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Early Lessons from the Front Lines of Value-based Care: How One APM Has Impacted Community-Based Oncology Practices

Posted on June 11, 2018 I Written By

The following is a guest blog post by Dr. Charles Saunders, CEO, Integra Connect.

The Oncology Care Model (OCM) – an alternative payment model introduced in July 2016 by the Center for Medicare and Medicaid Innovation – launched with the ambitious goal to further delivery of higher quality, more coordinated cancer care at a lower cost. Participants include 184 practices representing approximately one-third of community oncologists in the US. They receive a so-called “MEOS” (monthly enhanced oncology services) payment of $160 per beneficiary per month for the duration of a qualifying 6-month chemotherapy period, plus the opportunity to earn a share of savings if they exceed a target threshold. In return, oncologists are expected to take on increasing accountability for patient outcomes and well-being, while also generating sustainable cost savings across all co-morbidities and care settings, into the patient home.

OCM Performance Period 1 Results Exposed an Unexpected Misalignment   

As part of the OCM program, CMS tracks practices during 6-month intervals – so-called “performance periods” – then shares results back about one year later. In February 2018, practices participating in the OCM program received visibility into Performance Period 1 (PP1) data, including savings achieved, aggregate quality score, and effectiveness of identifying eligible patients. While most practices were unsurprised by their performance scores, many did not anticipate the extent to which CMS would recoup MEOS payments that it deemed paid in error. The most common scenario involved patients with co-morbidities who, while receiving chemotherapy and related services, also visited other providers regularly. Therefore, the oncology practice did not represent the required plurality of E/M codes for that beneficiary. It was not uncommon for practices to be asked to return up to 30% of the sum they had been paid – a major financial hit.

Lack of Data Hinders Practices’ Ability to Accurately and Proactively Identify Beneficiaries

In May 2018, practices received their Performance Period 2 (PP2) Attribution Lists, which summarized which CMS beneficiaries met OCM eligibility criteria, which episodes were attributed to each respective practice, and episode start dates from January 1, 2017 through June 30, 2017. Unfortunately, because there is a significant lag between actual Performance Period and delivery of CMS findings – delayed up to nearly a year after each performance period has ended – OCM participants were unable to retroactively apply PP1 learnings to PP2.

Why is this especially problematic? Practices are faced not only with MEOS recoupments for erroneous payments but, with only a 1-year window to submit claims, are often unable to bill in full for patients who were missed. Indeed, there are many opportunities to miss appropriate patients, as practices needed to have an accurate view of: 1) all beneficiaries; 2) those with a qualifying diagnosis; 3) those with a new chemo episode; 4) those not only prescribed an oral agent, but those who subsequently filled it; 5) those not in a hospice; and more. Given all the dimensions to track and measure, practices without advanced tools face delivering enhanced services that they cannot correctly bill for.

Best Practices from Community-Based Oncology Practices Include Robust Data

What best practices arose to get attribution right? A vanguard of OCM practices realized that they would need to take proactive steps to enable near real-time visibility into their patient populations, embracing the tenets of population health management. Below is an example of the best practices adopted by several of these community-based oncology practices:

  • Increased transparency into oral chemotherapies: Existing practice protocols did not open an episode when oral agents were prescribed, since there was no in-office administration. To address this, the practice introduced a rule-based algorithm to identify all OCM eligible patients, including those who had been prescribed orals. In addition, they enlisted a combination of automated and personal follow-ups to validate qualification and ensure orals had been filled.
  • Avoidance of duplication: To identify missed billing opportunities while also reducing the risk of duplicated claims, practice leadership invested in a robust analytics tool that enabled personalized queries at the patient level. These reports compared eligibility against their practice management report to identify gaps, from unpaid and unbilled to denied.
  • Targeted patient intervention: To balance the practice’s financial and clinical objectives while optimizing OCM performance, the practice introduced complex care management services and employed a series of triage pathways. This approach ensured engagement with attributed beneficiaries and decreased avoidable high-cost events among at-risk patients, such as inappropriate ER visits and inpatient stays.
  • Optimized treatment choices. As part of its commitment to ensure each patient received the most effective treatment for his or her disease, the practice provided increased transparency around the availability of equally effective generic or biosimilar drugs. They also supported better end-of-life planning for patients facing second or third-line therapies not expected to provide any clinical benefits, but that could significantly degrade remaining quality of life.
  • Continuous performance improvement: To track the effectiveness of these quality improvement initiatives, the practice leveraged its analytics tool to monitor resource utilization and care management performance, then intervened to address outliers in real-time.

