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Patient Satisfaction Drops After Ambulatory EHR Is Rolled Out

Posted on June 4, 2018 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 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.

In theory, EHR implementations are supposed to not only make providers’ jobs easier but ultimately, improve patient satisfaction too. The idea is that EHRs will eventually add something beneficial to physician routines and ultimately improving care processes. Of course, there’s a lot of question as to whether EHRs can now or will ever do so, but researchers continue to look at different use cases.

For example, new research published in JAMIA has concluded that while they weren’t too thrilled by the ambulatory EHR they were using, a group of OB/GYN practices showed some enthusiasm once the outpatient EHR was attached to the one collecting data on their related inpatient perinatal unit.

The purpose of the study was to look at how the installation of the ambulatory EHR within the OB/GYN practices and subsequent connection to an inpatient perinatal EHR affected providers’ attitudes toward sharing of clinical information. It also looked at the impact all of this had on patient satisfaction.

To conduct the study, researchers collected data on both provider and patient satisfaction. They assessed provider satisfaction by conducting four surveys staged across the phased implementation of the EHR. To measure patient satisfaction, meanwhile, they drew on data from Press Ganey surveys managed by the healthcare network using the usual process.

Their ultimate goal was to determine how provider and patient perceptions changed as the EHR system enabled greater information flow between the OB/GYN practices in the hospital.

What the study found was that the outpatient OB/GYN providers were less satisfied with how the EHR affected their work processes than other clinical and non-clinical staff. On the other hand, they grew more satisfied with their access to information once the inpatient perinatal triage unit offered useful functions. Specifically, they were happier with their access to information from the inpatient system once its capabilities included the ability to send automatic data flows from triage back to the OB/GYN offices.

On the other hand, overall patient reactions to the project appeared to be negative. Patient satisfaction fell after the installation of the ambulatory EHR, and researchers could find no evidence that patient satisfaction rebounded after the information sharing process began between inpatient and outpatient settings.

In summary, the study concluded, if providers are dissatisfied with their EHR system, and those difficulties undercut patient care, the process could negatively impact patient satisfaction. The authors recommended that healthcare organizations take extra care to maintain good communication with patients during this process.

Recording Doctor-Patient Visits Shows Great Potential

Posted on June 1, 2018 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 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.

Doctors, do you know how you would feel if a patient recorded their visit with you? Would you choose to record them if you could? You may soon find out.

A new story appearing in STAT suggests that both patients and physicians are increasingly recording visits, with some doctors sharing the audio recording and encouraging patients to check it out at home.

The idea behind this practice is to help patients recall their physician’s instructions and adhere to treatment plans. According to one source, patients forget between 40% to 80% of physician instructions immediately after leaving the doctor’s office. Sharing such recordings could increase patient recall substantially.

What’s more, STAT notes, emerging AI technologies are pushing this trend further. Using speech recognition and machine learning tools, physicians can automatically transcribe recordings, then upload the transcription to their EMR.

Then, health IT professionals can analyze the texts using natural language processing to gain more knowledge about specific diseases. Such analytics are likely to be even more helpful than processes focused on physician notes, as voice recordings offer more nuance and context.

The growth of such recordings is being driven not only by patients and their doctors, but also by researchers interested in how to best leverage the content found in these recordings.

For example, a professor at Dartmouth is leading a project focused on creating an artificial intelligence-enabled system allowing for routine audio recording of conversations between doctors and patients. Paul Barr is a researcher and professor at the Dartmouth Institute for Health Policy and Clinical Practice.

The project, known as ORALS (Open Recording Automated Logging System), will develop and test an interoperable system to support routine recording of patient medical visits. The fundamental assumption behind this effort is that recording such content on smart phones is inappropriate, as if the patient loses their phone, their private healthcare information could be exposed.

To avoid this potential privacy breach, researchers are storing voice information on a secure central server allowing both patients and caregivers to control the information. The ORALS software offers both a recording and playback application designed for recording patient-physician visits.

Using the system, patients record visits on their phone, have them uploaded to a secure server and after that, have the recordings automatically removed from the phone. In addition, ORALS also offers a web application allowing patients to view, annotate and organize their recordings.

As I see it, this is a natural outgrowth of the trailblazing Open Notes project, which was perhaps the first organization encouraging doctors to share patient information. What makes this different is that we now have the technology to make better use of what we learn. I think this is exciting.

