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CMS Finalizes 2016 Medicare Payment Rules for Physicians, Hospitals & Other Providers

CMS Finalizes 2016 Medicare Payment Rules for Physicians, Hospitals & Other Providers | Healthcare and Technology news |

The Centers for Medicare & Medicaid Services (CMS) issued final rules this week detailing how the agency will pay for services provided to beneficiaries in Medicare by physicians and other health care professionals in 2016 that reflects the administration’s commitment to quality, value, and patient-centered care. Payment rules for the 2016 calendar year for End-Stage Renal Disease Prospective Payment System, the Hospital Outpatient Prospective Payment System, Home Health Prospective Payment System, and the Physician Fee Schedule were all finalized this week.

“CMS is pleased to implement the first fee schedule since Congress acted to improve patient access by protecting physician payments from annual cuts. These rules continue to advance value-based purchasing and promote program integrity, making Medicare better for consumers, providers, and taxpayers,” said CMS Acting Administrator Andy Slavitt. “We received a large number of comments supporting our proposal to allow physicians to bill for advanced care planning conversations and we are finalizing this rule accordingly.”

Key policies finalized in the 2016 payment rules include:

  • Finalizing the Home Health Value-Based Purchasing model. This model, authorized under the Affordable Care Act, is designed to improve health outcomes and value by tying home health payments to quality performance. All Medicare-certified home health agencies that provide services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee will participate in this model starting January 1, 2016. Compared to the proposed rule, the maximum payment adjustment in the first year of the model was reduced from 5 percent to 3 percent. This was part of the Home Health Prospective Payment System final rule.

  • Finalizing updates to the “Two-Midnight” rule. The rule clarifies when inpatient admissions are appropriate for payment under Medicare Part A. This continues CMS’ long-standing emphasis on the importance of a physician’s medical judgment in meeting the needs of Medicare beneficiaries by providing clearer guidelines and a more collaborative approach to education and enforcement. This was part of the Hospital Outpatient Prospective Payment System final rule.
  • Finalizing the End-Stage Renal Disease Quality Incentive Program. The End-Stage Renal Disease final rule will apply payment incentives to dialysis facilities to improve the quality of dialysis care. Facilities that do not achieve a minimum total performance score with respect to quality measures, such as anemia management, patient experience, infections, and safety, will receive a reduction in their payment rates. 
  • Beginning the new physician payment system post the Sustainable Growth Rate (SGR) formula and supporting patient- and family-centered care. This is the first final Physician Fee Schedule final rule since the repeal of the SGR formula by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Through the final rule, CMS is beginning implementation of the new payment system for physicians and other practitioners, the Merit-Based Incentive Payment System, required by the legislation.
  • Finalizing provision to empower patients and their families regarding advance care planning. Consistent with recommendations from a wide range of stakeholders and bipartisan members of Congress, CMS is finalizing its proposal that supports patient- and family-centered care for seniors and other Medicare beneficiaries by enabling them to discuss advance care planning with their providers.
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CVS to connect with health systems via Epic

CVS to connect with health systems via Epic | Healthcare and Technology news |

CVS Health has partnered with four health systems nationwide to provide them patient prescription and visit information, securely sharing data through its Epic electronic health record system.

CVS has entered into new clinical affiliations with Sutter Health in California, Millennium Physician Group in Florida, Bryan Health Connect in Nebraska and Mount Kisco Medical Group in New York.

Through the partnerships – which bring the number of clinical collaborations for CVS Health and MinuteClinic to nearly 60 major health systems – these organizations' patients will continue to have access to clinical support, medication counseling, chronic disease monitoring and wellness programs at CVS/pharmacy stores and MinuteClinic, the retail medical clinic of CVS Health, officials say.

These providers will receive data on interventions conducted by CVS pharmacists, with the aim of improving patients' medication adherence for their patients. The affiliation encourages collaboration between the health systems and MinuteClinic providers to improve coordination of care for patients seen at MinuteClinic locations.

Affiliate organizations and MinuteClinic practitioners will also work together on planning strategies around chronic care and wellness, officials say: If more comprehensive care is needed, patients can follow up with their primary care provider and have access to the services at the health care provider as appropriate.

"In this era of health care reform, we are pleased to work with these health care organizations to develop collaborative programs that enhance access to patient care, improve health outcomes and lower healthcare costs in the communities they serve," said CVS Health Chief Medical Officer Troyen A. Brennan, MD, in a press statement.

