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Insurance and Pricing as Gateways to Changing the Health Experience

Posted on March 31, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site ( and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

“So why are you partnering with insurers and employers?” I asked the staff at Maxwell Health, who had just been regaling me with an expansive vision of consumer-centered health and transparency. Co-Founder and Chief Product Officer Vinay Gidwaney laid out a view that’s in line with everything reformers ask for: a long-range view of health care that guides people to proper health at home and not just in the clinic, giving the consumers choices along with the information to let them make good ones, etc. The kind of health system Maxwell Health aims at will be totally different from what we have now–and the current actors will have to change or vanish as it comes into being.

Maxwell Health on phones

Maxwell Health running on phones

But of course I knew why Maxwell Health is dealing with insurers and employers. In our health care system, you must join the guild to hang your street sign. Before you can get access to the consumer, you need access to the professional organizations with whom the health consumer interacts. Individuals may download one or two of the many thousands of available health and fitness apps, but few people stick with them–or with the fitness devices that carve their behavior into eternal records in the cloud.

Although doctors complain that they can’t change people’s behavior, people are more likely to adopt technology if it is recommended by their doctor, their insurer, or even the government. Furthermore, payment models have to reward the right things, or people will continue to engage in risky behaviors and costs will continue to expand.

So Maxwell Health has found a business model on the insurance side of health care’s multi-faceted polygon. Through this they hope to reach the consumer and create change.

Another company I met at the Health 2.0 Boston hackathon, a week after talking to Maxwell Health, is making a related play in order to prosper in the health care market. PokitDok offers health care appointments on both a pay-per-visit basis and using health insurance. To this end, they have relationships with both health care providers and insurers. They can be used by any individual consumer, whereas Maxwell Health deals with people through their employers. A PokitDok API allows developers to create apps that have access to prices, providers, insurers, referrals, etc.

PokitDok screen

Getting started with PokitDok

Let’s start with Maxwell Health. Their salient feature is “bundles” of health care options offered as benefits packages by employers, organized around a core of the insurance plans their staff can choose from. Maxwell Health can direct an employee to an appealing insurance package–for instance, one for people near retirement, another for a young couple about to have a baby. Benefits administrators create personas (hypothetical types of employee) around demographics such as age, income, and family status, then create bundles to offer to employees around these differences. Anyone who has tried to seriously compare his insurance options knows what a headache it is to figure them out. Medicare Advantage is a daunting market, and while no employer has such a large number of choices, they have enough to make the decision a nail-biter. I had trouble just choosing my tax-free flexible spending amounts each year, until the law changed this year and let employees roll unspent money forward. Maxwell Health hopes to turn benefit choices into an experience as appealing, well-integrated, easy as a good online retail shop.

While choosing an insurance plan, employees are prompted also to sign up for services that may help them with their health needs: fitness devices, coaching services, emergency day care, meal delivery services, etc. Bundles also contain services that benefits coordinators think would interest employees with a given persona.

The customer can also load apps from Maxwell Health that help them find services. For instance, they have a contract with Doctor on Demand, a popular telemedicine site. (This one-time telemedicine service is a convenience, not a replacement for developing a relationship with a provider who has a broad knowledge of the consumer and family.) Another service lets employees can take a picture of a confusing medical bill and contact an expert to explain and even change the bill.

On the back end, Maxwell Health provides typical web-based services to benefits administrators, making it easier for them to carry out their routine tasks such as determining participation in plans by employees and tracking the use of services. As PR and marketing associate Meg Murphy says, benefits administrators “can throw away their fax machine.”

The company’s solution requires a lot of work at each employer, but the insurance broker is well positioned to work with each employer to represent the benefits correctly, suggest new benefits, and serve up the benefits through the Web and mobile devices. In addition to its close work with insurers, Maxwell Health also lets fitness devices stream data to a Maxwell Health mobile app. This app has three overall parts: a virtual insurance ID card for every insurance plan in which the employee is enrolled, a wellness program with connections to fitness devices and rewards, and a healthcare concierge who handle requests like the confusing bill already mentioned.