Overcoming Data Silos Within The Health Care Ecosystem

Posted on May 30, 2018 I Written By

The following is a guest blog post by Dave Corbin, CEO of HULFT.

While there’s a barely an industry or sector that hasn’t been heavily influenced or redefined by the onslaught of data, in healthcare the impact is especially acute. Health care industry players are now having to negotiate a delicate balance between exploiting the opportunities that come with the deeper insights and actionable intelligence, with managing the growing technical complexities that arise.

Let’s face it – the health care sector is renowned for the depth of its silos. It’s a significant and wide-ranging challenge. It starts in the closed world of drug R&D to a generation of providers still using fax machines (remember those?) to share patient medical records. In theory, we’d all agree that improved health data exchange is a win-win for everyone involved (providers, policymakers, patients, etc.) In reality, before we can even begin to leverage the vast troves of data from electronic medical records (EMRs), we need to overcome two key issues.

The first is data security. According to the 2018 HIMSS Cybersecurity survey, the majority of respondents, 75 percent, experienced a significant security incident in the last 12 months. The threat landscape has grown in complexity and volume and it’s critical for health care organizations to invest in privacy-by-design defense mechanisms such as encryption, security analytics, and multi-factor authentication to protect valuable patient data. For seamless data sharing to become the norm, everyone in the ecosystem must be vigilant about data protection and online privacy.

The second is interoperability – the extent to which different IT systems, software applications, and devices can exchange data and interpret that shared data. Or, to be more specific, making EMRs more “portable” so they follow a patient’s journey. After all, care is happening at multiple venues – it’s happening in hospitals, rehab facilities, long term care facilities, hospices, and more.

My own knee surgery started with the orthopaedic surgeon, who referred me to external providers that would supply me with MRIs, blood tests, and EKGs. The day of surgery included not just the surgeon, but an outside surgery center and an anaesthesiologist, all requiring separate contracts. The net result was that my medical information for a relatively routine surgery was spread over five locations and many data types.

Without an enforced standard of interoperability, data exchanges can get complicated and time-consuming, which then hinders not just the flow of information but patient care. We can do better by reducing data complexity for the patient, doctor and service providers.

Speed, security, and accessibility when it comes to health data management and sharing don’t have to elude us. A holistic approach to health data security and ecosystem interoperability can be achieved in partnership with an intuitive data logistics platform that scales to evolving data complexities and cuts development time. This can help lead your organization to transcend healthcare’s many silos often without the need for a major overhaul of existing IT system. And that’s a powerful prescription.

Dave Corbin is CEO of HULFT, a comprehensive data logistics platform that provides both the secure back-end data transfer and integration technologies to help health care organizations form a foundation for an overall enterprise data strategy that makes data more accessible and useful. HULFT is a proud sponsor of Health IT Expo, a practical innovation conference organized by Healthcare Scene. Learn more here:    

Take Part in Practical Health Innovation Think Tank – #HITExpo

Posted on May 28, 2018 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’m certain that most of you know about the Health IT conference that Healthcare Scene is organizing called Health IT Expo. We’re thankful for hundreds of you who will be joining us in New Orleans for the conference. However, we understand that many of you couldn’t make it to HITExpo this year and so we wanted to find a way to share some of the practical innovations that will be shared at the conference.

With this goal in mind, we’ve brought together a number of the Health IT expo speakers, thought leaders, and experts in a Think Tank event that we’re making available in a free live stream event. As part of the Think Tank, we’ll be discussing the following three topics:

  • Going Beyond the EHR
  • Practical Health Innovation
  • Communication and Patient Experience

In order to join the live stream, you’ll need to visit the Healthcare Scene YouTube, Facebook, or Twitter accounts on Wednesday, May 30th from 9-2:30 PM CT. We’ll also embedding the live stream in this blog post on the day of the event. You can also follow along and join in on the conversation using the #HITExpo hashtag on Twitter. We’ll be watching the hashtag for questions and comments which we’ll try to incorporate in the conversation as much as possible.

We’re thankful for each of you that are part of the health IT community. Please carve out time to join the community to share practical innovations that can help move healthcare forward. Check out the Health IT Expo website to learn the group of experts that will be participating in person at the Think Tank.

Medicare ACOs May Be Slated For Big Changes — And Health IT May Be Part Of It

Posted on May 25, 2018 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 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.

