leaders of the Pack

Table I shows the top 20 EHR vendors’ installed base for all US practitioners. Not surprisingly, Epic leads with about 11 percent. Table II shows the market’s concentration: the top seven have almost half the market.

Table I All practioners

The remaining 13 vendors have about a 20 percent market share. The remaining vendors, about 470 companies, have the remaining 30 percent. But don’t go away just yet. There’s more to the story.

Table II All Shares

Market Share by Practice Size

Market share by practice size refines the picture a bit more. For their analysis, SK&A divided practices into five classes shown in Table III. Each of these is examined in turn.

Table III Group Size

As you’ll see, the larger the number of practitioners in a class, the more concentrated the market becomes. However, the greatest number of practices is in the smaller classes. For example, SK&A reports that 80 percent of practices have 10 or less practitioners.

For example, both EPIC and eClinicalWorks have a ten percent market share. EPIC does this by having a large percent of practices with the highest number of practitioners.

 eClinicalWorks, on the other hand, achieves its share by selling to a many, smaller practices. As a result, you’ll see ECW’s market share drop as the numbers in a class increases, while EPIC’s share will go up.

Class 1 – 1 to 3 Practitioners

Table IV shows the top twenty vendors and again shows a heavy concentration in a few vendors. eClinicalWorks is the leading small practice EHR vendor with a 10 market share. The eight top vendors have half the market in this class.

Table IV 1 to 3 Practitioners

The other 12 top vendors have a 20 percent market share. The remaining 470 vendors split the remaining 30 percent.

Two EHR cloud vendors, Practice Fusion and athenahealth, have an 11 percent market share. While others offer hosted or private cloud products, these two are the sole cloud only solutions in the top 20.

This market segment shows less diversity than those before it. In this case, four vendors have almost half the market, Epic, Allscripts, eClinicalWorks and NextGen.

Class 2 – 4 to 10 Practitioners

The remaining 52 percent, Table V,  is spread among 16 vendors. Notably, athenahealth and Practice Fusion drop in this class to about 3 percent.

Table V 4 to 10 Practitioners

As the next classes show, the market tightens up considerably with a few vendors having greater and greater shares.After NextGen, the other 16 vendors have 30 percent of the market. This leaves all the remaining vendors with 23 percent of the market.

Class 3 – 11 to 25 Practitioners

In this class, Tables VI and VII, three vendors have a market majority: Epic, Allscripts and NextGen. The top seven vendors have over three-quarters of it. The concentration among is so great that three top 20 vendors, AdvancedMD, AmazingCharts and Office Ally are no shows.

Table VI 11 to 25 Practioners

Table VII 26 to 40 Practioner

Class 4 – 26 – 40 Practitioners

Table VIII shows the bunching of vendors in this practitioner class. Only about half of the major vendors had any significant share. All the remaining top 20 vendors lack any significant shares.

Table VIII 26 to 40 Practitioners

Epic’s dominance is even more pronounced in this final class as shown in Table IX. EPIC’s share 47.7 percent and GE has 11.9. Together, they have market share of about 70 percent.

Class 5 – 41 Practitioners and More

Epic’s dominance is even more pronounced in this final class as shown in Table IX. EPIC’s share 47.7 percent and GE has 11.9. Together, they have market share of about 70 percent.

Table IX 40 Plus Practioners

The remaining five vendors have a 20 percent market share: Allscripts, Cerner, NextGen, McKesson. The other 400 plus vendors divide the remaining 10 percent.

There are some interesting changes in this class’ shares, Table X, compared to the previous classes. Cerner drops from second place with 12.5 percent to fourth place with 9.2 percent.

Table X 40+ Practitioners

MEDICTECH all but disappears dropping from 4.7 percent to 0.9. On the other hand, EPIC, GE, Allscripts, NextGen and Greenway increased their shares.

Source and Other Boring Details

The net has many EHR market share analyses, however SK&A’s stands out for several reasons. Most importantly is the active way they gather their statistics. They call every medical practice in the US every six months. This includes all hospitals, private or affiliated practices and urgent care clinics, etc. This approach means that few practices are left out and the answers gathered are on the same basis.