Now for PokitDok. The simplest part of their offering is an app helping consumers find doctors for individual fee-for-service procedures. A consumer can search for the medical procedure he needs and book an appointment through the service. PokitDok determines fees through a rather labor-intensive process (calling the doctors) as well as by checking actual prices paid in the past. The web site guides the user by showing a range of possible insurance costs (low, median, and high).

Once the user chooses a provider and books a procedure, PokitDok charges the posted fee and collects the money online. Hence, the welter of health care costs is managed by simply making each provider advertise his fee (already quite a break from the standard health market in the US.) PokitDok therefore includes a degree of transparency for its providers that Clear Health Costs provides through crowdsourcing for a wide range of popular tests and procedures.

But PokitDok also allows patients to pay through insurance. This is a much steeper challenge. Insurance reimbursements vary from doctor to doctor, plan to plan, and employer to employer. Nor do most of the actors in this masquerade want to reveal their prices and the yawning ranges they span. So PokitDok, once again, checks prices paid in the past to estimate the low, median, and high cost for insurance coverage. The user can also specify one or more insurers when searching for a procedure.

It’s interesting that John Riney, coder and technical evangelist at PokitDok, described their essential goal in terms very similar to those used by Maxwell Health representatives: let’s turn the search for health care into a consumer experience as simple and satisfying as good retail shopping.

Right now, the main actors in the health care space maintain silos. The new players like Maxwell Health and PokitDok feel the way most of us in the health movement feel: they would prefer an open ecosystem where the parts work together and anybody can sign up to play. Piggybacking on a complex payment system set up decades ago may be the necessary focal point on which new companies can press the lever of change.

Getting Paid for Telemedicine

Posted on March 30, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In case you’re like me and missed the slow rolling out of reimbursement for telemedicine, it looks like it’s slowly becoming a reality. 22 state mandated reimbursement of telemedicine is a really big deal. Makes you wonder if a federal law will be far away.

The biggest complaint I’ve heard over and over from doctors about telemedicine is that they don’t get paid to do it. Sure, every once in a while some will say that they’re not sure how well they can treat a patient over video (which is true in a number of cases), but the majority of the physicians I talk to would have no issue using telemedicine if they could just get paid for doing the work.

In fact, I think it’s some pretty genius marketing of Chiron Health (who created the tweet above) for mentioning in their Twitter profile that they’re a telemedicine provider and they want doctors to get paid for it. That’s a message the resonates with many doctors.

In fact, I think Chiron Health’s website hits the key areas where I’ve seen telemedicine taking off: Follow-Up, Chronic Patients and Behavioral Health. This image from their website describes well where I see Telemedicine working well:
Telemedicine Options

I’ll admit that I didn’t know anything about Chiron Health until today (Looks like they’re hiring which is a good sign for a company). However, I’m impressed by the way they’re approaching the telemedicine market. I’d love to learn more about the ways they help doctors get paid for telemedicine. Although, I’m certain that list is about to grow in a really amazing way. I have no doubt that telemedicine will be an important part of the future of healthcare.

A Few #HIMSS15 Twitter Tips and Tricks

Posted on March 27, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you haven’t been keeping an eye on the #HIMSS15 hashtag, it’s been incredibly active and we’re still a little over 2 weeks out from the event. I have no doubt that #HIMSS15 will shattered past years records for tweets at HIMSS.

While I’ve always been a huge fan of social media at conferences, I think it’s going to be used a bit differently at HIMSS 2015 than it’s been used in years past. I believe this, because I’ve seen it happen at other conferences that literally blow up the twitter stream for the conference hashtag. You have to take a different strategy.

Here are a few tips you might want to consider as you approach your use of Twitter at HIMSS 2015.

Get to Know Twitter Advanced Search – If you’re not familiar with Twitter’s advanced search feature, now’s the time to get familiar with it. The #HIMSS15 Twitter stream is so voluminous that advanced searches can be a really powerful way for you to find interesting people. For example, do a search for #HIMSS15 and people that are near whatever city you’re from. There’s nothing like traveling across the country to bond with people in your local area. If you’re looking for other Epic users, do a search for #HIMSS15 and Epic. Simple little filters like that will help you extract value out of the #HIMSS15 Twitter stream.

