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Details for 3 MIPS Performance Categories – MACRA Monday

Posted on September 19, 2016 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.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

Last week we got a bit side tracked on MACRA Monday as we covered the news about modifications to the MACRA timeline. That seems to be a welcome change. As we mentioned at the end of our post on the MIPS performance categories and MIPS composite score, now we’re going to start diving into the details of those performance categories starting with: Quality Performance, Resource Use (Cost), and the new Clinical Practice Improvement Activities Category.

Quality Performance Category
This category is a replacement for PQRS, but is a reduction from 9 to only 6 measures. Plus, there is no longer a domain requirement. MIPS also expands the program to include close to 300 measures. To combat this explosion of options, they’ll also be offering specialty specific measure sets so that each specialty can more easily identify the measures that might be best for their specialty.

The Quality Performance category makes up 50% of the MIPS composite score.

Resource Use (Cost) Category
The resource use category is also often called the cost category and is a replacement of the value based modifier. The great part of the resource use category is that there is no data submission required to report your work in this category. Instead, this MIPS category will be calculated based on your Medicare claims. MACRA will add 40+ episodic specific measures so providers have more options to participate in this category.

The Resource Use (Cost) category makes up 10% of the MIPS composite score.

Clinical Practice Improvement Activities Category
The CPIA (Clinical Practice Improvement Activies) category that is the new category created as part of MACRA. It will include 90+ activities to choose from and you must participate in a minimum of one activity. Small practices (ie. 15 or fewer professionals) can participate in 2 activities and receive full credit for CPIA. Practices participating as a Patient Centered Medical Home (PCMH) also receive full credit for this category. Participation in an APM gives you 50% credit.

The Clinical Practice Improvement Activities category makes up 15% of the MIPS Composite Score.

That’s the general overview for these three MIPS performance categories. We’ll cover the Advancing Care Information category next week since it’s a bit more complicated.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

Doctor Car Disparity

Posted on September 16, 2016 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.

My doctor friend recently sent me this great picture which highlighted the disparity in physician compensation as illustrated by the cars they drive:
doctor-perception-issues-and-car-disparity

Just to be clear, my friend is the one driving the Honda and not the BMW or Audi. I bet you could do a pretty great post comparing various physicians to various types of cars, but I digress. No doubt there’s a disparity in the cars doctors drive, but also between physician specialties as well.

The reason this picture really resonated with me is that I’ve regularly commented that doctors don’t do themselves any favors by driving super expensive, luxury cars. For the record, anyone is welcome to drive whatever car they want, but you can’t later be upset when people don’t believe you when you say that physicians don’t get paid well enough. There’s a massive disconnect when you’re able to drive such an expensive car and then claim you don’t get paid enough.

Take a look at the physician parking at your local hospital. After looking at it, it’s hard to argue that physicians aren’t getting paid enough even if it’s likely true for many specialties (starting with primary care). This picture seemed to illustrate that principle really well.

MGMA Blames Rise in HIT Costs on Fed’s Regs

Posted on September 15, 2016 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.

MGMA’s released a study of 850 member’s practices showing HIT costs up by more than 45 percent in the last six years. MGMA puts much of the blame on federal regulations. It’s concerned that:

Too much of a practice’s IT investment is tied directly to complying with the ever-increasing number of federal requirements, rather than to providing better patient care. Unless we see significant changes in the final MIPS/APM rule, practice IT costs will continue to rise without a corresponding improvement in the care delivery process.

There may be a good case that the HITECH act is responsible for the lion’s share of HIT growth for these and other providers, but MGMA study doesn’t make the case – not by far.

What the study does do is track the rise in HIT costs since 2011 for physician owned, multispecialty practices. For example, MGMA’s press release notes that IT costs have gone up by almost 47 percent since 2009.

In fairness, MGMA also notes that costs may have also gone up do to other costs, such as patient portals, etc. However, the release emphasizes that regulations are at great fault.