MinuteClinic, CVS/pharmacy and participating providers will work to streamline and enhance communication through their EHRs, such as the electronic sharing of messages and alerts from CVS/pharmacy to the health care organizations' physicians regarding medication non-adherence issues. MinuteClinic will electronically share patient visit summaries with patients' primary care physician when they are part of an affiliate organization and with the patient's consent.

"By allowing our electronic health records and information systems to communicate and share important information about the patients we collectively serve, we will have a more comprehensive view of our patients, which can aid in health care decision making and help ensure patients adhere to important medications for chronic diseases," said Brennan.

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Health IT Certification Policies Affect Healthcare Reforms

Health IT Certification Policies Affect Healthcare Reforms | Healthcare and Technology news |

Over the last five years, healthcare providers have had to pay greater attention to policy changes, meaningful use requirements, and ongoing ICD-1o transition delays as the nation worked toward reforming the medical sector to greater benefit patients and everyday citizens. Specifically, EHR implementation has been a great focus of the healthcare industry. Health IT vendors as well as federal agencies have focused on developing certified EHR technology through the Health IT Certification Program.

The Department of Health and Human Services (HHS) has recently issued a document detailing the submittal of test procedures and data under the Health IT Certification Program established by the Office of the National Coordinator for Health IT (ONC).

In early 2011, HHS established a certification program for health IT systems and EHR technology. In September of 2012, the program was renamed the “ONC HIT Certification Program.” At this point in time, HHS proposes to change the name of the program once again to the “ONC Health IT Certification Program.”

Over the last several years as the program operated, health IT designers have proposed that “testing efficiencies” could be garnered if the ONC Health IT Certification Program took advantage of operational testing including e-prescribing network testing.

“The National Coordinator is open to approving test procedures, test tools, and test data that meet the outlined approval requirements above for an applicable adopted certification criterion or criteria,” the HHS document proposal stated. “By way of this document, we strongly encourage persons or entities to submit such test procedures, test tools, and test data to ONC if they believe such procedures, tools, and data could be used to meet ONC’s certification criteria and testing approval requirements. We also note that there is no programmatic prohibition on the approval of multiple test procedures, test tools, and test data for a certification criterion or criteria.”

Along with the health IT certification program, some other new proposed guidelines on healthcare reform include the modified Stage 2 Meaningful Use requirements. As providers began moving toward attesting to Stage 2 Meaningful Use regulations, federal agencies began to see certain missteps with the requirements, which led them to modify the rulings.

Currently, the Centers for Medicare & Medicaid Services (CMS) has announced that public comments to the proposed Stage 2 Meaningful Use modifications are due by June 15, 2015. The proposed ruling changes certain requirements between the years 2015 to 2017 for those eligible professionals attesting to meaningful use under the Medicare and Medicaid EHR Incentive Programs.

Public comments can be submitted to CMS electronically, by courier, and by regular or express mail. Anyone interested in more information about the proposed ruling are encouraged to read themodifications to Stage 2 Meaningful Use requirements and view a factsheet on the CMS website.

As the healthcare industry continues toward a path of reform, federal agencies will likely continue developing new regulations and policies that will aim toward improving the quality of patient care, boosting health outcomes, and reducing medical spending.

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Reflecting on the Clash of Incentives Around “Information-Blocking” in the Push Towards the New Healthcare

Reflecting on the Clash of Incentives Around “Information-Blocking” in the Push Towards the New Healthcare | Healthcare and Technology news |

As Healthcare Informatics reported last month, the Office of the National Coordinator for Health Information Technology (ONC) released a report in early April that highlighted what the federal healthcare IT agency referred to as “information-blocking.” As Senior Editor Gabriel Perna noted in his April 10 report immediately following the release of the ONC document, “The report’s authors and researchers detailed several examples of electronic health record (EHR) developers and health systems blocking health information sharing between each other. The act of information blocking occurs when an entity or person knowingly and unreasonably interferes with the exchange of electronic health information. Examples of this,” he noted, “are charging prices and fees for data exchange; creating terms of a contract that restrict individuals access to their health information; developing health IT in a non-standard way that dissuades information sharing; and developing health IT in a way that locks in information.”