This differs substantially from studies that hang a question out and scoop in whatever they get. They don’t give all practices an equal chance to answer. They are flawed compared to those that actively contact practices or based on statistical samples.

Many other studies base their estimates on ONC’s MU attestations. In fact, most market studies I’ve seen cite ONC. The problem with ONC’s count is that it only includes those in the MU program. Those who don’t, perhaps 40 percent, are left out.

SK&A is not the only company that uses an active approach to determining market share. However, it is the only one I know of that actively surveys the market using that approach and publishes the results free. This is unusual.

I also want thank them for briefing me on their methodology. They did this with only the barest of descriptions of what I was up to.

Future Posts – Hospital and MU v Market Share

There are two other, related topics I’ll cover in future posts.

Hospital Practices

The first is a look at hospital based EHRs. Definitive Healthcare, similar to SK&A, actively surveys the in-patient market by calling practices. They have generously furnished their analysis to healthcarescene.com. Where SK&A breaks down its findings by class size, Dimension looks at hospitals by factors such as:

  • Bed size
  • Independent v affiliated hospitals, and
  • In-patient v ambulatory systems used in hospitals.

MU EHRs v Market Share

The last issue I want to look at is how the vendor rankings in MU’s attestations actually compare to those in this analysis. A preliminary look shows many differences.

How Technological Backwardness Wastes Health Care Money

Posted on May 23, 2014 I Written By

The following is a guest blog post by Andy Oram, writer and editor at O’Reilly Media.

A rather disconcerting report on the state of health care payments has been released by InstaMed, a billing network that connects payers, health care providers, patients, and third-party billing services. (You can download the report after just filling out a few fields or watch some of the report details in this video.)

I think we all know that the adoption of computing technology to coordinate treatment and payments in health care lags behind most industries. This report reveals the progress it has made along with the substantial distance it has yet to go–and the effects of the lag on all of us. Patients and doctors are all suffering financially by a continued reliance on paper.

We should be charitable: the field is making progress. Half of insurers conform (p. 11) to meeting federally mandated standards covering the complex dance by which doctors request payments, insurers report back the status of the request (Electronic Remittance Advice), sometimes repeatedly over many months, and–when the doctor wins the jackpot and gets the procedure approved–insurers remit payment (Electronic Funds Transfer). Moreover, when the survey was conducted in 2013, 86 percent of health providers accepted payments by credit card or similar mechanisms (p. 9), although fewer than half of their payments actually come in that way (p. 5).

Huge amounts of time and effort are still being wasted, though. Even as patient responsibility for payment rises–because plans have been increasing copays and deductibles–there is still a tremendous lack of transparency. “In 2013, 72 percent of consumers said that they did not know their payment responsibility during a provider visit.” (p. 14) Perhaps, even worse, “42 percent of providers said that they did not know patient responsibility during the patient visit.” (p. 7)

What is the result? Providers get fewer payments at the time of visit, and have to send multiple bills to the patient by snail mail, and often even make phone calls (p. 17). About one third of the time, providers couldn’t collect payment when the service was provided because of “patient resistance,” (p. 9) probably a way to blame the victim because the patient was broke. But another third of the time, the provider admitted it didn’t know how much to charge the patient.

All this adds up to large costs for the provider. Moreover, patients can’t make intelligent choices. (We’ll leave aside for now the larger destructive consequences of fee for service.) It’s worth noting that the American College of Cardiology and American Heart Association recently recommended that doctors consider costs when recommending treatments for heart problems–certainly a harbinger of a trend. None of this can happen with the Byzantine payment systems in place.

I mentioned earlier half of payers follow standards to accept electronic payments. Well, that means that half don’t. The use of paper or fax adds an extra tax to negotiations that sometimes take months, as invoices go back and forth and payers reject invoices for a blank space or miscoding in a single field.

InstaMed recommendations include: “payers and providers must work together to help consumers take control of their healthcare payments–or risk further consumer dissatisfaction and lost revenue.” (p. 16) This is an audacious enough agenda, but I go much deeper in my call for change:

  • Publish open data on costs, hospital errors, and outcomes for common procedures. We already know that no correlation exists between cost and quality.

