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Revenue Cycle and Patient Communication Dominates MGMA18 Exhibit Hall

Posted on October 3, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Two themes emerged from the exhibit floor of this year’s MGMA annual conference (1) Practices are spending money on improving Revenue Cycle Management – RCM and (2) Practice managers are looking for more comprehensive ways to communicate with patients.

The exhibit hall of the 2018 MGMA Annual Conference (#MGMA18Annual) came to a close today and as the booths were quickly deconstructed, I took time to reflect on 25 pages of notes that I took from the various conversations I had. As I flipped through my blue-ink chicken scratches, I kept seeing two words in the margins: “PtComm” (my short hand for Patient Communication) and “RCM” (Revenue Cycle Management). On page after page, I scrawled these words to summarize the conversations.

In the Health iPASS booth, I had the chance to speak with one of their customers – Judith Basile, MSM, FACMPE, Practice Administrator at Associates in Orthopedics. Basile told me that implementing Health iPass’s RCM platform made “a huge impact on the financial health” of their practice and that it allowed them to “catch up to the consumer experience patients have outside of healthcare, where they can make payments quickly and easily”. With Health iPASS, Associates in Orthopedics experienced a 35% improvement in patient payments. They had only been on the platform for 18 months.

Over in the Pulse Systems booth, I spoke with Dar Griffeth, the company’s new SVP of RCM Services. Griffeth’s role was created because the company recognized the need their customer had for expert RCM advice. His job is to work with customers to identify how components of the Pulse solution can be adapted to improve the RCM process. This is in contrast to the common approach of deploying technology and then redesigning the workflow to fit – an approach that often results in slow adoption or outright failure. Griffeth’s role would not exist if RCM was a low priority for physician practices.

Matthew Hawkins, CEO of Waystar, the company that resulted from the combination of ZirMed and Navicure, shared where they had been focusing some of their development efforts. “Lately we have been focused on helping reduce or eliminate claim denials,” said Hawkins. “Having a claim denied is terribly inefficient. Practices have to spend precious time and effort investigating and correcting the claim. We thought – why does it have to be this way? What if we could eliminate denials altogether? That’s what we’ve been working on and our customers are happy we have made significant strides in this area.”

The exclamation point was Waystar’s announcement that it was acquiring Ovation – a claims monitoring technology from UPMC to further enhance Waystar’s claims processing platform.

The conversation turned to patient communications when I stopped to speak with Rick Halton, VP of Product and Marketing at Lumeon. I was unfamiliar with Lumeon and was curious to find out more. Halton argued convincingly that the current paradigm of care coordination was flawed – that the top-down approach where a central care coordinator is expected to shoulder the work to gather data from patients and keep patients adherent to their care programs. was doomed to fail. Instead, an approach where patients are full partners in their care was needed. In Halton’s opinion, the key was two-way communication between patients and their care teams.

Lumeon’s Care Pathways Management platform allows for a more automated and orchestrated approach to care delivery. One that is centered on the ability for patients and care teams to communicate in a seamless manner via text and in-app messages. “Everything from discharge to pre-operative readiness to lifestyle coaching is possible through the platform,” said Halton.

In prior years at MGMA, whenever I talked to people about patient communications my conversations were only about sending out appointment reminders and links to patient educational materials. What Lumeon was showing me was true 2-way communication with patients across many care scenarios.

Further evidence of this shift in patient communications came from my conversations with Well Health, Rhinogram and CareCloud.

Well Health makes a platform that consolidates all patient communications in one place – and allows for seamless transition from broadcast message delivery to real-time two-way communication with patients. Their interface looked intuitive and because they system stored all prior communications, it allows practices to quickly reference prior conversations, helping staff get to the heart of the issue more quickly than having to search through the EHR.

“It’s all about making it easy for both the patient AND the staff in the healthcare organization,” said Bill Kinner, President of Well Health. “We have to realize that in the world of value based care, effective 2-way communication with patients is the cornerstone to keeping people healthy. It’s the last mile of any population health, medication adherence or mental health program.”

Rhinogram had a similar philosophy. A relative newcomer to the ambulatory space, the company has enjoyed years of success with dental practices. I asked Dr Keith Dressler, Chairman & CEO of Rhinogram what set their system apart from all the others on display at MGMA: “Quite simply we see ourselves not as a communication platform, but as an asynchronous telehealth platform that uses text, Facebook Messages and other channels rather than real-time video to connect with patients”

Dressler’s response was a great way to reframe the entire patient communication space and showed me that vendors were moving away from their provider-initiated communication roots to include patient-initiated communication as well.