The ONC cited examples in its report of anecdotal evidence

suggesting that “EHR application developers are breaking several of the rules in this regard,” Perna’s report noted. “Using interviews with people at regional extension centers (RECs), the authors detailed complaints from industry sources on how developers are charging fees that make it cost-prohibitive to send, receive, or export electronic health information stored in EHRs. Some EHR developers even charge a substantial transaction fee any time a user sends, receives, or queries a patient’s electronic health information, the report says. The variation in prices reported to ONC suggests that some are taking advantage of the situation.”

In announcing the availability of the report, National Coordinator for Health IT Karen DeSalvo, M.D. noted in a blog on the agency’s website that it is difficult to pinpoint concrete evidence of information-blocking. “The full extent of the information blocking problem is difficult to assess, primarily because health IT developers impose contractual restrictions that prohibit customers from reporting or even discussing costs, restrictions, and other relevant details,” she noted. “Still, from the evidence available, it is readily apparent that some providers and developers are engaging in information blocking,” she said.

Given all this, I read with interest a May 20 blog in Health Affairs online by Julia Adler-Milstein on this subject, because of the clear way in which she frames the dynamic tension taking place right now in the industry between the forces that would restrict information for profit or proprietary gain, and those that would advance it for the common good. AsAdler-Milstein, who is an assistant professor of information in the School of Information and an assistant professor of health management and policy at the School of Public Health at the University of Michigan, states very bluntly in her blog, “When it comes to sharing electronic patient health information, public good should trump private gain. While it may seem like an obvious statement, it represents a tectonic shift in the narrative surrounding health information exchange,” or HIE.

As Adler-Milstein notes, “For more than a decade, our federal strategy has largely left HIE to the market under the assumption that, if there is benefit to be created (and estimates suggest that there is), we should see the emergence of ways to capture that benefit. In practice, this means that HIE efforts have sprung up in various health care markets across the country, and where public money has been spent on HIE (largely at state and community levels), it has come in the form of one-time start-up funding, not a commitment of ongoing support or regulatory mandates for HIE participation.”

Here’s where Adler-Milstein really scores a home run on this, in my view: “What has been substantially underappreciated, however,” she writes, “is the fact that, for the key actors needed to enable HIE to occur—provider organizations and vendors—there might be more benefit, or at least more certain benefit, from not doing so. And as a result, these actors may behave in ways that interfere with the free-flow of patient information that is needed to improve health and health care.”

Instead, she says, “With the release of the information blocking report, which was produced in response to a 2015 Omnibus bill request that introduced the term ‘information blocking,’ ONC makes plain that this behavior will no longer be tolerated. This enormously exciting development means we might see real progress after decades of investment that has failed to convert into sustainable approaches to robust HIE. The key to such progress, however,” she warns, “lies in how well we can identify when information blocking is occurring. This will not be easy.”

And in those short paragraphs, we can see some of the core opportunities and challenges moving forward in this critical area. In this arena as in so many others in healthcare, we see a dynamic tension based on conflicting incentives within the U.S. healthcare system. On the one hand, there is broad consensus that data- and information-sharing will be essential to accountable care organization (ACO) development, population health management, bundled payment-facilitated care delivery, patient-centered medical home work, and indeed, every iteration of the new healthcare. Yet at the same time, there are many elements embedded even in those concepts that speak to at least short-term—and certainly arguably, medium-term as well—market advantages that can be gained through data- and information-hoarding.

It is this clash of incentives that we are collectively burdened with at this early stage of the trajectory towards the new healthcare. The rhetoric around healthcare policy right now is all about sharing for common gain, and yet the incentives in the moment are far from purely conducive to—well, purity.

That’s why it’s good to be reminded at times like this by elegantly concise writings like those of Julia Adler-Milstein. Adler-Milsteiin’s blog reminds us what the ultimate prize is, on which we should at least theoretically all be setting our eyes. This is not to engage in the laying of blame on those working for specific market advantage, but rather to affirm the need to continue to push forward collectively as an industry and indeed as a society, towards a more mature healthcare system—one in which all the incentives really all will be aligned. In other words, keep watching this space.

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EHR roadblocks holding docs back

EHR roadblocks holding docs back | Healthcare and Technology news |

Anna Orlova, senior director, standards at AHIMA, compares the currentinteroperability of today's electronic health record systems to treadle sewing machines of the early 20th century.

"What we give physicians is a mechanical sewing machine," she says. "You just need to move your legs to create data. It shouldn't be that way."

Steven J. Stack, MD, president-elect of the American Medical Association, says difficulties exchanging and sharing data stem in large part from "an overabundance of measures with specifications that are unaligned," creating confusion for overburdened physician practices.