Create a Twitter List – Spend some time creating a Twitter list of people that you trust and respect that will be at HIMSS. Then, you can just check out the tweets from the people on that list. I’d suggest you add @ehrandhit, @HITMarketingPR and @techguy to that list, but I am a bit biased. A few others I’ll be watching are @nversel, @healthcarewen, and @mandibpro to name just a very few. I’d love to hear your list of #HIMSS15 people we should follow on Twitter in the comments.

Follow @HITConfGuy – The man behind this account does a lot of work to filter through the #HIMSS15 stream, so you don’t have to. I’m pretty sure this year I’ll be relying on this account a lot more than I have any other year. He does a good job keeping it interesting.

Interact with People Directly – Gone are the days that you can just say something on #HIMSS15 and get tons of responses. If you want to get a response from people, then mentioned them directly. Plus, you can tag someone in a tweet as well. You can be sure there will be some side threads happening with a whole group of interesting people tagged in the tweet. While we can’t always watch the full conference stream, most people watch when they’re mentioned or tagged on Twitter.

Check Out the Subtags – Each year, a number of new hashtags come out of the HIMSS conference. In fact, HIMSS puts together their official hashtag guide with all of them. However, even their list can be a bit overwhelming. I think the two hashtags that will be most interesting are #IHeartHIT and possibly #HITWorks. I’m happy that the #HITMC hashtag was also listed by HIMSS for those interested in social media marketing and influencing. I guess this article would technically be appropriate for the #HIMSS15Hacks hashtag.

Shake Hands, Dance, Share a Meal – While I love social media as much as the next person, don’t forget to enjoy all of the in person stuff that happens at HIMSS was well. For me, social media often facilitates many of the in person meetings and events that I attend. However, the opposite can also be the case. If you sit down and meet someone over lunch or on the dance floor at the opening reception, share and connect with them on Twitter. I always love when a year or two later someone tweets me with “Do you remember when…” and then usually “I’ve been following you ever since and…” Twitter is a fantastic way to stay connected with people you meet throughout the show.

There’s a few tips or tricks to get the most out of your interactions on Twitter. If you have other suggestions or if you disagree, I’d love to hear it in the comments.

Some Warnings for Physician’s Wanting to Be Entrepreneurs

Posted on March 26, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Last year I got to know a bit about an organization called the Society of Physician Entrepreneurs. It’s a fascinating organization that works to help physicians with their entrepreneurial dreams come true. I love the concept because so many doctors have ideas that can benefit healthcare, but commercializing an idea is always a challenge.

Arlen Meyers, MD, and Co-founder, President and CEO of the society has a great blog post up called “Don’t Throw Away Your White Coat.” In the post he gives a list of 10 reasons why doctors might want to think twice about leaving medicine for their entrepreneurial dream:

1. Most doctors don’t have an entrepreneurial mindset.

2. Doctors are trained to be risk averse.

3. Doctors are more interested in being problem solvers than problem seekers.

4. Doctors tend to be multidimensional, unwilling to expand their networks beyond an inner circle.

5. The culture of academic medicine, where almost all doctors are trained, tends to be anti-entrepreneurial and sees “money as dirty”

6. The ethics of medicine frequently are at odds with the perceived ethics of business.

7. While things are changing, most doctors are independently minded and not team players.

8. Some are “know it alls” who are not receptive to new ideas

9. Doctors spend a lot of time, money and effort becoming doctors. The opportunity costs or leaving clinical medicine to pursue an entrepreneurial venture is high.

10. The cost to society of losing a clinician at a time when there is a predicted doctors shortage is high.

I really appreciate this kind of frank talk about physician entrepreneurs. I’ve seen both sides of the equation and so I know that many doctors shouldn’t be entrepreneurs. I’ve also seen some doctors who probably should have been entrepreneurs and not doctors. In fact, I’m glad they became doctors because then they’re better able to be healthcare entrepreneurs. However, we shouldn’t be shy in talking about the challenge that many doctors have in crossing the chasm to entrepreneurship. Just like we shouldn’t be shy in talking about a tech person trying to learn healthcare.

Thanks Dr. Meyers for expanding the discussion. What do you think of his list? Have you seen examples of these? Can you leverage some of these challenges into strengths for your healthcare company?