Here’s why MGMA’s case falls flat:

  • Seeing Behind the Paywall. If you want to examine the study, it’ll cost you $655 to read it. Many similar studies that charge, provide a good synopsis and spell out their methodology. MGMA doesn’t do either.
  • Identifying the Issue. It’s one thing to complain about regulations. It’s quite another to identify which ones specifically harm productivity without compensating benefit. MGMA cites regulations without so much as an example.
  • Lacking Comparables. MGMA’s press release notes that total HIT costs were $32,000 per practitioner. However, this does not look at non HIT support costs, nor does it address comparable support costs from other professions.
  • Breaking Down Costs. The study offers comparable information to practitioners by specialty types, etc. However, all IT costs are lumped together and called HIT.
  • Ignoring Backgrounds. MGMA notes that HIT costs rose most dramatically between 2010 and 2011, which marked MU1’s advent. It doesn’t address these practices’ IT state in 2009. It would be good to know how many were ready to install an EHR and how many had to make basic IT improvements?
  • Finessing Productivity. Other than mentioning patient portals, MGMA ignores any productivity changes due to HIT. For example, how long did it take and what did it cost to do a refill request before HIT and now? This and similar productivity measures could give a good view of HIT’s impact.

It’s popular to beat up on HITs in general and EHRs in general. Lord knows, EHRs have their problems, but many of the ills laid at their doorstep are just so much piling on. Or, as is this case, are used to make a connection for the sake of political argument.

Studies that want to get at the effect HIE and EHRs have had on the practice of medicine need to be carefully done. They need to look at how things were done, what they could accomplish and what costs were before and after HIT changes. Otherwise, the study’s data are fitted to the conclusions not the other way around.

MGMA’s a major and important player with a record of service to its members. In this case, it’s using its access to important practice information in support of an antiregulatory policy goal rather than to help determine HIT’s real status.

Physician Practices Lack Good Models For EMR Adoption

Posted on September 14, 2016 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

“All happy families are alike; each unhappy family is unhappy in its own way.”
― Leo TolstoyAnna Karenina

When hospitals roll out an EMR, they go through complex and rich information-gathering process. Health IT leaders tackle problems of scale, systems integration and feature development with support from multiple leaders in other departments. There are best practices to consider and vendor selection processes to observe, references and case studies to collect, and user group meetings they can attend to fine tune their EMR rollout and answer questions.

But when it comes to physician practices, particularly the smaller ones that dominate the medical landscape, the way is not as clear. Often without even a full-time IT staff member to assist them in their selection process, EMR adoption by physician groups is far less structured. Sure, physicians may check references like their hospital colleagues do, explore customer case studies and participate in software demos, but in most cases their process is far less systematic and informed than that of a hospital.

What’s more, if their EMR implementation runs into trouble, smaller medical groups may have far less support than hospital IT leaders. After all, not only are they less likely to get much help in selecting an EMR, they probably don’t have a robust network of peers who can answer questions in context. Like any small business, they make their idiosyncrasies work for them, but when they get into trouble with IT they are unhappy in their own unique way.

Standardizing Physician EMR Adoption
Of course, practice leaders who are struggling with their EMR investment can turn to the vendor that sold them the system, but that can backfire pretty easily. While the vendor is obviously the last word on how the contract is structured, they may or may not have a strong incentive to address gripes and concerns, even if they are obligated to address outright failures of the system.

If the vendor offers a fairly open support model, practices may get some help as they evolve. But if their vendor charges by the hour for support, it’s unlikely many practices be willing to pay for the time to address anything but major problems. That may cut practices off from the knowledge and context they need.

Given these concerns, I’d argue that we need to develop a generalizable, reproducible model for physician EMR adoption and rollout. As I envision it, it should include:

  1. A standardized form smaller practices can use to identify their key needs, allowing them to pick and weight their priorities from an evidence-based list of key selection criteria
  2. A frequently-updated database, maintained by a third party, which collects physician ratings on how a given vendor meets these well-articulated needs
  3. A post-implementation form, once again drawn from research evidence, helping them identify and weight their EMR’s performance based on objective criteria

The idea behind all of this is to standardize physician groups’ EMR selection and rollout, and turn what can be a groping, uneven process into an evidence-based one. Not only will this help physicians from the outset, it allows for building a knowledge base which cuts across vendors, geographies, practice sizes and technical sophistication levels. If physicians had such tools, their process of learning would become iterative and collaborative in a far more effective way.

Don’t get me wrong, I know that virtually any software selection process will address issues that don’t make it into a model like the above.  But if you offer practices a more structured way to adopt an EMR, they are more likely to be happy with their overall results. This is going to become even more and more important as small practices switch EHR software due to EHR consolidation and other factors.

In The Trenches: Primary Care Practice Saves With EMR Transition

Posted on September 13, 2016 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

This is the first in an occasional series of stories I’m writing on how medical practices – particularly smaller groups – are handling their health IT challenges. If you have suggestions for future columns please feel free to write to me at anne@ziegerhealthcare.com.