"A recent study found this uncoordinated approach resulted in too much variability in the large array of measures being promoted across the healthcare system," says Stack.

The study in question – "Effects of Health Care Payment Models on Physician Practice in the United States" – finds physicians faced roadblocks to data analytics caused by missing quality performance feedback or drug prices. The joint effort with RAND Corporation recommends addressing physician concerns about operational issues to improve the effectiveness of alternative payment models.

"The underlying problem is EHRs don't talk to each other very well," says lead author Mark Friedberg, a senior natural scientist at RAND. "The analogy is to train tracks. Each EHR is different," says Friedberg who notes that interoperability "has never been incentivized by the Office of the National Coordinator for Health IT."

Orlova underscores the importance of getting interoperability standards back on track.

"In the past six years, we've seen a derailing of government as leader in the private-public partnership of developing standards needed by physicians," she says. "We're so far behind half the world. Estonia is ahead of us."

Immature standards prevent existing health IT systems from cooperating, she adds.

"The government doesn't mandate standards," says Orlova. "We need to create interface standards for semantics, technical and functional." Instead, she points out, "standards today exist only for technical" aspects of interoperability.

Stack agrees. "Many of the exchange requirements and functional objectives, identified in these programs, are based on immature standards that are untested, under-developed or lack market consensus," he says.

"The federal government could incentivize and direct healthcare interoperability through policy measures, such asmeaningful use and the standards and interoperability framework, originated by the Health Information Technology Policy Committee.

"For the most part, data is being exchanged between EHRs in the form of large, unwieldy, multi-page documents that provide little value to physicians or their patients," says Stack. "ONC's certification program currently does little to ensure the successful end-to-end exchange of data between sites and services."

Meaningful use, he says, "has hindered, rather than bolstered (interoperability) across the nation."

However, Friedberg calls EHR certification one way interoperability could be enforced.

"Using the railroad analogy, all tracks have to have the same grade," he says. "For physicians to receive a bonus through meaningful use, they have to use certified EHR. Conceivably, that could put pressure on EHR vendors to become certified and ensure physicians are meeting MU requirements."

Orlova says it's a "crime" to put interoperability requirements in place without certification. "Certification must be in place and we have a good example of this in the IRS," she says. "Every time we file our taxes, we're certifying that we did it to the best of our ability."

Stack calls medical coding diagnostic changes in October "one more burden facing physicians," noting that "every certified EHR needs to have updated software to handle ICD-10 coding. There could be a considerable number of challenges during the transition.

"If a vendor doesn't have updated software ready, installed and deployed in time, physicians will be out of compliance with HIPAA and risk significant processing and financial interruptions," he says.

Simply put, "physicians shouldn't be struggling with this stuff," says Orlova. She believes that "the current ONCadministration and Congress understand the role of government as leader and facilitator." She expects collaboration between the AHIMA and HIMSS will result in a blueprint for interoperability standards within two years.

"Five years from now, we'll see activities take off," she says. "We're working to make this easier for physicians, as well as HIMSS. We have to be patient, but we know where we're going."

"Chasing data for uncoordinated measures requires significant time and resources that could be better spent on patient care or technology that practices need to achieve desired outcomes for patients," says Stack. "Efficient data flow is key. Data must drive the rapid cycle design and implementation of quality improvement efforts."

Friedberg thinks the best use of federal energy would be "in areas where there are needs for massive coordination. If everyone's off playing their own instruments, they need a conductor. Government could be that conductor."

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Son's ICD-10 Software Helps Save Dad's Solo Practice

Son's ICD-10 Software Helps Save Dad's Solo Practice | Healthcare and Technology news |

Nitin Desai has the kind of medical practice you don't see much anymore. Desai, an internist, is the only physician in the practice in Columbus, Ga. His patients are like family; they know the staff personally and even have the doctor's cell phone number. Desai's wife, Bhavna Desai, is the practice manager, and his sons, Parth and Koosh, grew up in and around the practice, cutting the grass, helping out in the office, and developing a love for the practice of medicine that would led them both to medical school.

Sadly, increasing regulations and requirements for health information technology are making it more and more difficult to keep this kind of practice afloat. "I was under a lot of pressure to sell out to a hospital or join a group of other doctors," said Desai. "It is seriously hard to maintain a solo practice these days." Coming so soon after installing an EHR, the requirement to switch to ICD-10 was the last straw for Desai. Running a medical practice as a family business just didn't seem possible any longer.