Before I get started, I want to offer a hat tip to Becker’s Hospital Review, which turned me onto the following news. That news, in brief, is that CMS might make changes to its ACO program that could have a big impact on the doctors and hospitals that participate.

According to Becker’s, CMS Administrator had some negative things to say about so-called “upside only” risk contracts, which don’t pay out anything to the agency if they miss financial and clinical benchmarks: “These ACOs are actually increasing Medicare spending, and the presence of these ‘upside-only’ tracks may be encouraging consolidation in the marketplace, reducing competition and choice for beneficiaries,” Verma told the AHA’s Annual Membership Meeting earlier this month.

At present, a whopping 460 of 561 ACOs in the Medicare Shared Savings Program are in Track 1, the agency’s upside-only program. At present, ACOs can only participate in two three-year contracts on this track, so next year 82 ACOs will be required to take on financial risk. Obviously, they don’t like this.

However, CMS isn’t exactly being unreasonable to consider curtailing Track 1. Looked at one way, the Medicare Shared Savings Program has failed utterly achieving its core purpose, and upside-only contracts are the primary reason.

According to Becker’s, which cited research from Avalere, while the program was supposed to generate $1.7 billion in net savings from 2013 to 2016, upside-only contracts were responsible for $444 million in federal spending. On the other hand, downside-risk ACOs cut spending by $60 million, a relatively tiny number when you consider the scale of CMS’s budget but positive side nonetheless.

All that being said, let me interject here and note that HIT may be part of the problem. I’m betting some of the expected savings was based on assumptions about how health IT would help ACOs meet clinical and financial benchmarks.

After all, the federal government spent many billions of dollars paying doctors and hospitals Meaningful Use incentive, which obviously gave them a convincing reason to adopt EMRs. No one approves that level spending without believing it would make everything better.

As it turns out, though, that might have been a flawed assumption. If I’m right, the Track 1 failure suggests that health IT isn’t doing as much to create efficiencies as federal health leaders had hoped. I know, particularly if you’re a doctor reading this, you’re saying “I could’ve told you this a decade ago.” Still, it’s worth repeating.

While health IT organizations — especially those housed in progressive health systems — are making great progress with improving care, we haven’t met the lofty goals of such approaches by any means. But if they want to progress toward value-based care, they’ll probably have to put their health IT to better use.

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 – 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.

Competition Heating Up For AI-Based Disease Management Players

Posted on May 21, 2018 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 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.

Working in collaboration with a company offering personal electrocardiograms to consumers, researchers with the Mayo Clinic have developed a technology that detects a dangerous heart arrhythmia. In so doing, the two are joining the race to improve disease management using AI technology, a contest which should pay the winner off handsomely.

At the recent Heart Rhythm Scientific Sessions conference, Mayo and vendor AliveCor shared research showing that by augmenting AI with deep neural networks, they can successfully identify patients with congenital Long QT Syndrome even if their ECG is normal. The results were accomplished by applying AI from lead one of a 12-lead ECG.

While Mayo needs no introduction, AliveCor might. While it started out selling a heart rhythm product available to consumers, AliveCor describes itself as an AI company. Its products include KardiaMobile and KardiaBand, which are designed to detect atrial fibrillation and normal sinus rhythms on the spot.

In their statement, the partners noted that as many as 50% of patients with genetically-confirmed LQTS have a normal QT interval on standard ECG. It’s important to recognize underlying LQTS, as such patients are at increased risk of arrhythmias and sudden cardiac death. They also note that that the inherited form affects 160,000 people in the US and causes 3,000 to 4,000 sudden deaths in children and young adults every year. So obviously, if this technology works as promised, it could be a big deal.

Aside from its medical value, what’s interesting about this announcement is that Mayo and AliveCor’s efforts seem to be part of a growing trend. For example, the FDA recently approved a product known as IDx-DR, the first AI technology capable of independently detecting diabetic retinopathy. The software can make basic recommendations without any physician involvement, which sounds pretty neat.

Before approving the software, the FDA reviewed data from parent company IDx, which performed a clinical study of 900 patients with diabetes across 10 primary care sites. The software accurately identified the presence of diabetic retinopathy 87.4% of the time and correctly identified those without the disease 89.5% of the time. I imagine an experienced ophthalmologist could beat that performance, but even virtuosos can’t get much higher than 90%.