In short, to optimize performance under the OCM, practices are beginning to leverage the data to which they already have access – both clinical and financial – to risk-stratify their patient populations; identify OCM eligible patients; and gain near real-time visibility into quality and cost performance. Practices are also investing in better data integration and analytics that enable rules-based identification of eligible patients.

Population Health Analytics Help Practices Be Proactive and Succeed Under the OCM

Oncology is on the forefront of value-based care adoption and these early experiences from the OCM have provided a guide for other specialties. Based on their early results, what has come to the forefront is the need for a combination of comprehensive data management and robust analytics, coupled with the principles of population health management, which enable practices to step up and take control of the cost and quality for their attributed populations.

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.

#HIMSS16: Some Questions I Plan To Ask

Posted on February 1, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

As most readers know, health IT’s biggest annual event is just around the corner, and the interwebz are heating up with discussions about what #HIMSS16 will bring. The show, which will take place in Las Vegas from February 29 to March 4, offers a ludicrously rich opportunity to learn about new HIT developments — and to mingle with more than 40,000 of the industry’s best and brightest (You may want to check out the session Healthcare Scene is taking part in and the New Media Meetup).

While you can learn virtually anything healthcare IT related at HIMSS, it helps to have an idea of what you want to take away from the big event. In that spirit, I’d like to offer some questions that I plan to ask, as follows:

  • How do you plan to support the shift to value-based healthcare over the next 12 months? The move to value-based payment is inevitable now, be it via ACOs or Medicare incentive programs under the Medicare Access and CHIP Reauthorization Act. But succeeding with value-based payment is no easy task. And one of the biggest challenges is building a health IT infrastructure that supports data use to manage the cost of care. So how do health systems and practices plan to meet this technical challenge, and what vendor solutions are they considering? And how do key vendors — especially those providing widely-used EMRs — expect to help?
  • What factors are you considering when you upgrade your EMR? Signs increasingly suggest that this may be the year of the forklift upgrade for many hospitals and health systems. Those that have already invested in massiveware EMRs like Cerner and Epic may be set, but others are ripping out their existing systems (notably McKesson). While in previous years the obvious blue-chip choice was Epic, it seems that some health systems are going with other big-iron vendors based on factors like usability and lower long-term cost of ownership. So, given these trends, how are health systems’ HIT buying decisions shaping up this year, and why?
  • How much progress can we realistically expect to make with leveraging population health technology over the next 12 months? I’m sure that when I travel the exhibit hall at HIMSS16, vendor banners will be peppered with references to their population health tools. In the past, when I’ve asked concrete questions about how they could actually impact population health management, vendor reps got vague quickly. Health system leaders, for their part, generally admit that PHM is still more a goal than a concrete plan.  My question: Is there likely to be any measurable progress in leveraging population health tech this year? If so, what can be done, and how will it help?
  • How much impact will mobile health have on health organizations this year? Mobile health is at a fascinating moment in its evolution. Most health systems are experimenting with rolling out their own apps, and some are working to integrate those apps with their enterprise infrastructure. But to date, it seems that few (if any) mobile health efforts have made a real impact on key areas like management of chronic conditions, wellness promotion and clinical quality improvement. Will 2016 be the year mobile health begins to deliver large-scale, tangible health results? If so, what do vendors and health leaders see as the most promising mHealth models?

Of course, these questions reflect my interests and prejudices. What are some of the questions that you hope to answer when you go to Vegas?

Cerner Dev Partnership With Advocate Fits Emerging Model

Posted on April 17, 2015 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.