It only took six months for Clem Surak to realize that his current EMR system wasn’t going to cut it. Surak, who bought Wilmington, NC-based primary care practice Health Partners in 2011 with his wife, didn’t originally come from the healthcare business, but he quickly saw that his IT platforms weren’t cost-effective.

The systems he inherited to run the practice, an Allscripts EHR sprawling across three servers and a companion practice management platform called Tiger, were “very proprietary” and tech support wasn’t easy to access. And they cost $20K per year to support two doctors.

Worse, the product wasn’t very current. “Meaningful Use had to be downloaded as a separate module,” said Surak.

Not surprisingly, Surak began looking for other options. After consulting with his local Regional Extension Center, he went with a new system from Amazing Charts (full disclosure: a former client of your editor). The new system, which went live in June 2012, offered some important benefits, including:

* Savings:  It cost Health Partners $5,400/year to license the integrated Amazing Charts EHR, a $14,600 savings over the Allscripts systems.

* Maintenance: Because the new solution is cloud-based, the practice doesn’t need to maintain the software or cope with technical breakdowns directly.

* Rollout: Implemented over the course of three months, with no slowdown or reduction in physician hours needed. “We kept our normal pace,” Surak says.

* Data transfer: To bring patient demographic data over from Allscripts to the new system, all the practice had to do was export Allscripts data into an Excel spreadsheet, then run an Amazing Charts wizard which imported it.

Of course, the practice faced some challenges as well, largely around adjusting workflow and phasing out the old system:

* Running in parallel:  For the first few years after the transition to Amazing Charts, Health Partners had to keep the Allscripts system running alongside the new system.

* Practice management lag:  Amazing Charts didn’t offer a practice management module at the time Health Partners acquired the EMR. Until mid-2015, when a practice management module became available, it had to keep doing patient scheduling and accounting in the Allscripts system.

Ultimately, despite some transitional hassles, Surak is glad he made the shift to a set of systems that work effectively in tandem. Putting a new EMR and practice management system in place hasn’t just saved money, it’s helped Surak keep efficiency high, running the practice with just a couple of support staffers.

“Most offices this size would have five to seven support staffers, but we don’t have to,” he says. “And keeping overhead down is the key to remaining independent.”

Modifications to the MACRA 2017 Reporting Period #PickYourPace – MACRA Monday

Posted on September 12, 2016 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.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

As we mentioned near the start of the MACRA Monday series, many were predicting a delay or at least a modification to the MACRA timeline. While we’re still waiting for the MACRA final rule to come out with the official changes, Andy Slavitt, Acting Administrator of CMS, has announced some of the changes that will be in the MACRA final rule. Here’s the introduction to why they’re making these changes to MACRA (or the Quality Payment Program as they like to call it now):

We heard from physicians and other clinicians on how technology can help with patient care and how excessive reporting can distract from patient care; how new programs like medical homes can be encouraged; and the unique issues facing small and rural non-hospital-based physicians. We will address these areas and the many other comments we received when we release the final rule by November 1, 2016.

It’s comforting to many to know that they hear doctors pleas for help with all the reporting. We’ll see if the changes in the MACRA final rule will be enough.

As part of the announcement, Andy Slavitt said that the MACRA and MIPS program will still begin on January 1, 2017 with payment adjustments (ie. incentives or penalties) being paid in 2019 like we’d noted before. However, CMS now plans to provide multiple options to eligible physicians and other clinicians to avoid the negative payment adjustments in 2019.

There will now be 4 options available:

Option 1 – Test the Quality Payment Program.
For this option, you just have to submit “some data” to the Quality Payment Program and you’ll avoid the negative payment adjustment. Basically, CMS just wants to make sure you’re connected and ready to participate in future years. While you won’t get a negative payment adjustment, you always won’t get a positive adjustment either. It will be interesting to see what the final rule defines as “some data.” I expect it will be pretty minimal.

Option 2 – Participate for part of the calendar year.
This option allows you to submit information for a reduced number of days in 2017. In other words, your performance period could start after January 1, 2017 and you could just do MIPS reporting for part of the year. This would qualify you for a small positive payment adjustment. I’ll be interested to see the details in the MACRA final rule which outlines how much smaller the payment adjustment will be and how it will be calculated.