And I shouldn’t forget the 1,000-ton presence of Google, which according to analyst firm CBInsights is making big bets that the future of healthcare will be structured data and AI. Among other things, Google is focusing on disease detection, including projects targeting diabetes, Parkinson’s disease and heart disease, among other conditions. (The research firm notes that Google has actually started a limited commercial rollout of its diabetes management program.)

I don’t know about you, but I find this stuff fascinating. Still, the AI future is still fuzzy. Clearly, it may do some great things for healthcare, but even Google is still the experimental stage. Don’t worry, though. If you’re following AI developments in healthcare you’ll have something new to read every day.

Nurse Satisfaction With EHRs Rises Dramatically, But Problems Remain

Posted on May 18, 2018 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 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.

In the past, nurses despised EHRs as much as doctors did – perhaps even more. In fact, in mid-2014, 92% of nurses surveyed weren’t satisfied with the EHR they used, according to a study by Black Book Research. But things have changed a lot since then, Black Book says. The following data is focused largely on hospital-based nursing, but I think many of these data points are relevant to medical practices too.

Despite their previous antipathy to EHR’s, as of Q2 2018, 96% of nurses told Black Book that they wouldn’t want to go back to using paper records. That score is up 24% since 2016, the research firm reports.

Part of the reason the nurses are happier is that they feel they’re getting the technical support they need. Eighty-eight percent of responding nurses said that their IT departments and administrators were responding quickly when they asked for EHR changes, as compared with 30% in 2016.

On the other hand, the study also noted that when hospitals outsource the EHR helpdesk, nurses don’t always like the experience. Twenty-one percent said their experience with the EHR’s call center didn’t meet their expectations for communication skills and product knowledge. On the other hand, that’s a huge improvement from 88% in 2016.

Not only that, RNs are eager to improve their EHR skillsets. Most nurses are now glad that they are skilled at using at least one EHR, and 65% believe that persons who are skilled at working with multiple systems are seen as highly-desirable job candidates by health systems.

Providers’ choice of EHR can be an advantage for some in attracting top dressing talented. Apparently, RNs are beginning to choose job openings for the EHR product and vendor the provider uses as an indication of how the working environment may be than the provider itself. Eighty percent of job-seeking RNs reported that the reputation of the hospital’s EHR system is one of the top three considerations impacting where they choose to work.

That being said, there are still some IT issues that concern nurses. Eighty-two percent of nurses in inpatient facilities said they don’t have computers in each room or handheld/mobile devices they can use to access the EHR. That number is down from 93% in 2016, but still high.

These statistics should be of great interest to both hospitals and physicians. Obviously, hospitals have an institutional interest in knowing how nurses feel about their EHR platform and how they supported. Meanwhile, while most average size practices don’t address the same IT issues faced by hospitals, it benefits them to know what their nurses are looking for in a system. There’s much to think about here.

The Bad and the Ugly of Prior Authorization and How Technology Will Fix It

Posted on May 16, 2018 I Written By

The following is a guest blog post by Karen Tirozzi, VP of Solutions, ZappRx.

Specialty drugs, which are usually defined by their complex instructions, special handling requirements or delivery mechanisms, are typically priced much higher than traditional drugs and cost more than the average American family’s salary. These medications are priced higher for a variety of reasons such as manufacturing costs, smaller patient populations and patient services like IV administration or at-home care required to support patients who will take these medicines.

Due to the costly nature of these treatments, payers insist on a comprehensive prior authorization (PA) process to ensure qualified patients are receiving the medications they need. The PA process involves cumbersome paperwork and fax machines and are a huge burden to physician’s and their staff. Physicians have even resorted to hiring extra, dedicated staff just to process these prescriptions as nurses, NP’s, PA’s and medical assistants tend to fall victim to the prior authorization nightmare. According to a recent study, it is estimated that $85,276 was spent on personnel costs to address billing and insurance issues associated with prior authorization, which is approximately 10 percent of practice revenue.

To put just how inefficient the PA process into perspective, a recent AMA survey of 1,000 physicians providing 20 or more hours of care a week, showed that doctors receive an average of 37 PA requests a week, which took an average of 16.4 hours to process. Extrapolate 16.4 hours a week over a year and clinicians are spending around 41% of their time annually doing paperwork, making calls and or sending faxes just to navigate PA and get medications to their patients. It includes enrollment forms and signatures from the patient, which can be done while the patient is in the office, however, it’s often done through mail, which slows down the process even more. Providers also have trouble ensuring they have the right forms for the insurer’s preferred specialty pharmacy, as sending to the wrong pharmacy also causes delays. Providers are tangled in faxes and phone calls for weeks on end so that all parties have all the information they need to approve just one prescription. In 2018, how is it that the medical community still heavily relies on fax machines to process information and deliver life-saving drugs to patients.