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For most of the time I’ve spent covering health IT — going back to the early 90s — vendor and provider technology development hung out in separate silos. Sure, the smarter vendors at least took time to talk with customers about their needs, but most pushed products and features developed in a vacuum.

While that’s still the case today for many vendors, I believe the paradigm has begun to shift. These days, health IT vendors are increasingly working with providers to create products for rapidly-emerging arenas like population health and tools to support ACO management.

One great example of this trend is a deal recently struck between Cerner and Kansas City, MO-based Advocate Health Care, along with Advocate Physician Partners (announced, not too surprisingly, the Friday before the glory that is HIMSS). While this deal is extending an existing long-term partnership, not kicking off a new project, it’s still gives us a nice look at how vendor/provider partnerships are evolving.

To be sure, Cerner is still playing the traditional vendor role to some extent. For example, Advocate has invested in Cerner’s HealtheCare, a community-based care management solution, as well as having the vendor keep hosting Advocate’s Cerner EMR through 2024. But that’s just the tip of the iceberg.

The heart of the deal is the development partnership, which if all goes well should give both parties a leg up in creating technologies that aren’t just shovelware. With the Advocate folks will bring their on-the-ground population health and process smarts to the table, and Cerner will share its population health and EMR technology.

Over the next seven years, the Physician Partners group will help Cerner develop a sophisticated set of population health tools. Meanwhile, Physician Partners gets access to HealtheRegistries, a tool which aggregates clinical, financial and operational data to offer a broad look at patient activity.

While this may seem like dressed-up vendor sales win puffery, my instinct is that it’s more than that. After all, both Cerner and Advocate stand to benefit substantially if they truly work together. Advocate gets the first look at EMR and population health tools that could shape their patient care strategy for decades, and Cerner gets vital provider input on a line of business which could prove to absorb EMR technologies in its wake.

And that, my friends, is why a vendor the size of Cerner — which could probably force its internally-designed products down the throat of health systems for quite a while — is developing real partnerships with its customers. In the emerging world of health IT, providers may very well filter their care management and documentation in ways that relegate the EMR to back-end status.

If other vendors are smart enough to see that the “we make it, you buy it” model of health IT dev isn’t aging well, the great engines that power care are likely to be robust, relevant and productive. If not, well, what’s the harm if Cerner turns a bigger profit over the next several years?

Parkinson’s Disease and Health Data: A Personal Story

Posted on March 5, 2015 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.

For 20 years, I’ve been writing about clinical data management, analytics and what has now come to be known as Big Data. Like everyone else who follows this sector, I’ve been exposed to many examples of brilliant thinking about leveraging health data, and of late, a growing number of examples where data analytics has improved care and saved lives.

I’ve also reported on dozens of notable case studies in which combing EMRs for telltale signs of disease has resulted in finding dangerous or even life-threatening conditions, including heart disease, diabetes and to a more limited degree cancer. What’s even more remarkable is that we’re likely to see the list of conditions detectable by data analytics expand greatly, particularly if we make smart use of the growing flood of mobile health data.

The problem is, we’re still extremely far from achieving universal health data interoperability, and no amount of inspiring speeches by HIT thought leaders or Congressional bellyachers will achieve this goal on their own. We need a shift comparable to cultural transformation that fueled the astonishing progress of our space efforts. (Maybe someone should claim that the Russians are ahead of us in the interoperability race — we can’t let them Russkys achieve national health data interoperability before we do, durn it!)

And none of this will help me get the last few years of my life back.

You see, while the diagnosis hasn’t been all-out finalized, it appears that I have a case of early-onset Parkinson’s Disease. I won’t bore any clinicians with a detailed description of the illness, but suffice it to say that it’s neurological in origin, potentially disabling and at present, uncurable and unstoppable.  I can probably still live a good life, particularly if I respond well to standard drugs, but all told, this thing is a major buzz kill.