Nowhere was this shift more apparent than in the CareCloud booth. A year ago I wrote a post about the launch of the company’s then-new Breeze platform – a patient experience platform built in partnership with First Data. Breeze was designed to be the backbone for all sorts of new patient engagement applications. At MGMA18, CareCloud announced the launch of a customizable survey tool for capturing patient satisfaction information on Breeze.

“Our new survey capability is very exciting,” said Juan Molina, Vice President of Strategy and Business Development at CareCloud. “The surveys are customizable by the practice without the need for development resources. This allows our customers to quickly construct surveys that can gather patient feedback on anything – new programs they want to offer or changes they want to make to the practice itself. The sky is the limit. But at the core, this survey capability means our customers have another way to engage patients in a 2-way conversation about their experience.”

I must admit, prior to MGMA18 I had thought the patient communication space was played out. But having spoken with every patient communication vendor on the exhibit floor, I have a new appreciation about where the technology is headed. I’m actually excited to see what advancements will be made in the next 12 months.

PS: I also had great conversations with Kevin Pho MD – founder of KevinMD.com, Todd Evenson – COO at MGMA, Corinne Proctor Boudreau – Senior Manager at MEDITECH and Niko Skievaski – cofounder & President at Redox. Those conversations will be the subject of upcoming articles.

Better Performing Practices Invest in Communications

Posted on October 1, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

MGMA’s Winning Strategies From Top Medial Groups report identifies better-performing practices have invested in: (1) New/upgraded EHRs; (2) Electronic communication systems; and (3) Upgraded coding and revenue cycle management systems.

The Medical Group Management Association (MGMA) released their Winning Strategies From Top Medical Groups report – on the morning of their annual conference. The report is based on data gathered from 3,000+ medical groups that were identified by MGMA as top-performers in at least one of four categories:

  1. Better-performing practices focus on using resources efficiently and create + stick to a financial plan.
  2. Better-performing practices are those whose providers and staff successfully contributed to earned revenue for the practice.
  3. Better-performing practices have lower operating costs as a percentage of revenue and manage their revenue cycle better.
  4. Better-performing practices report on quality metrics while also excelling in at least one other category.

According to the report, being a better-performer reaps significant benefits.

  • Better performing independently-owned surgical specialty practices have 20% lower operating costs vs other practices
  • Better performing primary care practices have 8.6% greater net income per physician vs other practices
  • Better performing practices collect 10% more accounts receivable in the first 30 days vs other practices

Overall, the report identified three key strategies that better-performing practices pursue:

  1. Building an engaging, patient-focused culture
  2. Focusing on long-term, strategic progress
  3. Constantly investing in improving operations

What was the most surprising result in the report? Todd Evenson, Chief Operating Officer of MGMA had this to say “I found it surprising how much more productive Better Performers were in terms of Work Relative Value Units (RVUs). Better-performing non-surgical specialty practices, for example, were found to have an average of 9,115 RVUs per physician compared to 7,300 for all other practices. The report highlights having the right staff, the right technology and the right people can make a big difference.”

For me, the most interesting aspect of the report was where HealthIT investments were being made. The report identifies that better-performers had or were planning to invest in:

  1. New or upgraded EHRs to support better patient communication, better provider experience and workflow efficiency
  2. Electronic communication systems (like secure texting) for use between providers and with patients
  3. Upgraded billing/coding software and revenue cycle management systems

I did not expect to see communication so prominent in the top Health IT priorities. For many years communication has been an afterthought. It is encouraging to see that in 2018 practice leaders are putting an emphasis on tools and systems to help bring the people who are delivering care closer to peers and closer to patients.

“The reality is, any practice can achieve top performance when the people within it make a sustained effort to do more of the right things well,” said Ken Hertz, Principal MGMA Consultant. “We developed this report not only to give practices strategies to get the most from their business but to show them that these efforts pay off—for practices and patients alike. When practices invest in improving their business, patients are more efficiently served, increasing patient satisfaction and health outcomes, and improving patient retention rates. It’s a feedback loop that benefits everyone.”

The Winning Strategies From Top Medical Groups report is available exclusively to MGMA members.

Marginalized Populations Continue to Struggle for Access to Healthcare

Posted on May 23, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

I recently had the privilege of attending the annual #Cinderblocks5 event in Grantsville MD. Organized by the incredible Regina Holliday, this event is a blend of art school, community town-hall, healthcare update, and patient rally. It is definitely not your typical healthcare conference. This was my third year attending and every year I get more out of the event.