Parth Desai, a first-year student at Mercer University School of Medicine in Macon, Ga., learned early about the business side of medicine. When he was just 16, health problems forced his mother to take a break from her duties as office manager. Parth stepped in to help out. His computer skills came in very handy, since neither of his parents is very computer savvy. When Parth heard about the ICD-10 transition, he knew that he could help with that, too.

Parth and his best friend, Will Pattiz, a computer programmer with experience developing training platforms and e-learning courses, built software that creates ICD-chart templates and converts codes from ICD-9 to ICD-10. For the 70 percent of codes that have one-to-one matching, conversion requires little more than the click of a button. For the 30 percent that are more complex, "You can go through and edit, fill in the codes you use, and customize as you go," Parth explained.

The pair's "ICD-10 Charts" software is quite valuable, with many practices seeking an easy way to convert to the new coding system. But Parth isn't aiming to make money from his software; he just wants to help his dad. "Dad has always helped me," he says simply.

One lesson Parth did not miss growing up in the heart of a community-focused medical practice was the imperative to help others. Parth and Pattiz have made the software available free on the Web [at] for anyone who can use it. In addition, the Physicians Foundation, a nonprofit organization dedicated to advancing the work of physicians practices, has stepped in to fund the project. With the foundation's support, additional free resources, including free coding training, will be available soon. "The Physicians Foundation is also helping us spread ICD-10 Charts throughout the country so that the project can benefit as many struggling practices as possible," said Parth.

Meanwhile back home, Nitin Desai says his son's software has made a noticeable difference in his practice's bottom line. "We're okay for now." And in the long run? "The chances are very high," says Desai, "that the boys will come home and join the practice."

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Can Middleware Technology Solve Healthcare’s Interoperability Problems?

Can Middleware Technology Solve Healthcare’s Interoperability Problems? | Healthcare and Technology news |

In February, Black Book Research’s annual health information exchange (HIE) stakeholder survey concluded that the current state of operative HIEs in the U.S. can best be described as “persistent unpredictability,” and the industry appears a ways away from achieving meaningful interoperability.

The survey revealed that while some simple healthcare information is being exchanged among parallel electronic health record (EHR) systems in pockets of communities, 94 percent of America’s providers, healthcare agencies, patients and payers persist as meaningfully unconnected in Q1 2015. Outside of their garden walled EHR networks, providers are dropping HIE as a priority, as evidenced by a 5 percent drop in regional connectivity from last year, the data showed.

What’s more, the federal government and healthcare stakeholders seem to be at odds when it comes to addressing interoperability issues. To this end, Donald M. Voltz, M.D., department of anesthesiology and medical director of the main operating room at Aultman Hospital in Canton, Ohio, says there is an answer that solves healthcare’s interoperability problems that other vertical markets such as retail, banking, and transportation have shown to work—middleware. Middleware is software that is used to connect one or more different software applications; it has been simplified as the glue or plumbing used to pass data between applications. It is currently being used to connect completely unrelated software into a single user-friendly interface, and also to connect legacy and emerging technology that have been developed using different designs, data models, or architecture, Voltz says.

A board-certified anesthesiologist, researcher, and medical educator with more than 15 years of experience in healthcare, Voltz has been involved with many facets of medicine. He has performed basic science and clinical research and has experience in the translation of ideas into viable medical systems and devices. “I wanted to try to solve these interoperability problems, but implementing processes that work both on the administrative hospital and health system side, and the clinical side, is almost impossible,” he says. “We’re constrained by whatever platform it is, be it a single EHR or multiple EHRs, based on what they bring to the table. You need to build systems that operate but also bring action to the data on the clinical side.”

Voltz says that EHRs are not smart systems, but are more about collecting data right now. They are still at the database level, he says. “We talk about putting business logic on top of them, but we’re not there yet in the sense that we haven’t addressed the needs of how we interact with the system or what kind of information can be collected from an ambient type interaction,” he says. “In anesthesia, there are issues with what am I documenting, when should I be documenting, and what’s being tracked in the EHR Open loops are putting us at risk from a medical legal standpoint but they are also blocking my ability to communicate with other providers that are taking care of the same patient.”