Option 3 – Participate for the full calendar year.
This option is basically what’s in the MACRA proposed rule. You can take part for the full 2017 calendar year and potentially qualify for a modest positive payment adjustment. CMS suggests that many will be ready for this. We’ll see if that’s the case given the compressed timeline from when the final rule is published and the release cycles of EHR software companies.

Option 4 – Participate in an Advanced Alternative Payment Model in 2017.
It seems that participation in an Advanced APM is the same as the proposed rule. Of course, if you’re participating in an Advanced APM, then you avoid the penalties and don’t have to worry about MIPS. Nothing new there.

It’s no surprise that fewer penalties and looser requirements has been applauded by many in the healthcare community. It’s pretty rare that people complain about a loosening of government regulation and wish they would require more. Personally, I think the changes are a good thing. CMS will still be able to get data from organizations that participate for the full year. Hopefully, they’ll use that to guide any modifications for future years. However, they also aren’t penalizing those organizations who won’t be fully ready in 2017 because of the short timelines.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

Enterprise EHR Vendors Consolidating Hold On Doctors

Posted on September 9, 2016 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

When I stumbled across a recent study naming the EHRs most widely used by physicians, I don’t know what I expected, but I did not think big-iron enterprise vendors would top the list. I was wrong.

In fact, I should have guessed that things would play out this way for giants like Epic, though not because physicians adore them. Forces bigger than the Cerners and Epics of the world, largely the ongoing trend towards buyouts of medical groups by hospitals, have forced doctors’ hand. But more on this later.

Context on physician EHR adoption
First, some stats for context.  To compile its 2016 EHR Report, Medscape surveyed 15,285 physicians across 25 specialties. Researchers asked them to name their EHR and rate their systems on several criteria, including ease of use and value as a clinical tool.

When it came to usage, Epic came in at first place in both 2012 and 2016, but climbed six percentage points to 28% of users this year. This dovetails with other data points, such that Epic leads the hospital and health system market, according to HIT Consultant, which reported on the study.

Meanwhile, Cerner climbed from third place to second place, but it only gained one percentage point in the study, hitting 10% this year. It took the place of Allscripts, which ranked second in 2012 but has since dropped out of the small practice software market.

eClinicalWorks came in third with 7% share, followed by NextGen (5%) and MEDITECH (4%). eClinicalWorks ranked in fifth place in the 2012 study, but neither NextGen nor MEDITECH were in the top five most used vendors four years ago. This shift comes in part due to the disappearance of Centricity from the list, which came in fourth in the 2012 research.

Independents want different EHRs
I was interested to note that when the researchers surveyed independent practices with their own EHRs, usage trends took a much different turn. eClinicalWorks rated first in usage among this segment, at 12% share, followed by Practice Fusion and NextGen, sharing the second place spot with 8% each.

One particularly striking data point provided by the report was that roughly one-third of these practices reported using “other systems,” notably EMA/Modernizing Medicine (1.6%), Office Practicum (1.2%) and Aprima (0.8%).

I suppose you could read this a number of ways, but my take is that physicians aren’t thrilled by the market-leading systems and are casting about for alternatives. This squares with the results of a study released by Physicians Practice earlier this year, which reported that only a quarter of so of practices felt they were getting a return on investment from their system.

Time for a modular model
So what can we take away from these numbers?  To me, a few things seem apparent:

* While this wasn’t always the case historically, hospitals are pushing out enterprise EHRs to captive physicians, probably the only defensible thing they can do at this point given interoperability concerns. This is giving these vendors more power over doctors than they’ve had in the past.

* Physicians are not incredibly fond of even the EHRs they get to choose. I imagine they’re even less thrilled by EHRs pushed out to them by hospitals and health systems.

* Ergo, if a vendor could create an Epic- or Cerner-compatible module designed specifically – and usably — for outpatient use, they’d offer the best of two worlds. And that could steal the market out from under the eClinicalWorks and NextGens of the world.

It’s possible that one of the existing ambulatory EHR leaders could re-emerge at the top if it created such a module, I imagine. But it’s hard for even middle-aged dogs to learn new tricks. My guess is that this mantle will be taken up by a company we haven’t heard of yet.

In the mean time, it’s anybody’s guess as to whether the physician-first EHR players stand a chance of keeping their market share.

Where’s the Humanity in Healthcare?