The only thing I can compare #Cinderblocks5 to is summer camp. Remember going to camp in the middle of nowhere – seeing old friends and meeting new ones while doing things you don’t normally do? That’s kind of what #Cinderblocks5 is like. It’s the only event on my calendar where I will hear a plea from an HIV-positive patient about the need for better access, followed by an update from a local community leader about the latest in affordable housing, followed by a walking tour with a park ranger.

Set in the idyllic hills of Northwestern Maryland, Grantsville is a tiny little community that is a stone’s throw from Interstate 68. It was historically a stop on the National Road (US Route 40) which once carried thousands of pioneers. The town of 800 is now home to a budding artisan community and has one of the best hidden gems of a restaurant I have ever eaten at – The Cornucopia Café.

Of course the town is now the home of my good friend Regina Holliday: speaker, tireless advocate and community leader. She is the force of nature who created the #TheWalkingGallery which I am honored to be a member of.

Although there is never a planned theme to #Cinderblocks5 events, one always emerges. For me, the theme of this year’s event was marginalized populations and their access (or lack of access) to healthcare. The first speaker was none other than Amy Edgar APRN, CRNP, FNP-C @ProfAmyE who spoke about her work pioneering mental health work at Children’s Integrated Center for Success @CICSuccess. Access to mental health services remains a challenge – especially for those who need it most: marginalized people.

We later heard from Heather Hanline, Executive Director of the Dove Center @dovecenter_gc –  which provides safety, advocacy and counseling to survivors of domestic violence and sexual assault. There is such a need (unfortunately) for these types of services in rural communities, a point made by Hanline several times in her impassioned presentation. Without the Dove Center, trauma survivors would have to drive miles into the big cities to get help.

We also heard from Robb Fulks @TheIncredibleF. Fulks is an incredible human being. For almost his entire life the odds have been stacked against him. He has numerous comorbidities including HIV. As if that is not enough he is coping on a shoestring budget. In the past Fulks has spoken out against the rising cost of life-sustaining medications that used to be <$20 and against exclusionary tactics by insurance companies. This year Fulks said the most powerful line at #Cinderblocks5:

Other speakers at #Cinderblocks5 included:

  • Ashley Elliott a recovering addict (sober since 2012) who talked about how she battles the stigma in her small town and how there is a lack of recovery programs in rural communities
  • Michael Mittelman @mike_mitt who highlighted how poorly living organ donors are treated by the healthcare system after their life-saving gift is given
  • Jade Kenney and Kendra Brill who spoke about their struggle to build a safe haven (Rainbow Bridge Home – https://www.rainbowbridgehome.org/) for the LGBTQIA community in a rural setting and how they were/are both marginalized by “polite society”

Being at #Cinderblocks5 was a poignant reminder that: (a) art, music and reflection are as much a part of healthcare as IT, workflows and treatment regiments; (b) there is no substitute for in-person meetings; and (c) that we still have a lot of work to do when it comes to people at the margins of healthcare. Whether it’s because of economics, social norms, mental health issues or belief systems, there are many people who do not have access to healthcare that need our help. We cannot forget about these people when designing the health systems of the future and the Health IT solutions that will power them.

#HIMSS18 Exhibitors Shift Away from Glitz & Glamour in Vegas

Posted on March 9, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

The crucible that is the #HIMSS18 exhibit hall is over. 1300+ vendors have taken down their booths and rushed off to catch flights home. In the quiet aftermath of the vendor exodus, I had the chance to reflect on the overall themes of this year’s exhibits.

AI was everywhere and nowhere

Going into #HIMSS18 I fully expected that artificial intelligence would be a dominant theme. It was…and then some. AI was splashed across banners and monitors as far as the eye could see. Michael Rothman PhD, Co-founder and Chief Science Officer at Pera Health summed it up best: “Artificial Intelligence was liberally sprinkled across the #HIMSS18 show floor. It was the pixie dust that blanketed everything.”

Yet after speaking with many vendors, it became apparent to me that the term was being used very broadly to include: machine learning, data mining and rules-based workflow. Worse, a few vendors I spoke to were unable to describe how the addition of AI made their products incrementally better than what they offered before. Will “AI” go the way of neural networks, hydrogen cars and 3D TV? Doubtful, but it is concerning how quickly the term has become a marketing buzzword.

Fewer brochures handed out

In years past, you couldn’t walk down the aisles at HIMSS without vendors handing you nicely printed marketing brochures. This year, there was a noticeable lack of brochures. Several vendors had no paper handouts whatsoever, electing instead to email materials directly to booth visitors rather than force bulky paper brochures into their hands.