I’ve had signs and symptoms that fit the diagnosis for at least a couple of years, and I dutifully reported them to the caregivers I saw. That included several encounters with doctors associated with the large, high-quality health system which serves the region where I live.  The health system providers entered the symptoms into their jet-fueled Epic EMR, but it seems that despite that, they never put two and two together.  (And as is still the norm, the data gathered at PCP visits has been in no way connected to the data living in the hospital Epic system.)

Fortunately, picking up on the earlier signs of Parkinson’s — if that is indeed my condition — wouldn’t have done anything to slow the progression of the illness. (If I had a malignant cancer, of course, this would be a different story.)  But heaven knows I would have had the clarity I needed to make good self-care choices.

For example, I could have seen physical therapists to help with growing muscle weakness, occupational therapists to help me adjust my work style, joined patient groups to gather support and volunteered for clinical trials. (I live in the DC metro, not too far from NIH, so that may well have been an option.) And most importantly, as I see it, I wouldn’t have had to live with the vague but growing dread that something was Just Not Right for years.

Because I’m not a clinician, I’ll never know how likely it is that I could have been diagnosed earlier if all my caregivers had all of my health data.  But I’m confident that interoperability and the accumulation of population data will help with earlier diagnosis and treatment of many unpleasant, disabling or even fatal conditions.

So when you go about the business  of improving data analytics tools and interoperability, mining population health databases for trends and leveraging mHealth to improve chronic disease management, I invite you to think of me — not a tragic figure by any means, but someone who’s counting on you to keep connecting the dots.  Never doubt that the human value of what you do is extraordinary, but never forget that real people are waiting in the wings for you to supply insights that can give them their life back.

The Financial Need for Quality Improvement in Healthcare Infographic

Posted on November 3, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently received a well done infographic on the negative financial impact of poor quality healthcare on the health system. The infographic was created by Caradigm, a population health company. I think you’ll find some interesting insights in the benefits of quality healthcare in this infographic.
Need for Quality Improvement in Healthcare

Data Sources:
GE Healthcare. “Clinical Decision Support Decision: Defining our Problem Statement. 2011.
The Advisory Board. 2008. based on Kleven, RM. “Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals 2002.” 2007.
The Advisory Board. “The Tip of the Iceberg: Adverse Events are Costing You More than Ever.” 2011.
GE Reports. “The Unknown Killer: Healthcare Associated Infections.” 2011. http://www.gereports.com/the-unknown-killer-healthcare-associated-illnesses/
NEMJ “Care in US Hospitals” July 2005.
HealthAffairs. Reducing Waste in Health Care. December 2012. http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=82
Centers for Medicare and Medicaid Services, “National Patient Safety Initiative: Saving Lives Saving Money,”

Another Example Of EMR “Golden Age” Applications

Posted on July 30, 2013 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.

Not long ago, John posted a piece about the “Golden Age of EMRs Being Over” and how that’s playing out from an EMR vendor perspective. Since writing that piece he’s found that while the Golden Age of EMR buyer frenzy has passed, we’re entering a new EMR Golden Age which will feature amazing applications for clinicians and public health administrators. John calls these applications Smart EMR.

Today, I came across some news which I think is a perfect example of the kind of innovative applications John is predicting will emerge as EMRs mature. At the University of Notre Dame, researchers have developed a system which uses collaborative filtering of EMR records to better guide treatment, manage disease and predict disease risks across a population.

Notre Dame computer science associate professor Nitesh Chawla and doctoral student Darcy Davis call the new system the Collaborative Assessment and Recommendation Engine (CARE). CARE uses collaborative filtering to detect similarities between patients and produce personalized disease risk profiles for individuals. It does so by looking at diseases in similar patients.

“In its most conservative use, the CARE rankings can provide reminders for conditions that busy doctors may have overlooked,” Chawla said in a prepared statement. “Utilized to its full potential, CARE can be used to explore broader disease histories, suggest previously unconsidered concerns and facilitate discussion about early testing and prevention, as well as wellness strategies that may ring a more familiar bell with an individual and are essentially doable.”

Ultimately, Chawla says, such a system can produce a host of benefits. For example, he suggests, it can reduce readmission rates, improve quality of care ratings, help demonstrate Meaningful Use and improve personal and population health. On a more micro level, it can allow patients to walk out of their doctor’s office with a list of recommendations based on predicted health risks, he notes.