Posted on September 8, 2016 I Written By

The following is a guest blog post from Snarky Frog. Yes, that’s her real name. Ok. You got us. No, it’s not her real name, but that’s how she wants to be known online. Who are we to judge her if she loves frogs and snark that much?
Snarky Frog
There was a time when I blogged. There was a time when I wrote about living with POTS (Postural Orthostatic Tachycardia Syndrome) and EDS (Ehlers Danlos Syndrome). There was time when I wrote about having a parent who…well…if I were to explain in this piece, I would lose all credibility.

There was time when I thought people would read what I wrote. There was a time when I thought people would care about how my father died (Yes hospital in CT, I do hold you accountable for that).

There was a time when I thought people would care that when I was half conscious after fainting, a nurse took it upon herself to show me what happens to drug users – apparently folks who use drugs have no rights to sexual dignity.

I wasn’t using illegal drugs then and I don’t now. The more you read about POTS patients, the more you read about how strange our symptoms are. I still argue my symptoms don’t matter, the way I was stripped of my humanity did and still does – turns out nobody really agrees with me. Guess you can do whatever you want to drug users (I’ve since learned this again and again via EMTs and others). As it turns out, you can also pretty much do this to patients you think are faking their disease.

There was a time when I blogged about how I couldn’t understand that a patient advocacy org promoted things one day, disagreed with them the next, then went back and forth for years. By the way, what’s still up with that? Will exercise heal me or is it IVIG I need or is it small fiber neuropathy all around? Oh… you need to study more – well hate to tell you patient group, if I need IVIG, exercise won’t save me. Though, it honestly may help.

There was a time in life when I questioned things. There was a time when I wrote. There was a time I cared. I probably still do all of those things but I do all of it less.

Nobody cared what I wrote so I stopped publicly blogging. The things I tried to get folks to care about – I was on my own with. I wrote but my writing was for me. I took my blog pieces down one by one.

By that time my writing abilities were somewhat gone after I had taken a few too many hits to the head. Things became mostly jots on google docs. My posts are now long gone into the ether and even the WayBackMachine can’t find them.

Right now I could write about not having a single doc who knows much about any of my diseases. I could write about having 3 different specialists who each understood different pieces of EDS / POTS leave their practices in the same year. I could write about fighting with hospital billing offices. I could write about how a doctor who played a role in quality affairs at an academic medical center could literally get nowhere with my insurance when he tried to get me some assistance. I could write about the discussions I have had with the insurance co regarding how much my POTS costs them (about 90-100K in 2015, likely to be more this year) and the various suggestions I’ve given them to lower those costs. I could write about how they respond with the fact that none of those suggestions, while cost saving to them, are part of my plan, and as such, are not things they can or will do.

I could write about my grief over a friend. I could write about the things I saw happen to her the one time I visited her in the hospital. I could write about how I wanted to help more but couldn’t.

I could write about system failures. I could write and I could write and I could write some more about how every single part of the system has failed me and has failed my friends. It might not all make sense but I could write. The irony is the thing that matters to me the least is the specific cost yet that’s what people care about.

I care about the fact that my friend died.

I care about my losses as a human being. I care how much of my human dignity I have lost and how much has been taken away from me since I started getting sicker. I care about the fact that I will likely lose my job (days off, their having to worry or perhaps lack of worry about my falling on the job, my requests for accommodations etc.). I care about the fact that I will never be able to do what I wanted to do with my life – PhD, fieldwork – yeah, not a chance.

I care about the fact that I will eventually get so physically injured by a fall, by EMTs, by hospital staff, or other that I will no longer be able to get out of bed. I care about the fact that I will forever wonder whether one of these things will kill me, and if so, when.

I can give you the health care cost numbers but they don’t matter to me. Ask any chronic illness patient for his or her own costs of care and you’ll find the same thing. Once you go past “typical” or “trendy” chronic illnesses, there is no care coordination, there is nobody to turn to for help, and your insurance company, well maybe they’ll pay for something and maybe they won’t. I do wonder, if I were sick and rich would I still be as sick?

One thing I do know, I’m damned tired of being sick. I’m tired of identifying myself that way and I’m tired of others doing so. I’m also tired of wondering if it’s in my head and tired of having people tell me it is. (And if it is all in my head, then please, by god, someone help me treat that.)

If creating a blog post that delineates each and every expense will help me find a doctor who can help me with whatever the heck is wrong, yes, I will write one. That said, that post would take away a part of me, the part that says humanity matters most and that’s what we should care about.

This post is part of our effort to remind us of the patient perspective by sharing patients’ stories. Thanks Snarky Frog for sharing your story with us. If you have a patient story you’d like to share, please reach out to us on our Contact Us page.