In my mind this is a win-win-win. The environment wins because fewer trees are transformed into glossy brochures with smiling doctors staring at computer screens. HIMSS attendees win from not having to carry heavy brochures. HIMSS exhibitors win from not having to print and ship brochures.

Fewer tchotchke’s, more in-booth experiences

One of the staples of HIMSS has been the amazing promotional items given out by vendors in the exhibit hall. This year, however, vendors scaled back their giveaways, opting instead to invest more on in-booth experiences. I counted no fewer than 20 podcasting stations and 15 video/livestream setups embedded in vendor booths. The soundproof podcast studio in the Cerner booth was amazing.

Also notable were the number of in-booth theatres that dotted the exhibit floor. I stopped counting after reaching 250. What impressed me was that it was not just sales presentations that were happening on these stages. Many vendors featured panel discussions and live interviews of industry thought leaders as part of their programs.

In my mind the hands-down winner was the CDW Healthcare Jeopardy station. Every day there was a crowd of people actively participating in a game-show style contest that pitted up to 6 teams of participants against each other. The show host was particularly charming and engaging. He really got the crowd excited. Bonus: the questions were all healthcare based.

Special shout out to @MedicaSoftLCC @FogoDataCenters @NextGate @emedapps for gathering donations for SafeNest an organization that helps victims of domestic abuse in Las Vegas.

Booth Models becoming extinct

It’s one thing to hire an entertainer like a magician or look-alike to attract people to your booth. It’s quite another to hire an attractive model to do nothing more than to stand in your booth and be attractive. At HIMSS18 I noticed very few of these hired helpers. There were certainly models who were hired to play the part of a patient in mock exam rooms, but there were no scantily-clad flamingo girls or bare-chested tuxedo men handing out company brochures like in years past when HIMSS was in Las Vegas. I’m hoping this downward trend continues.

Smaller Booths

The most surprising aspect of the HIMSS18 exhibit floor was size of the booths themselves. There were the usual giant footprints from industry titans: Epic, Cerner, Allscripts and IBM Healthcare. But other than the new Change Health booth, it felt like most vendors chose smaller booth sizes. Salesforce, Oracle, Microsoft, Google, Amazon, DellEMC and Verizon had moderately-sized booths at HIMSS18 relative to the size of those companies.

Healthcare IT has never been about glitz and glamour. Despite being held in Las Vegas – the city that is the epitome of glitz – the vendors in the #HIMSS18 exhibit hall showed restraint and practicality. Hopefully this is a trend that continues next year at #HIMSS19

Thanksgiving Medical Humor

Posted on November 23, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Happy Thanksgiving to all our Healthcare Scene subscribers. We are so thankful for your engagement and readership. We are also thankful to all our wonderful sponsors. Without your support and belief in us, we wouldn’t be here. Thank you for helping us bring the Healthcare Scene community together.

Stay safe. Smooth travels. Happy Thanksgiving!

Here is a little Thanksgiving humor to get you into the holiday mood.

Twitter Highlights from AMIA17

Posted on November 15, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Last week I had the privilege of attending the 2017 American Medical Informatics Association (AMIA17) annual conference in Washington DC. I thoroughly enjoyed the experience and came away with new appreciation for the work informaticists do. Check out this blog for key AMIA17 takeaways.

One of the most enjoyable aspects of AMIA17 was the quantity and quality of the live-tweeting. My twitter feed hadn’t been that active at a healthcare conference since HIMSS17. There were no less than 20 attendees actively tweeting throughout the conference.

Below is a selection of memorable AMIA17 tweets.

I wasn’t familiar with Carol Friedman’s work, but her lovely tribute video was riveting – almost Hidden Figures-esque. Friedman not only had to overcome being a female data scientist, she was one of the few in her field to believe Natural Language Processing could be applied to healthcare. Her acceptance speech was filled with humor and funny stories.

One of the major announcements at AMIA17 was the creation of a new open access journal – called JAMIA Open. This new publication will be AMIA’s attempt to break down one of the biggest barriers to innovation – a lack of access to research papers. It will be interesting to track the progress of JAMIA Open in the months and years to come.

A very interesting concept discussed at AMIA17 was the use of EHR audit logs as way to identify areas for improvement. This included finding opportunities where retraining might be needed and where bottlenecks exist in clinical workflows. Suddenly it’s not so bad that EHRs record every action…or maybe it is if you are a bottleneck.