Great ICD-10 Image and Poll

Posted on March 25, 2015 I Written By

John Lynn is the Founder of the 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 and 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 saw this great graphic on Twitter today which made me laugh:

I have friends in DC with AHIMA trying to make the case to their representatives in Congress that they shouldn’t delay ICD-10. Word on the street is that as of now (subject to change as we saw last year), the SGR fix bill doesn’t contain an ICD-10 delay. Of course, the real challenge with ICD-10 now is the uncertainty of it all.

I thought it might be interesting to see what the readers of EMR and EHR predict for ICD-10. So, here’s a simple ICD-10 poll about whether ICD-10 will be delayed or not.

There Are Some Things You Just Can’t Do Without an EHR

Posted on March 24, 2015 I Written By

The following is a guest post by Tom Giannulli, MD, MS, Chief Medical Information Officer, Kareo. Follow and engage with him on Twitter @drtom_kareo or @GoKareo.
Tom Giannulli - Kareo EHR
Over the past two years, there has been a lot of talk about a big EHR switching trend. Some of this has been because of Meaningful Use, and some of it has been because of market changes. There are simply more options today if you are unhappy with your current EHR.

Surveys show that many physicians are frustrated with the cost or functionality in their EHR, which has prompted considering a switch. There is also frustration with too much third party interference and regulation. Despite some of these challenges, one thing is clear. Most physicians believe EHRs improve care, reduce errors, and improve billing.

What sometimes gets left out are the other opportunities created by using an EHR. Some of these are new revenue sources that might be impossible or very hard to access without one. Here are a few examples, but certainly not the only ones.

Medicare Programs
There are some new codes that have come out in the last two years for services that are revenue generators, but you really do need an EHR to manage them. The first is transitional care management (TCM). While TCM doesn’t require you to use an EHR, the complexity of it makes it hard to do without one. The ability to easily put in your notes and set reminders for needed follow up makes managing TCM much easier. With reimbursement ranging anywhere from about $100 to over $200 per patient, this can be a great opportunity for providers who see many patients who need post hospitalization follow ups.

The other Medicare program is newer and does require the use of a certified EHR. It is the Chronic Care Management (CCM) code that came out this year. The reimbursement is about $42 per patient and can be billed once a month. The requirement is that the patient has two or more chronic conditions that are expected to last at least 12 months or until the patient’s death. Clinical staff must spend at least 20 minutes performing CCM services for the patient each month that the code it billed. The services are non-face-to-face and direct supervision is not required, which means that nursing staff or non-physician practitioners can render CCM even if the physician is not in the office. Again, if your practice sees a lot of patients with chronic health problems, this can be a great way to add revenue by using nursing or mid-level staff.

Affordable Care Act Opportunities
By now I hope everyone knows that preventive care services are covered with no copays or deductibles. What many providers still aren’t very aware of are the other types of programs that are now covered by insurance that can be great revenue generators. While they don’t require an EHR, this is another area where using an EHR makes running these programs much easier. The two programs that make a lot of sense for primary care providers and specialists who see patients with certain types of qualifying conditions are group visits and weight loss programs.

With group visits, the practice identifies a group of patients who have a similar, chronic condition that requires frequent visits. You can do this using your EHR (it would be tough using paper charts). Some examples include HIV, chronic pain, COPD, and hypertension. Vitals are done individually as patients arrive and then the whole group spends the rest of the 1.5 – 2 hour visit together with the provider. Once a group visit is completed, each patient’s insurance is billed for the appropriate E&M code for their individual situation. The ability to use templates and copy note features in the EHR can make documenting after the group visit much faster and easier than it would be if done by hand.

For patients with certain conditions, a weight loss program may be mostly or fully covered by insurance like preventive care. The great thing about this is that it can be as simple or complex as you are willing to manage. You can do simple nutritional counseling and weigh-ins or go for a fully formed program through a third party that includes food and supplements. Again, using an EHR makes it much easier and faster to manage and track multiple follow up appointments, set reminders, and copy notes and simply update them each time. You can even have a group visit component!

The key to all of these opportunities is that an EHR helps reduce the complexity of managing the requirements and helps insure that you can quickly and easily show accurate, thorough documentation to payers. Without an EHR, these revenue generating programs would simply seem too difficult to manage. In a time when every penny counts, you can’t ignore opportunities like these.