Department Of Defense (DOD) EHR Delayed By “Aggressive Schedule”

Posted on September 7, 2016 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

The Department of Defense has announced that it will be delaying the deployment of its massive EHR project, citing issues identified in testing and an “aggressive schedule” as reasons for the decision. If the DoD and its vendors are right, the deployment delay will be a negligible few months, though one setback to an effort of this kind usually to leads to another.

On the plus side, military officials said, they’ve made significant progress with developing user-approved workflows, interfaces and technical integration of its legacy system to date. But they’re not ready to engage in the concurrent system configuration, cybersecurity risk management, contractor and government testing yet.

The deployment has been in the works for little over a year. Last summer, the DoD Healthcare System Modernization Program awarded the $4.3 billion contract to upgrade its existing Military Health System EHR to a group including Cerner and defense contracting firm Leidos. The Cerner/Leidos team won out against some tough competition, including a partnership including Allscripts, HP and Computer Sciences Corp. and an Epic/IBM bid.

The ten-year project is about as large and complex an integration effort as you’re likely to see even by Cerner standards. The effort will connect healthcare systems located at Army hospitals, on Naval vessels, in battlefield clinics across the globe. MHS GENESIS will bring all of this data — on active-duty members, reservists, and civilian contractors — into a single open, interoperable platform. The new platform should serve 9.5 million military beneficiaries in roughly 1,000 locations.

The project is upgrading the DoD from AHLTA (Armed Forces Health Longitudinal Technology Application), which has been in place since 2004. AHLTA has many flaws, though none that would surprise a health IT expert. (For example, when patients are referred to non DoD providers, the data is not captured and integrated into the system.)

Ultimately, it won’t matter very much whether the DoD manages to kick off its project on time. The larger question, here, is whether over the course of a 10-year integration effort, the project becomes, as Forbes columnist Loren Thompson puts it, “obsolete before it’s even built” and incapable of the data sharing that fueled its conception. Of course, any systems integration with a long timeline faces that risk, but not all industries are changing as quickly as healthcare.

The truth is, this is arguably an awkward time for any large entity to be making big interoperability plans. I’d argue that while there are more initiatives than ever aimed at the problem, they’ve effectively made things worse rather than better. After all, the unfortunate truth is that the more people compete over interoperability standards, the less possible data sharing becomes.

A Circular Chat On Healthcare Interoperability

Posted on September 6, 2016 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

About a week ago, a press release on health data interoperability came into my inbox. I read it over and shook my head. Then I pinged a health tech buddy for some help. This guy has seen it all, and I felt pretty confident that he would know whether there was any real news there.

And this is how our chat went.

—-

“So you got another interoperability pitch from one of those groups. Is this the one that Cerner kicked off to spite Epic?” he asked me.

“No, this is the one that Epic and its buddies kicked off to spite Cerner,” I told him. “You know, health data exchange that can work for anyone that gets involved.”

“Do you mean a set of technical specs? Maybe that one that everyone seems to think is the next big hope for application-based data sharing? The one ONC seems to like.” he observed. “Or at least it did during the DeSalvo administration.”

“No, I mean the group working on a common technical approach to sharing health data securely,” I said. “You know, the one that lets doctors send data straight to another provider without digging into an EMR.”

“You mean that technology that supports underground currency trading? That one seems a little bit too raw to support health data trading,” he said.

“Maybe so. But I was talking about data-sharing standards adopted by an industry group trying to get everyone together under one roof,” I said. “It’s led by vendors but it claims to be serving the entire health IT world. Like a charity, though not very much.”

“Oh, I get it. You must be talking about the industry group that throws that humungous trade show each year.” he told me. “A friend wore through two pairs of wingtips on the trade show floor last year. And he hardly left his booth!”

“Actually, I was talking about a different industry group. You know, one that a few top vendors have created to promote their approach to interoperability.” I said. “Big footprint. Big hopes. Big claims about the future.”

“Oh yeah. You’re talking about that group Epic created to steal a move from Cerner.” he said.

“Um, sure. That must have been it,” I told him. “I’m sure that’s what I meant.”

—-

OK, I made most of this up. You’ve got me. But it is a pretty accurate representation of how most conversations go when I try to figure out who has a chance of actually making interoperability happen. (Of course, I added some snark for laughs, but not much, believe it or not.)

Does this exchange sound familiar to anyone else?

And if it does, is it any wonder we don’t have interoperability in healthcare?