Genomics is very exciting. Carolyn Petersen, an Editor at Mayo Clinic, tweeted one out an interesting use case during AMIA17 – using genomic info to prevent adverse drug reactions. Amazing.

This was an extremely interesting question posed by Dr. Danny Sands. In the OpenNotes session he attended the presenters found that physicians were more honest in their documentation notes than they were with the patients they were seeing face-to-face. This makes for an intriguing scenario when patients gain access to those notes after a visit.

One of the more prolific live-tweeters at AMIA17 was Dr Wayne Liang. I enjoyed reading his tweets from sessions that I was unable to attend. This tweet stood out for me. He expertly summarized the 5 ways HealthIT systems could be improved to allow for better data analytics.

Another active live-tweeter was Pritika Dasgupta, PhD student at University of Pittsburgh Department of Biomedical Informatics. This tweet nicely summed up how sensitive the issue of decision support tools has become. Patients and clinicians both want the latest and greatest tools that will lead to the best outcomes. From that perspective, evidenced-based decision support tools can be very effective. However, medicine is more than simply a set of if/and/or statements. It is truly a craft and there is a concern that we lose something when we try to reduce patients to a set of input parameters.

It is always a special treat to listen to a Ross D Martin live performance. At AMIA17 he performed his latest creation – a theme song for #digituRN, an initiative to transform nursing through digital innovation. You can listen to the song on YouTube.

Shout out to Pritika Dasgupta, Dr Wayne Liang, Carolyn Petersen, Rebecca Goodwin, Dr Paul Fu Jr, Dr Arlene Chung, Jenn Novesky, Scott McGrath, Dr Danny Sands, Ross Martin, Alex Fair and Michael Rothman. It was fun to live-tweet with you at AMIA17.

Better Performing Practices More Efficient with IT Spending According to MGMA

Posted on October 23, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

The Medical Group Management Association (MGMA) recently released its 2017 MGMA DataDive Better Performers data, a report that provided a glimpse into the health of US medical practices across four key performance categories:

  1. Operations
  2. Profitability
  3. Productivity
  4. Value

Of the 2,941 physician practices that provided their performance data for the report, only 32 were found to be “better-performing” than their peers in three of the four categories. No practice was considered better-performing on all four categories.

For a deeper dive into the report, check out this post from Anne Zieger.

The report’s most surprising results were in the Operations – Information Technology category:

  • Physician-owned practices spent more than 2x on IT Per FTE Physician than their hospital-owned practices
  • Better performing physician-owned practices spent LESS on IT than their peers
  • Better performing hospital-owned practices spent MORE on IT than their peers

At first glance these results run counter to what many would expect. How could independent physician practices be spending more than 2x hospital-owned practices on IT – especially when you consider that a hospital has many more IT systems and applications.

To help make sense of the results, we sat down with David N Gans, MSHA, FACMPE – Senior Fellow, Industry Affairs at MGMA.

Why are hospital-owned practices spending less overall on HealthIT?

Gans: The raw numbers that we received from the practices was a bit deceiving. What we found was that not all IT costs borne by the hospital are filtering down to the practices owned by that hospital. Server costs, IT department salaries, support costs and network infrastructure costs, for example, did not appear as line item costs for the practices. Only equipment and the EHR licenses used by the practice’s staff were considered IT costs. Independently owned practices, however, bear all the costs associated with IT including licensing, servers, support and ongoing maintenance. Thus, it only appears that hospital owned practices are spending less than their counterparts. It is a quirk of the way costs are allocated in a hospital setting.

Why are better performing physician-owned practices spending less on HealthIT than their peers?

Gans: The scoring system we used for this report rewards efficiency. The more efficient you are in any category, the higher you will score. Using that lens, practices that were more judicious with their IT spending achieved higher efficiency scores. What you are seeing in the report results is an associative effect – the more effective you are with IT, the more efficient your practice is considered.

Gans was quick to point out that the survey did not measure the impact of or the outcomes achieved from the implementation of HealthIT. There was also not linkage between overall IT spend and practice profitability.

Why is it important that practices strive to be efficient. Isn’t that an antiquated notion?

Gans: It’s actually more important than ever for practices to focus on being efficient. If you go back to 2001 and look at three key economic indices it becomes painfully obvious why efficiency is the key to practice survival. Just look at this chart we have compiled:

The red line is the % increase in practice operating costs per FTE Physician relative to what it was in 2001. By 2020, costs will be 116.7% of what they were in 2001. The blue line is the consumer price index. The green line is the rise in Medicare reimbursements. There is no way a physician practice can stay in the black without taking a serious look at their operational efficiency. If you do nothing, costs will eat up your practice.