Kareo, the leading provider of cloud-based software and services for independent medical practices, is a sponsor of EMR and EHR. Find out more about Kareo’s award-winning solutions at

Why I Hope to Help End EHR’s Lack of Interoperability

Posted on March 23, 2015 I Written By

The following is a guest blog post by Donald M. Voltz, MD.
Dr Voltz
I am tired of waiting. Millions of medical professionals and patients are tired of waiting.  We have been waiting for EHR interoperability since the dawn of EHRs in the 1960s. Enough is enough! Our goal is to achieve EHR interoperability through a grass roots coalition of medical professionals and patients who are tired of waiting.

The simple life-saving ability of hospital EHRs to connect to one another so healthcare providers can easily and readily access patient data is not being addressed.  This type of issue is traditionally solved by industry or government initiatives. But so far they have not, and apparently will not solve it so I have decided to raise this issue through an outpouring of angry citizens, hospital patients, physicians and others being impacted.

Petition on

I have posted a petition on to demand EHR operability. Please visit the site and sign it if you are tired of waiting and want change now.  This is an issue that affects all U.S. Citizens.  My goal is gather 25,000 signatures so the petition is reviewed by the White House and acted upon.  I don’t care is this is done through an executive order, a law passed in Congress or industry initiative, as long as it is done.

By signing the petition, we are telling the President and Congress that we need a direct path of communication between all EHR systems through a specific and comprehensive policy of interoperability.

Why do we need government intervention?

  • There has been no improvement in patients’ health information flow in medical communications systems and no support for sharing this crucial data flow among care providers since the transition from paper to electronic medical records. The result is the high number of medical errors leading to death will remain unchanged without government intervention.
  • Hospital boards have no incentive to adopt technology to solve the problem because inaction costs less money than fixing it. The result? Hospitals are not actively looking for a solution, unless it is mandated as part of a government intervention, similar to the same intervention to transition from paper to electronic medical records.
  • Most of healthcare vendors, notably electronic health record (EHR) vendors, have no incentive to address these issues in order to push for their own product solutions. This leaves the lack of EHR interoperability, the most critical area to reduce medical errors leading to death, with no near term improvement.
  • Existing government bodies are in place, but the focus and timetable are not aligned with the urgency for improving patient outcomes, which claim US lives on a daily basis.

Approximately 400,000 Americans die every year because of industry self interests, slow pace of government oversight and care providers stuck in the middle.  In the end, patients are the customers, yet they are bearing the brunt of this disservice.

1,000 Die Daily

At a recent senate subcommittee hearing, it was revealed that more than 1,000 people are killed and 10,000 injured every day due to medical errors largely caused by technology mistakes.  Approximately 40% of these errors are directly related to information omissions and miscommunications.  Why do these errors occur?

Many of these errors are a direct result of a technological communication disconnect within the electronic medical record system. Simply put, these programs designed to make access to crucial medical information easier do the opposite.

The average hospital operates competing EMR’s systems; none of which can share information with each other and all of which present that information in completely different ways, causing confusion by healthcare providers and taking away time with patients. The result are misread charts and forgotten results. Patients are also put at risk by healthcare providers who might not receive timely data in a life threatening crisis.

6th in the U.S. for Deaths

If the Center for Disease Control reported a category for erroneous medical deaths, it would rank 6th in the U.S.  And the cost?  A cool trillion dollars a year. Sadly, this figure is not too far from similar statistics found 15 years ago.  By implementing an EHR connectivity solution, hospitals and medical professionals would save billions in lower insurance premiums as there will be fewer medical death and error lawsuits.  These actions will lower medical costs and will benefit everyone.

The medical industry has had many opportunities to bring about interoperability. The January 2009 passage of the Health Information Technology for Economic and Clinical Health Act (HITECH), a $30 billion effort to transform healthcare delivery through widespread use of EHR technology. Also, the Meaningful Use EHR Incentive Program requirements have helped to create greater commonality in basic EHR functions across systems at a much faster pace than would have otherwise occurred.

Please join me in helping bring an end to this tragedy!