As such, middleware technology can connect to various pieces of information and develop on top of those connections without having to move or duplicate all of the data around it, Voltz says. Specifically, for the last several years, Voltz has been using software from the San Jose, Calif.-based Zoeticx, whose platform’s architectural design has been successfully used to link data from multiple databases, irrespective to the database platform or where the database is located, Voltz says. Essentially, it is a padding layer between EHR systems that provides interoperability, he notes. Voltz says there aren’t many “true” middleware solutions on the market today— the ones that are out there are more attempts at middleware but fall short as full platforms, and are thus more like messaging systems, he says. “They’re worried about interconnecting data but not addressing the problems in healthcare,” Voltz says. Nonetheless, earlier this year, the Plymouth Meeting, Pa.-based consulting company ECRI Institute dubbed middleware as one of 10 key technologies that healthcare CIOs need to be watching.

One of the problems that actually isn’t complained about by physicians, because they don’t know the term of it, is the concept of data provenance, Voltz continues. “I don’t know care where the data resides, but I need to know that it’s accurate or I’ll end up duplicating it,” he says.  Another problem, he adds, is not knowing who on the care team has addressed an issue—or if anyone even did. “As a surgeon for instance, I don’t even have access into the flow of an EHR system. So I don’t know who has looked at the information or what new information has bubbled to the top of an EHR system, whether that’s a consultant, a nurse putting in a concern about a patient, or a lab value that just came back.  So as an anesthesiologist, I’m sitting in the middle of this trying to orchestrate and coordinate not only the patient but how I allocate resources in the OR and how I respond to issues in the ER. There’s no way to do that well with an EHR system,” Voltz says

Middleware, on the other hand, allows Voltz to connect these systems and connect the people, and have a more efficient way to communicate with other providers or nurses that are on the care team, he says. “We can now message information even though it’s coming from disparate systems. So if I have Allscripts in one of the offices and Cerner in the hospital, I can connect those two in a secure and stable fashion, and get the data I need,” he says. For instance, currently says Voltz, he might need to get an EKG for comparison purposes at midnight in his office in order to make a decision on the fly. “Do I proceed with this patient without comparing an EKG or another lab value or do I not?  These are real issues right now and they are not solvable with our current platforms,” he says. Another example he gives is connecting an Epic platform to the McKesson drug dispensing system. “I shouldn’t have to be the connector where I have to manually re-enter all of the patient’s information and go through multiple allergy screens again on two different systems,” he says.

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The radical potential of open source programming in healthcare

The radical potential of open source programming in healthcare | Healthcare and Technology news |

Everyone wants personalized healthcare. From the moment they enter their primary care clinic they have certain expectations that they want met in regards to their personalized medical care.

Most physicians are adopting a form of electronic healthcare, and patient records are being converted to a digital format. But electronic health records pose interesting problems related to sorting through vast amounts of patient data.

This is where open source programming languages come in, and they have the ability to radically change the medical landscape.

So why aren’t EHRs receiving the same care that patients expect from their doctor? There are a variety of answers, but primarily it comes down to how the software interprets certain types of data within each record. There are a variety of software languages designed to calculate and sort through large amounts of data that have been out for years, and one of the most prominent language is referred to as “R”.

What is R?

According to “R is an integrated suite of software facilities for data manipulation, calculation, and graphical display.” Essentially this programming language has been built from the ground up to handle large statistical types of data.

Not only can R handle these large data sets, but it has the ability to be tailored to an individual patient or physician if needed. There are a variety of other languages focused on interpreting this type of data, but other languages don’t have the ability to handle it as well as R does.

How can a language like R change the way in which EHRs function?

Take, for instance, the recent debate regarding immunization registry. EHRs contain valuable patient data, including information associated with certain types of vaccine.

If you were able to cross reference every patient that had received a vaccine, and the side effects associated with said vaccine, then you could potentially sort out what caused the side effect and create prevention strategies to deter that certain scenario from happening again.

According to Victoria Wangia of the University of Cincinnati, “understanding factors that influence the use of an implemented public health information system such as an immunization registry is of great importance to those implementing the system and those interested in the positive impact of using the technology for positive public health outcomes.”

This type of system could radically change the way we categorize certain patient health information.

Programming languages like R have the ability to map areas that have been vaccinated versus those that haven’t. This would be ideal for parents who wish to send their children to a school where they know that “x” number of students have received a shot versus those that haven’t. Of course, these statistics would be anonymous, but this information might be critical for new parents who are looking for a school that fits their needs.