Gans is hopeful that new technologies and changes to the reimbursement mechanisms will help reduce the performance gap for practices. According to Gans, Artificial Intelligence, like IBM’s Watson, could make practices exponentially more efficient. It can crunch numbers much faster than a human ever could, which would allow physicians to offer more personalized care or care via less expensive channels (ie: telehealth).

“One thing is clear,” says Todd Evenson, Chief Operating Officer at MGMA. “As we change from volume to value, the financial metrics we track in this report will have to change. We will need to de-emphasize the production-style metrics we have used in the past to more value based ones. We will also need to find a way to measure the quality of care provided by practices. This will make this report even more important and relevant in the years to come.”

Patient Generated Data, Workflow and Usability Coming Into Focus for EHR Vendors

Posted on October 16, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

At the recent Medical Group Management Association annual conference (MGMA17), I made a point of visiting as many of the EHR vendors in the exhibit hall as I could so that I could ask them two questions:

  1. What are you working on right now, given that there is a bit of a lull between ONC requirements?
  2. How do EHRs and EHR vendors need to evolve over the next 5 years?

Below are some of the best responses I received.

Steve Dart, Senior Director of Product Management at AdvancedMD believes that both EHRs and EHR companies need to fundamentally change their paradigms in order to thrive over the next five years. “EHRs should facilitate the job that needs to get done rather than serve as a documentation repository,” says Dart. “What is that job? Helping patients live healthier lives while at the same helping physicians be happier at work. We really missed the boat during the Meaningful Use (MU) gold rush. We neither helped patients be healthier nor did we make physician lives easier. In fact, as an industry we generally made things more difficult for doctors.”

AdvancedMD is charting a new path forward, instead of just fixing their user interface (UI), they are rethinking their entire approach to their EHR. The company is taking full advantage of the lull in MU requirements by using the time to bring together designers, UI experts, physicians and office managers to design a brand new EHR. Dubbed the “connect the dots” strategy, AdvancedMD is centering their next generation on clinical and administrative workflows.

“When you think about it, healthcare is really just a journey of sequential workflows,” Dart explains. “A patient starts by experiencing symptoms, then moves to research physicians online, schedules an appointment, comes in for their visit, goes to get lab tests done, comes back to discuss the results and fills a prescription. What EHR companies have done is create whole bunch of point solutions for each one of these situations. What we haven’t done well is connect these all together with technology. We siloed everything. Instead what we need to realize is that each situation is actually a complex workflow and we journey from one workflow to another as patients. What we need now, and what AdvancedMD believes, is that we should build technology that enables these workflows – make them easier and more seamless for patients and physicians. Data collection, for example, should happen on devices that both doctors and patients already use and in a way that doesn’t detract from the visit.”

To illustrate that AdvancedMD is doing more than just giving their theory lip-service, Dart showed an early design prototype of an EHR interface that provides a longitudinal view of a practice. Instead of clicking down into one patient to order labs or renew prescriptions and then clicking down into the next patient to do the same, the new interface groups all lab orders together and all the prescriptions together. One click and the physician can see all that they need to do and clicks once to push the orders ahead. The new interface is highly intuitive and functional.

Juan Molina, VP of Strategy and Business Development at CareCloud also believes that EHRs need to radically change. “EHRs need to allow doctors and their staff to do their jobs better,” says Molina. “We have to stop asking doctors to be data entry clerks and documentation specialists. They need to go back to being 100% focused on the patient and providing care. As an industry we have focused too much on checking the box. We need to move beyond that through better use of technology – especially modern cloud-based architectures.”

Mollna is most excited about the potential of real-time analytics and Artificial Intelligence (AI) at the point of care. He feels that the promise of precision medicine and true personalized care will only be possible if “massive amounts of health data is crunched and context from that data delivered to the doctor at the time when they are seeing a patient.” CareCloud is using the freedom from compliance requirements to work on new partnerships for deep analytics, AI and patient experience (read about their partnership with First Data here).