  • Collect detailed data about outcomes, deidentified in the best manner we know, in order to supplement clinical trials, which suffer from their own distortions. Find out where we’re wasting money just by assigning the wrong treatments.

  • Create better interfaces for submitting doctors’ bills, to eliminate the absurd ritual of multiple submissions that get rejected repeatedly by payers and create an entire third-party market just to get invoices right. Standardize billing procedures across payers. (I’m not taking on the issue of single-payer here.)

  • Eliminate fee-for-service and complete the payers’ current trend toward paying for outcome. This requires a lot more of the data mentioned in the second item, so we know what illnesses actually should cost to treat.

Digital Therapeutics

Posted on May 22, 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.

Here’s a new term for you to consider: digital therapeutics. I guess I could add it to the list I polled about earlier: Digital Health, Connected Health, Wireless Health, Mobile Health, and Telehealth. By the way, the poll results are showing a mix basket when it comes to using these terms. Digital Health leads the way with mobile health following pretty closely behind and connected health with quite a few votes.

I don’t think adding digital therapeutics to the ring helps to clear up the confusion of terms, but I think it can open us open to a new way of thinking when it comes to how we use digital in healthcare. I’ve long loved the idea of prescribing an app and digital therapeutics is along those same lines. Can we prescribe a digital therapy that will help improve a patient?

Since we’re throwing out new terms that stretch our thinking, how about the ideas of digital chemistry and digital biology. I like these because they suggest a rigor in their study and understanding like you might see in chemistry and biology. I think it’s fair to say that the very best healthcare IT companies are going to be digging into the digital chemistry and digital biology world.

Once you start digging into these areas though, you better be ready for the FDA regulation that comes with therapeutics. I’ve written quite a bit about EHR and FDA regulation and this is why I don’t think EHR vendors will be digging into this type of digital therapeutics. Instead, I think the EHR will stick to being the database of healthcare.

In a recent video interview I did with Alan Portela, he made a really good point about the transition to really smart mobile health technologies that start to suggest treatment (some might call that a shift to digital therapeutics). The problem with many mobile health technologies that have avoided FDA clearance is that they won’t be able to do digital therapeutics. It will take a company that’s FDA cleared and understands that process to put these type of digital “treatments” into place.

I’m excited about the potential for digital therapeutics (or whatever word you prefer). This will change the way we look at healthcare and that will be a very good thing.

Will Telemedicine Really Lower Costs?

Posted on May 21, 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 was talking with the mobile health lead at one of the large telcom providers recently and we had a good discussion about telemedicine and its possible impact for good or bad on healthcare. She asked a really good question, “Will telemedicine lower the cost of healthcare or just add new touch points?

The translation to that question is whether telemedicine will replace other healthcare costs or if it will just create new healthcare costs that never existed before. I should say that her feeling was that telemedicine would end up lowering costs, but the question is well worth asking. In fact, even if the answer is that telemedicine will lower healthcare costs, there are many on the payer side of the equation that aren’t as confident.

The reality is that a telemedicine visit likely could raise costs. The idea of having to uproot yourself, go to the doctors office, wait in the waiting room, wait in the exam room, etc is a really big deterrent that stops many of us from going to the doctors. The idea that I could click on a link and see a doctor from the comfort of my own home with no wait times (or at least I’m waiting at home where I can get other things done) will definitely cause us to see the doctor more often.

This means that the real question isn’t whether telemedicine will increase the number of visits to the doctor (and more visits equals more costs). Let’s assume that we do see the doctor more often in a telemedicine enabled world. This then begs the question of whether these extra visits will reduce the long term costs of healthcare.

Using our assumptions above, it suggests that we’ll visit the doctor earlier under telemedicine than we would today. Could these early visits catch a disease earlier? Could these early visits avoid a hospitalization or other expensive healthcare cost? Could early treatment of an issue prevent someone from having a visit (or dozens of visits) later? Looking at it from a different angle, can telemedicine make a doctor more efficient?

