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Should Doctors Offer Concierge IT Security Services?

Posted on December 20, 2017 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.

Today, just for fun, I’m gonna start with a thesis and work my way back to see if you agree with its foundations. My conclusion: With the cost of IT security services climbing, the cost of care coordination rising and practice income in many cases remaining relatively level, group practices will have to change their business model substantially.

Specifically, though this may sound insane, I’m suggesting that they may have to begin charging patients for beyond-the-call-of-duty security efforts.

Of course, as we all know, practices are required to offer at least a minimal level of security protection as specified in rules like those in HIPAA. Necessary though it is, it’s a pricey exercise for many groups.

Even so, cold economics may push them to cut data protection further. Given that care coordination will be necessary to meet population health goals, and that quality monitoring and management are indispensable, they may see security as the most dispensable of these spending options.

As the need for care coordination staff, quality management and other necessities of value-based care rise, paying for IT security services will become almost impossible to pay for without borrowing from another source.

That source can come from an internal budgetary resource, such as money allocated for routine general expenses, or other overhead, such as salaries for existing staff members, neither of which is desirable. Of course, there’s also the possibility of obtaining a line of credit, but that’s arguably even worse for the future of the company.

But since no medical organization can go entirely without IT security protection, it will have to find the funds to pay for it somehow. Given that any of the possibilities discussed above will drain the practice and possibly cut its finances to the bone, but something will have to give.

At this point, many practices decide to sell their group to a hospital or health system. That’s certainly a legitimate way of taking on unmanageable levels of overhead and getting access to far more infrastructure options and financial resources.

But if that’s not the direction you want to take, here’s off-ball idea for recapturing some IT security revenue: concierge security services.

While every patient’s data needs to be protected, obviously, you could offer concierge security patients access to extra layers of security attentiveness, such as a private IT staff or to answer any data privacy and security questions they might have about the practice, hospital where they are seen or other entity.

Toss in a special “security report” (in all candor, probably info they could’ve read in any trade magazine), personalized to patient needs, and a free zip drive with secured copies of their data and you’ll have them hooked.

If this worked, and I’m not suggesting that it necessarily would, it could help carry the cost of mundane IT security services. What do you think? Would this model have a chance?

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.”

Medical Groups Can Use EHR Data To Analyze Clinical Workflows

Posted on October 17, 2017 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.

Typically, ambulatory care organizations don’t do workflow studies, as leaders assume they have neither the time nor the data available to make it happen.

They may have more options than they think, however. A group of researchers has concluded that timestamp data found in their EHR can be used to predict ambulatory workflow.

The research article, which appears in the Journal of the American Medical Informatics Association, notes that workflow studies typically require large amounts of timing data which are too expensive to collect through observation or tracking devices. Historically, ambulatory care organizations have had to make do with observation and intuition rather than sophisticated interventions.

In fact, the relationship between health IT and ambulatory care workflow redesign hasn’t been a friendly one. A 2015 study by the Agency for Healthcare Research and Quality concluded that health IT implementations could make a mess of existing workflows. Problems included “a redistribution of clinicians’ and clinic staff’s time on different clinical tasks, repurposed usage of workspace, increased level of interruptions, multitasking, and off-hours work activities.”

According to the current group of researchers, however, these organizations may have the data they need at their fingertips. The study, which used EHR timestamp data to predict ambulatory workflow timings, suggests that this approach is valid.

To conduct the study, the researchers studied the workflow at four outpatient ophthalmology clinics associated with the Oregon Health and Science University, observing their workflows and timing each workflow step. They then mapped the EHR timestamps to workflow steps to see how they compared.

They found that workflow times generated by EHR timestamp analysis were within three minutes of observed times for greater than 80% of the appointments. What variance they did observe between observed times and timestamps seems to have been due to EHR use patterns.

Even giving these variances, ambulatory care organizations can get a lot of value out of EHR timestamp data, researchers said. “EHR timestamps…can be used to create simulation models, analyze HR use, and quantify the impact of trainees on workflow,” they concluded.

Even given this option, few ambulatory care organizations are likely to conduct formal workflow studies unless they’re backed by a deep-pocketed health system. Most medical practices have their hands full collecting what they’re owed by health plans and managing operations on a day-to-day basis.

This isn’t to suggest that they are unsophisticated, but rather, that workflow studies may require a level of time, commitment and resources that smaller practices simply don’t have. Most U.S. medical practices are small businesses.

Still, it’s good to know that if they choose, medical groups can use data already available in their EHR to make meaningful workflow improvements. Perhaps it’s time for vendors to step forward and support the use of EHRs for this purpose.

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.