About Dr. Donald M. Voltz
By Donald M. Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University. 

Board-certified in anesthesiology and clinical informatics, Dr. Voltz is a researcher, medical educator, and entrepreneur. With more than 15 years of experience in healthcare, Dr. Voltz has been involved with many facets of medicine. He has performed basic science and clinical research and has experience in the translation of ideas into viable medical systems and devices.

Voltz petition on demands that the government and medical industry implement a solution to end what is a very easy problem to fix.  Once signed by 25,000 U.S. residents age 18 and older, the petition will be sent to the White House for review and a specific, timely action plan. 

Fascinating Drawings from #DoMoreHIT Dell Healthcare Think Tank Event

Posted on March 20, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This week I got the change to spend the day at SXSW at the Dell Healthcare Think Tank event. This is my third year in a row participating and it’s always an exciting event. In case you missed it, I’ve embedded the 3 Healthcare Think Tank sessions on EMR and HIPAA so you can watch the recorded video stream from the event.

Also, during each of the three sessions of the event, an artist was capturing what was being said. You can see each of the three drawings below (Click on the drawing to make it larger).

Session 1: Consumer Engagement & Social Media
Consumer Engagement and Social Media

Session 2: Bridging the Gap Between Providers, Payers and Patients
Bridging the Gap Between Payers Providers and Patients

Session 3: Entrepreneurship & Innovation
Healthcare Entrepreneurship and Innovation

Healthcare Enterprise Mobility Framework

Posted on March 19, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently saw the following healthcare enterprise mobility framework shared with me on Twitter by Clinic Spectrum.

Healthcare Enterprise Mobility Framework

While the image gives some interesting stats and the breadth of what an organization needs to do to really adopt mobile in their organization, I was struck by something else. In the bottom left it shows which organizations are “actively adopting mobility.” It’s quite the list of industries. However, I think you could put just about any industry there, no? Am I wrong? Is there an industry that’s not actively adopting mobile? It’s got to be a pretty niche industry (can you call it an industry if it’s so niche?) if it’s not adopting mobile.

Those in healthcare might also laugh about healthcare being listed as an industry that’s actively adopting mobility. There is a lot of mobile use in certain areas of healthcare, but in a lot of areas it’s still very immature.

Most important, this graphic is a reminder about the importance of mobility. Which reminds me, I need to finish working on the mobile optimized version of this website. We’ll be rolling that out soon.

Full Disclosure: ClinicSpectrum is a sponsor on EMR and HIPAA.

Unlocking EHR Data to Accelerate Clinical Quality Reporting & Enhance Renal Care Management

Posted on March 18, 2015 I Written By

John Lynn is the Founder of the 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 and 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 Christina Ai Chang from DaVita and Vaishali Nambiar from CitiusTech Inc.
Christina and Vaishali
When healthcare providers began achieving Meaningful Use (MU) — the set of standards, defined by CMS, that allows for providers to earn incentive dollars by complying with a set of specific criteria — a health IT paradox emerged. The reports required for incentive payments are built on data the EHR captures, however, EHRs don’t typically have built-in support for automated reporting. This places a time-intensive manual burden on physicians as they report for MU quality measures. In other words, a program intended to increase the use of technology inadvertently created a new, non-technical, burden. The need to manually assemble information for reports also extended to the CMS Physician Quality Reporting System (PQRS) incentive program. As with many providers, EHR reporting shortcomings for these CMS programs severely impacted the kidney care provider, DaVita Healthcare Partners, Inc. (DaVita).

As one of the largest and most successful kidney care companies in the United States, DaVita has constantly focused on clinical outcomes to enhance the quality of care that it provides to its patients. In its U.S. operations that include 550 physicians, DaVita provides dialysis services to over 163,000 patients each year at more than 2,000 outpatient dialysis centers. These centers run Falcon Physician, DaVita’s nephrology-focused solution that largely eliminates paper charting by capturing data electronically and providing a shared patient view to caregivers within the DaVita network.