This impact won’t likely happen immediately, but is the long term hope of what telemedicine can become and how it could lower healthcare costs. I personally lean towards telemedicine being able to realize these goals. Although, we won’t know until we figure out the way to reimburse a doctor for a telemedicine visit. Not to mention overcoming the physician licensing issues with telemedicine. Each of those will happen though and then we’ll really know if telemedicine lowers the costs of healthcare or not.

Meaningful Use Stage 2 Delayed Until 2015 (Unless You Don’t Want to Wait)

Posted on May 20, 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.

Big news coming out of HHS today, CMS issued a proposed rule that changes the EHR certification requirements, firms up the meaningful use stage 3 delay that was announced previously, and most importantly delays the meaningful use stage 2 requirement until 2015. I guess one could argue that it’s not a delay since you can still attest to MU stage 2 in 2014 if you’d like (some already have), but for practical purposes this is a delay in the enforcement of meaningful use stage 2 for many organizations.

It looks like CMS and ONC was listening to the backlash against meaningful use stage 2 and the potential fallout. This isn’t quite blowing up meaningful use, but it’s a step in that direction. Here’s the chart that ONC put out that shows the new timelines:
New Meaningful Use and EHR Certification Timelines - Meaningful Use Stage 2 Delay

It’s worth noting that this is just a proposed rule, but there were usually very few drastic changes between proposed rules and final rules in the past. Sure, there could be a few tweaks, but I bet this goes into place essentially as it stands.

This will be a relief to hundreds of EHR vendors that are behind on becoming 2014 Certified. I expect most will continue with their 2014 Certified plans, but many of their users will likely opt to stick with the simpler meaningful use stage 1 objectives and measures. What’s not clear to me is if the attestation process will stay the same (ie. self attestation in MU stage 1) or not. I’ve asked HHS and will update the post (see update at the bottom of the post) once I hear from them.

What do you think of these changes? What impact will this have on you and your organization?

Here’s another email that CMS sent out:

CMS and ONC Release NPRM Allowing CEHRT Flexibility and Extending Stage 2

Today, CMS and ONC released a notice of proposed rulemaking (NPRM) that would allow providers participating in the EHR Incentive Programs to use the 2011 Edition of certified electronic health record technology (CEHRT) for calendar and fiscal year 2014.

The NPRM will grant flexibility to providers who are experiencing difficulties fully implementing 2014 Edition CEHRT to attest this year. The proposed rule would allow providers to use EHRs that have been certified under the 2011 Edition, a combination of the 2011 and 2014 Editions, or the 2014 Edition.

Beginning in 2015, all eligible providers would be required to report using 2014 Edition CEHRT.

2014 Participation Options
Under this proposal, valid only for the 2014 reporting year, providers would be able to use 2011 Edition CEHRT for either Stage 1 or Stage 2, would have the option to attest to the 2013 definition of meaningful use core and menu objectives, and use the 2013 definition CQMs.

Providers currently working on Stage 1 in 2014 would be able to demonstrate:

  • Stage 1 (2013 Definition) using 2011 Edition CEHRT, or using a combination of 2011 and 2014 Edition CEHRT; or
  • Stage 1 (2014+ Definition) using 2014 Edition CEHRT.

Providers currently working on Stage 2 in 2014 would be able to demonstrate:

  • Stage 1 (2013 Definition) using 2011 Edition CEHRT, or using a combination of 2011 and 2014 Edition CEHRT;
  • Stage 1 (2014+ Definition) using 2014 Edition CEHRT; or
  • Stage 2 (2014+ Definition) using 2014 Edition CEHRT.

UPDATE: Here’s the response I got from CMS about the reporting periods:

Reporting periods are not changing.

For 2014 Only
Because all providers must upgrade or adopt newly certified EHRs in 2014, all providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a three-month (or 90-day) EHR reporting period in 2014:

Medicare eligible professionals beyond their first year of meaningful use must select a three-month reporting period fixed to the quarter of the calendar year for eligible professionals. Providers must attest to these reporting periods no later than February 28, 2015 at 12 am ET.

Medicare eligible professionals in their first year of meaningful use may select any 90 day reporting period.

Medicaid eligible professionals can select any 90-day reporting period that falls within the 2014 calendar year.