It is refreshing to hear EHR companies talk about collaboration. Over the past several years it was frustrating to see vendors attempt to build everything themselves only to end up with inferior solutions to what was readily available in other industries from other vendors. Partnership and collaboration are a welcome shift in EHR strategy.

athenahealth is actively pursuing partnerships as part of their More Disruption Please (MDP) program. “We are constantly expanding and improving our cloud-based platform to align with our vision,” says Stephanie Zaremba, Director of Government and Regulatory Affairs at athenahealth. “We want to see a healthcare industry free from administrative burden, enabled to care for diverse and disparate populations, and one that ultimately lets doctors be doctors. We believe that the current paradigm of federal regulations hinders, rather than helps, our industry from making this vision a reality. The innovation we so desperately need can’t flourish in the confines of check-the-box requirements that do not grow and evolve with technological advances. But even if we’re stuck with the regulatory status quo, in the next five years, we hope that vendors will continue to embrace their collective potential, shifting from competitors to collaborators in an effort to create a more provider-friendly, patient-facing, and connective tech landscape that captures the full continuum of care.”

The announcement of the partnership between Pulse Systems and InteliChart at MGMA17 is a prime example of this newfound collaborative spirit. For years Pulse offered a perfectly serviceable patient portal, yet they recognized that they would never pour as much time and effort into that area of their solution versus a company like InteliChart.

“We are pursuing an open-EHR strategy,” explains Chris Walls, President & CEO of Pulse Systems. “Although we provide a comprehensive solution, we recognize that clients may not want every component from our stack. They may want to keep a best-of-breed solution that they already have in place. Rather than force our clients to change, we are working to ensure we can integrate and play nice with others.”

Pulse arrived at this open approach by listening closely to clients and prospects. What they found was an under-current of a best-of-breed approach. Physician offices wanted to use different tools and applications from different vendors but the lack of integration and internal IT resources forced them to go with a single monolithic solution instead.

Through this listening exercise, Pulse also realized that it was more than an EHR vendor to its clients. Many of their clients are smaller practices which do not have ready access to technical support. Rather than deflect their client’s calls for help with mundane things like anti-virus updates, internet connection issues and printer failures, they leaned into it. They created a dedicated IT Field Support team that handles calls for routine IT issues and will even fly out to help a client if needed.

By proactively helping their clients in this manner, Pulse has found that they reduce EHR issues down the road and they engender tremendous loyalty. When you think about it Pulse is essentially applying a Population Health approach to their own clients – offering preventative maintenance to avoid more costly support calls in the future.

Most impressive is how Greenway Health is using this lull in compliance requirements. “Now that we are freed from working on ONC compliance work, we are putting focus on customer requested enhancements” says Mark Janiszewski, EVP of Product Managmeent & Corporate Development at Greenway. “Much to the delight of our customers, we can now apply resources to the enhancements that they have asked for, but that were lower in priority compared to what was needed to comply with regulations and the Meaningful Use program.”

Greenway is also using their “found time” to take a serious look at EHR usability. They recognize that there is tension between physicians and EHR makers caused by the endless clicking and confusing user interfaces. Greenway is hoping to relieve that tension by collaborating with clients to improve their system. According to Janiszewski, the company has planned a series of customer visits where a team of designers and engineers can observe how people interact with their system over a 2-3 day period.

The team has already identified several areas of improvement after observing how admin staff were copying down ID numbers from one screen onto post-it notes in order to key it in on a different screen to bypass a lengthy click-path. The team is hard at work to ensure data is transferred across the system more seamlessly.

Over the next five years, Janiszewski believes that EHR companies will have to embrace the concept of multiple care settings and multiple data sources: “EHRs will need to have a higher degree of interoperability as patients move between care settings – from acute care to rehab to home care or from acute care to elder care. EHRs will also need to solve for Patient Generated Data. We are all wearing fitness trackers and using apps to track our health. This data needs to be incorporated in a meaningful way into the EHR. “

The responses from MGMA17 demonstrates that companies are well aware of the negative feelings healthcare providers have towards EHRs. What is very encouraging is that fixing the user interface is only one of many different solutions being pursued by EHR companies. Rather than myopically focusing on the shiny object in front of them, companies like Greenway, Pulse, athenahealth, CareCloud and AdvancedMD are taking a step back and looking at healthcare with a broader perspective in order to identify opportunities for improvement. It will be interesting to circle back with them a year from now to see what progress has been made.

#SHSMD17 in 17 Tweets – Perspectives on Healthcare Marketing

Posted on October 4, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

The AHA’s Society for Healthcare Strategists and Marketing Development recently held its annual conference – SHSMD17 – in Orlando Florida. For three full days, 1,500 attendees shared ideas and traded insights on the latest trends healthcare marketing trends. The 60+ concurrent sessions covered a variety of topics including:

  • Developing online support groups for patients
  • Successful blog-driven content marketing
  • Media relationships
  • Communication and preparedness during a crisis
  • Chatbots
  • Consumerism

For daily summaries of SHSMD17, check out these Day 1, Day 2 and Day 3 blogs. As well see this blog on the release of SHSMD’s Bridging Worlds 2.0 report during the conference.