This technology could have much bigger implications pertaining to personalized data, specifically healthcare records. Ideally, an individual could tailor this programming language to focus on inconsistencies within patient records and find future illnesses that people are unaware of.

This has the potential to stop diseases from spreading, even before the patient is aware that they might have a life threatening illness. Although such an intervention wouldn’t necessarily stop a disease, it could be a great prevention tool that would categorize certain types of illness.

Benefits of open source

One of the more essential functions that R offers is the ability to be tailored to patient or doctor’s needs. Most information regarding patient health depends on how a physician documents the patient encounter, but R has the ability to sort through a wide variety of documentation pertaining to important statistical information that is relevant to physician needs. This is what makes open source programming languages ideal for the medical field.

One of the great components associated with open source programming languages in the medical field is the cost. R is a completely free language to start working in, and there is a large amount of great documentation available to start learning the language. The only associated cost would be paying a developer to set up, or create a program that quickly sorted through personalized information.

Essentially, if you were well rounded in this language, the only cost associated with adopting it would be the paper you would need to print information on.

Lastly, because of HIPAA, the importance of information security has been an issue, and should be a primary concern when looking at any sensitive electronic document. Cyber security is always going to be an uphill battle, and in the end if someone wants to get their hands on certain material, they probably will.

Data breaches have the ability to cost companies large amounts of money, and not even statistical data languages are safe from malicious intent. A recent issue has been the massive amount of resources that are being built in R that have been shared online. Although this is a step in the right direction for the language, people are uploading malicious code. But if you are on an encrypted machine, ideally the information stored on that machine is also encrypted. Cloud based systems like MySQL, a very secure open source server designed to evaluate data, offer great solutions to these types of problems.

These are some of the reasons why more physicians should adopt these types of languages, especially when dealing with EHRs. The benefits of implementing these types of systems will radically alter the way traditional medicine operates within the digital realm.

More statistical information about vaccinations and disease registries would greatly benefit those that are in need. The faster these types of systems are implemented, the more people we are able to help before their diseases becomes life threatening.

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The Pain (and Gain) of Building a Private HIE in NYC

The Pain (and Gain) of Building a Private HIE in NYC | Healthcare and Technology news |
Frat Iqbal, senior manager of information management at New York University’s Langone Medical Center, led off his presentation at HIMSS15 in Chicago with two photos that provided a stark reminder of what happens when information doesn’t flow properly through the healthcare system. They were two pictures of his brother two years apart, one in full health and the other wheelchair-bound and permanently disabled by multiple sclerosis.
“It took two years to diagnose MS as he went from doctor to doctor, lab to lab,” he said. “His life was ruined by inefficiencies in the healthcare system.”
Iqbal said it is a reminder of the importance of improving patient care at the community level, of connecting all the small practices in New York so that data can flow from their offices to specialists, labs and hospitals. 
NYU Langone has been working to build a private health information exchange to link 200 practices and 1,900 clinicians using 26 different EHRs as the state and country work toward building larger exchanges.
The HIE was established in mid-2011 and privately funded by NYU Langone Medical Center. The goal was to become a central repository of clinical information for community providers to review, reference and share data and to provide 360-degree care to patients, Iqbal said.
Anthony Antinori, senior director of clinical affairs IT at NYU Langone, said a private HIE has advantages over a public one. “We can make decisions quickly. We have a small ecosystem of private practices and one governing body. We are local and funded by a private organization, with no federal or state funding required,” he said. The HIE is able to rapidly align itself with the strategic goals of the organizations it is serving, he added.
Instead of dictating which EHRs it would support, NYU Langone decided to work with whatever the providers had. “We left it open. If the EHR has the capability, we will integrate with it. It’s more headaches for us, but we did that for the community,” he said. 
They knew it was going to be challenging, and it has been, Iqbal said. “It is one of the most complicated projects I have ever embarked on,” he said. Interfacing with all those EHRs has been a “project management nightmare,” he added. Project prioritization has been tough, in terms of deciding which data is most valuable to the HIE. A whole team has been focused on privacy and security of the 4 million patient records in the HIE.
There are technical challenges, but more difficult have been cultural changes and setting the right expectations, he said. Many physicians are not inclined to share data and don’t want to change. Most EHRs are designed to retain, not share, information. 
Some providers are resistant to change. They don’t care if more information is available and they don’t want to share information. With these providers, you really have to make them realize the benefit the HIE brings to the table, he said. (Members of the NYU Provider Network are mandated to connect to the HIE.)
Legal and policy issues were a challenge. Getting data sharing agreements vetted by the practices, vendors and NYU Langone’s legal teams took longer than the integration itself. Consent policies are also difficult to work through, he said.
Despite the huge challenges in getting it set up, the HIE offers an array of benefits. Here are a few listed in the NYU presentation:
• Providers gain immediate access to valuable clinical data that provides a more holistic view of patient health when using the HIE;
• Providers will be able to reduce unneeded patient visits and lower the cost of care;
• Providers can begin to embrace the powerful benefits of trend and pattern analysis toward new decision-making frontiers;
• HIE facilitates evidence-based medicine and creates a potential positive feedback loop between health-related research and actual practice.
• Patients can expect improved payment coordination and smoother care transitions
• Duplicative procedures or tests will be reduced and visit satisfaction will be improved when patients opt to participate in the HIE;
• The collection and linking of data across the HIE facilitates extensive and robust community health records that can foster the ability to quickly detect, respond and efficiently prevent threats to public health;
• The HIE will also enhance public health practices at all levels of government through infectious disease case investigation and health surveillance.
The next step, he said, is analytical innovation that will pull together payer data, HIE data and Epic data from the hospital system to get more proactive at recognizing issues and monitoring patients and populations.
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A Strive Towards “Meaningful” Data Exchange in the Midwest