A Brighter Future

Digitizing the entire prior authorization process will significantly reduce the administrative burden on clinicians and get patients their medications in a much more streamlined manner. Healthcare providers should be able to, in one place, order a specialty prescription, see the paperwork and signatures needed and follow its progress until it reaches the patient’s hands. The healthcare industry needs to start utilizing the technology available today to streamline workflows and decrease operational expenses, which in turn, can help save patients’ lives.

By embracing technology, clinicians can also leverage the rich data sets generated to better understand their patients’ needs, trends within the space they’re treating and ultimately, improve patient care. Data can also be used by pharmacies to understand how their medications are trending within the market and catch any snags that may cause delays. The potential for pharma companies to use this level of information to provide insights and improve products in real-time is invaluable.

Let’s take the next step

Inherently risk adverse and with siloed stakeholders, healthcare must begin taking steps toward change. With what the space has at its disposal from a next-generation technology standpoint, there is no excuse to remain chained to the fax machine.

The good news? Providers, pharmacists and biopharma have options to improve this cumbersome process today. Forward thinking innovators are beginning to break down silos and uncover new methods with technology to streamline the prior authorization process and get patients their specialty medications in days, not weeks.

About Karen Tirozzi
ZappRx Vice President, Solutions, Karen Tirozzi, leads a fast growing team that is focused on transforming the specialty pharmaceutical prescribing process. With a focus on client success, Karen and her team are innovating technologies to automate traditionally manual and cumbersome processes in an effort to save clinicians time and resources, and deliver lifesaving drugs to patients in a timely manner.  Having spent more than 15 years in the industry, Karen’s unique background in HIT and clinical social work serve as the basis for her ability to deliver successful programs in highly disruptive healthcare services and IT companies.

How Will CMS Handle Issues Surrounding MACRA Changes?

Posted on May 14, 2018 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 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.

As most readers will know, when CMS released details on MIPS and the Alternative Payment Model incentives it embarked on a new direction for quality programs generally. As most readers will know, MIPS consolidated PQRS, the Physician Value-based Modifier and the Medicare EHR Incentive Program for EPs (Meaningful Use). But CMS is still updating the Medicaid incentive program.

If I were a physician, I’d be even more interested in the CMS initiative dubbed Promoting Interoperability. In some of the biggest news to come out of the agency in ages, CMS is restructuring the EHR Incentive Programs to become the Promoting Interoperability Programs. Promoting Interoperability replaces the Advancing Care Information category of MIPS.

Whoa. That would be a big enough deal on its own, but the issues the rule raises are an even bigger one.

CMS’s has been working towards this goal for a few years. Per HIMSS, here are some changes suggested in the proposed rule that might have the biggest impact on the health IT world:

  • The rule would cut down measures from 16 to six
  • It would use a new performance-based scoring methodology which would include measures of performance on e-prescribing, health information exchange, provider to patient exchange and public health and clinical data exchange
  • The agency will define and work to prevent “information blocking”

On a related note, CMS has posted a request for information asking for stakeholder feedback on program participation conditions. This is pretty unusual for the agency.

Like many CMS proposals, this one leaves some important questions open. (Apparently, CMS itself wonders how this thing will work, as the request for information suggests.)

For example, the new performance-based scoring method will award providers anywhere from 0 to 100 points. Measuring health IT performance is always a tricky thing to do, and there’s little doubt that if this becomes a final rule, both providers and CMS will have to go through some struggles before they perfect this approach. In the meantime, providers face some big challenges. How will they adapt to them? Its too soon to say.

Addressing so-called “information blocking” should be an even bigger challenge. Everyone from members of Congress to providers to vendors acts as though there’s one way to describe this practice, but there’s still a lot of wiggle room. Honestly, I’ll be amazed if CMS manages to pin it down the first time around.

Still, the time is more than overdue for CMS to take on interoperability directly. Without real data interoperability, many promising digital health schemes will collapse under their own weight. If CMS can figure out how to make it happen, it will be pretty neat.