If I had to pick an overall theme for SHSMD17 it would have to be “perspective”. The four keynote speakers and many of the session presenters urged the audience to break out of our boxes in order to truly “see” healthcare from multiple viewpoints – including patients, clinicians and government. Only by putting ourselves into the shoes of healthcare’s various stakeholders can we create effective marketing campaigns and hospital programs.

During the conference, there was a lot of live-tweeting and there were many conversations happening via social media with people who were not in attendance. I thought it would be fun to highlight 17 tweets from SHSMD17.

Here goes.

Fun SHSMD17 Tweets

 

CareCloud + First Data Partnership a Hopeful Sign of Things to Come

Posted on October 3, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Earlier today, CareCloud and First Data (NYSE: FDC) announced they have partnered to create Breeze, a new patient experience management platform. Built on First Data’s Clover infrastructure, Breeze’s mobile, web and kiosk based applications provide consumer-style convenience to patients while helping practices streamline workflows. Through Breeze, CareCloud customers will be able to offer patients the ability to book appointments, fill out medical forms, check-in remotely and manage payments from their phones.

“We looked outside of healthcare for inspiration on what patients want” says Juan Molina, VP of Strategy and Business Development at CareCloud. “What we found was that consumer interactions have changed from in-person transactions to online experiences. We wanted to give patients the same experience in healthcare that they are used to from the rest of the world through apps like Uber, OpenTable and Amazon.”

At a Breeze-enabled CareCloud practice, the “happy path” patient interaction would be as follows:

  • Patient is invited to Breeze by their doctor’s office through a text with a specific link
  • Patient downloads the Breeze app to their phone through that link
  • Patient books an appointment through the app
  • Prior to the appointment date, patient is reminded by the app to fill in paperwork which could include: demographic information, consent forms and insurance data (photo of insurance cards can be uploaded)
  • On the day of the appointment, patient can check in remotely
  • After the appointment, patient can manage payments through the app (credit card on file, Apple Pay, Android Pay or other options made available by the practice)

By automating parts of the appointment booking, patient intake and payment workflows, Breeze reduces the workload on front-line staff.

“From the moment that the patient walks in, they are happier, and my staff no longer has to spend time dealing with packets of registration papers. Our front office can now focus on patient care and delivering the excellent level of service that they deserve,” says Barbara Arbide, a practice manager who is using Breeze in her allergy practice in Coral Gables, FL.

The CareCloud and First Data partnership is encouraging. For many years now, EHR vendors have tried to build their own walled gardens where customers and partner companies could play nicely together. Unfortunately, a lack of useful application interfaces (APIs) and a high cost of entry for potential partners, resulted in a barren courtyard with high walls (aka a prison) for customers rather than a thriving garden.

By partnering with First Data, CareCloud is showing that it is a company willing to break from traditional EHR vendor thinking. They have opted to play in someone else’s ecosystem in order to bring more functionality to their customers at a faster pace.

First Data’s Clover platform already has hundreds of useful business apps built for it including employee scheduling tools, customer loyalty apps, inventory management systems and survey programs. By basing Breeze on Clover, CareCloud’s customers have access to this rich library of apps.

“After just two days of using Breeze,” Molina told EMRandEHR.com, “A practice in southern Georgia went and downloaded a time-and-attendance app for their system from the Clover library. This replaced a cumbersome Excel spreadsheet that they had been using. This helped the practice become more efficient and sophisticated.”

Could CareCloud have developed a time-and-attendance app on their own? I’m sure they could have. Would it have been a wise investment of their time? Probably not. Would it have been delivered in two days? Absolutely not. Although in theory CareCloud is forgoing potential revenue, their partnership with First Data allows them to focus on what truly matters – improving the clinical and practice operations side of their own platform.

What’s next for Breeze? According to Molina: “Patient expectations are only going to climb higher and higher as more and more consumer apps bring more sophistication into their lives. We have to pay attention to what’s happening outside of healthcare – how people are booking tickets online, speaking to Alexa, tracking their fitness with wearables and getting food from uberEats. Patients don’t want to be transported back to the 1980s when they come to a physician office where you have to fill out forms on a clipboard. With Breeze we have a flexible platform that can continue to grow and expand. We will be able to build new patient-centric applications faster, that help our clients with more and more of their workflows.”

Hopefully this new partnership is a sign of things to come.