This is just one example of the kind of new applications that are emerging as EMRs mature and the use of big data becomes a tool for wellness. I expect to see lots of announcements of this kind over the next year or two. It’s an exciting time.

EHR Interoperability Benefits Not Related to Physician Data Sharing

Posted on February 5, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I always love when someone can take a subject and expand my thinking on that subject. Whenever I thought about EHR interoperability I always thought about it from the perspective of a physician sharing that data with another physician. In this case it would be one EHR sharing with another EHR (possibly with an HIE in the middle). In a recent post, Dr. Doug Fridsma from ONC, (I love that ONC blogs) expanded my thinking when it comes to the possible benefits associated with data standards and EHR data sharing when he shared the following list:

  • Patient safety advocates may want to use EHR systems to collect patient safety information, leveraging existing standards like the AHRQ “common format” for patient safety reporting
  • Providers and researchers may want to use the EHR systems to collect data for clinical research, including patient-centered outcomes research, and to identify patients who could benefit from participating in a research study
  • Providers may want to give referrals to their patients for community services, like smoking cessation or weight management programs, after discussing these topics with them during an office visit
  • Providers working with disease surveillance case report forms may wish to collect additional information about reportable conditions, such as infectious diseases
  • Provider’s office staff can use EHR’s to gain pre-authorization of certain kinds of medical devices where health payers may want to leverage clinical information collected in EHRs to support additional review of expensive medical equipment.

After just publishing my recent post about The Coming Physician EHR Revolt, I can’t help but ask what any of the above items do to help a doctor. The last one could help a physician’s workflow, but the rest of them have limited specific value to a physician. This is one of the challenges with EHR data sharing. Doctors don’t buy and implement an EHR because they want to give better referrals to their patients for community services. There’s a mismatch between providers’ needs and healthcare data exchange desires.

ICD-10 Benefits for Population Health

Posted on November 13, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve asked many people why we haven’t had more stories on the benefits of ICD-10 since so many other countries have been using ICD-10 for many years.

In the following video I asked Doris Gemmell, BSc, MBA, CHIM, Director of Coding Services at Accentus Inc. about the benefits of ICD-10 to population health and she provided an answer from her ICD-10 experience in Canada.

You should also check out this video where Doris Gemmell talks about the patient benefits of ICD-10. Plus, Doris also has a blog.

EMR Interfaces Gone Wrong, Or The Tale Of The Albanian Patient

Posted on October 16, 2012 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, for your consideration, we have the tale of the Albanian patient who wasn’t Albanian.  More broadly, I’m here to discuss the perils of adding an extra interface consideration to the workflow of busy EMR users, and the impact that has on data quality.

Scope, a blog published by the Stanford School of Medicine, shares the case of the Merced County, California physician who, exasperated with the requirement that he identify the ethnicity of each patient, chooses “Albanian” for all of them. Why? Simply because “Albanian” is the first item of the rather long list in the pulldown menu.

As a result of this interface issue, any attempt to mine this veteran doctor’s data for population health analysis is weakened, writes Anna Lembke, MD, asssistant professor of psychiatry and behavioral sciences at Stanford.  And this physician’s choices should give the “big data” users pause, she suggests:

Misinformation in electronic medical records, whether accidental or otherwise, has far-reaching consequences for patients and health care policy, because electronic medical records are being actively ‘data-mined’ by large health care conglomerates and the government as a basis for improving care. This is an important downside to consider as we move forward.

Dr. Lembke’s observations are important ones. If government entities and health organizations would like to mine the increasingly large pools of data EMRs are collecting, it’s important to look at whether the data collected actually reflects the care being given and the patients being seen.

I’m not suggesting that we audit clinicians’ efforts wholesale — they’d rightfully find it offensively intrusive — but I am suggesting that we audit the interfaces themselves from time to time.  Even a quarterly review of the interfaces and workflow an EMR demands, and results it produces, might help make sure that the data actually reflects reality.