Falcon Physician serves DaVita very well in its design: renal-care specific EHR capabilities and workflows to support patients with chronic kidney disease (CKD). However, federal incentive programs like MU and Physician Quality Reporting System posed their own challenges. Falcon, like most EHRs, did not have the sophisticated data processing and analytics capabilities needed to meet the complex clinical quality reporting mandated by these programs. With limited built-in support for automated reporting, DaVita physicians had to manually calculate denominators and complete forms for submission to CMS for quality measures reporting, typically taking five to six days per report. With the organization averaging 800 encounters per physician each month, this placed a highly time-intensive and manual burden on physician offices. In addition, manual reporting often resulted in errors, since physician offices had to manage ten or more pieces of data to arrive at a single measure calculation, and do that over and over again.

The Need to Automate Reporting – But How?

To address the time and accuracy issues, DaVita recognized it would need to unlock the data captured by the EHR and use an effective data analytics and reporting tool. To begin evaluating options, the organization put together a team to explore two potential paths: creating a proprietary reporting capability within the EHR, or integrating a third-party solution.

It became clear that proprietary development would be challenging, mainly because of the technological expertise that would be needed to build and maintain sufficiently advanced analytics capabilities. It would require special skillsets to build the rules engine, the data mapping tools, and the visualizations for reporting. In addition, DaVita would need to maintain a clinical informatics and data validation team to assess the complex clinical quality measures, develop these measures, and test the overall application on an ongoing basis. Further, DaVita would also need to get this functionality certified by CMS and other regulatory agencies on a periodic basis.

While looking for a third-party solution that could easily integrate with Falcon, DaVita came across CitiusTech, whose offerings include the BI-Clinical healthcare business intelligence and analytics platform. This platform comes with pre-built apps for multiple reporting functions, including MU and PQRS. Its application programming interface (API) simplifies integration into software like Falcon. The platform aligned closely with DaVita’s needs, and with a high interest in avoiding the expense, time and skillset hiring needed to build a proprietary reporting function, the organization decided to move forward with third-party integration.

Accelerated Implementation and Integration

Implementation began with a small proof of concept that delivered a readily scalable integration in fewer than six weeks. DaVita provided the database views and related data according to the third-party solution’s specifications. This freed DaVita not just from development, but also from testing, installation, and configuration of the platform; thereby, saving time and money, and creating a more robust analytics platform for DaVita’s physicians. In the end, going with an off-the-shelf solution reduced implementation time and cost by as much as two-thirds.

Integration with the third-party platform enabled DaVita’s Falcon EHR system to completely automate the collection and reporting of clinical quality measures, freeing up tremendous physician time while improving report accuracy. With additional capabilities that go beyond solving the reporting problem, the new solution translates EHR data into meaning performance dashboards that assist DaVita physicians in the transition to pay-for-performance medicine.

The platform with which DaVita integrated is ONC-certified for all MU measures for eligible professionals (EPs) and eligible hospitals (EHs). Falcon was able to leverage these certifications and achieve both MU Stage 1 and Stage 2 certification in record time. This also enabled Falcon to accelerate its PQRS program and offer PQRS reporting and data submission capabilities.

Automated Reporting and Dashboards in Action        

Today, hundreds of DaVita physicians use the upgraded EHR, and the integrated business intelligence and analytics function eliminates the need for these doctors to perform manual calculations for MU and PQRS measures. Where manually creating reports used to take five to six days, pre-defined measure sets now complete reports and submit data almost instantly.

With the manual reporting problem solved, DaVita’s physicians now take automation for granted. What they see on a daily basis are the quality-performance dashboards. These dashboards give them a visual, easily understood picture of how they’re doing relative to quality measures, and the feedback has been extremely positive. Many powerful reporting features are highly appreciated, such as key measurements appearing in red when it’s time to change course in care provision to meet a particular measure. Such information, provided in real-time with updates on a daily basis, has led to very strong adoption of the new reporting capabilities among physicians.

Currently, DaVita is working to develop a benchmarking tool that can rate all physicians within a location. The focus on quality-measurement rankings relative to their peers, with drill-downs to specific indicators such as hypertension and chronic kidney disease progression, will allow physicians to focus on enhancing care delivery.

Unlocking data located in the EHR has helped DaVita comply with MU and PQRS. In the coming years, the upgraded EHR will help physicians comply with evidence-based guidelines and optimize increasingly complex reimbursement requirements.