A Strive Towards “Meaningful” Data Exchange in the Midwest | Healthcare and Technology news |

Although the successful exchange of health data has been a struggle in most U.S. regions, a commitment to the free flowing of information on a patient’s history—regardless of what local healthcare facility they have been at—has helped spur health information exchange (HIE) in the Midwest.

Indeed, the Lewis and Clark Information Exchange (LACIE) is one of the first fully operational, multiple-state HIEs in the country, providing patient information to healthcare systems and providers in Kansas and Missouri. Getting the HIE up and running to a point where it could successfully exchange data required a few key elements, starting with getting hospitals on board that were willing to share data. To this end, in the last 18 months, LACIE announced two major connections: first with the Kansas Health Information Network (KHIN), another major HIE in Kansas. This was a significant moment for data exchange in the Midwest, as in the past, the two organizations had failed to reach an agreement on sharing data.

A few months after that, LACIE announced that patients' electronic medical records (EMRs) were being securely shared with Tiger Institute Health Alliance (TIHA) in Columbia, Mo. In total, LACIE is now connected to 17 hospitals in two states in addition to three accountable care organizations (ACOs), the two aforementioned regional HIEs, multiple private HIEs, and the Kansas City Metropolitan Physician Association (KCMPA), a large independent physician group with 80 clinics and 350 providers. The 24 different EMRs those organizations use have been connected via a hub that has been put in place from Cerner, says Mike Dittemore, the executive director for LACIE. Dittemore says that LACIE connects to that hub so it doesn’t have to do all of the independent connections, leading to greater efficiencies and cost savings.

However, getting different provider organizations on board has not been easy, Dittemore admits. “There are always challenges with provider participation, and one of reasons we had the strategy to work with hospitals and get them on first is that we felt if we did a good job with them, that would spur participation from others. The best marketing out there as far as HIEs go is word of mouth by providers who actually use it,” he says. What’s more, LACIE’s board of directors consists of several physicians, including multiple CMIOs of organizations in the Kansas City area. “That’s really helped us, having these physicians have conversations with other providers or their clinics and talk to them about why it’s important to share this information and participate,” says Dittemore. “They can show other [providers] the value by being able to not tie up so much staff in administrative time in tracking information down that already exists in the HIE.”

Still, there are additional challenges for independent providers who have all kinds of mandates and rules they are struggling with, in addition to low reimbursement rates, Dittemore notes. “So we try to have a price point that works for them, and we also have found some grant funds through the Office of the National Coordinator for Health Information Technology (ONC). In Kansas, we used some of those funds to help folks to connect, but it’s always an uphill climb to get individual providers on board. We do think that if we can get in and meet with clinic managers, maybe not the providers themselves, but a trusted person they go to, and show them the value, getting these smaller providers on board might not be as hard,” he says.

One of these physicians on LACIE’s board is board chair, Gregory Ator, M.D. CMIO and practicing physician at the University of Kansas Hospital. Ator says that as of late, LACIE has become much more focused in getting smaller practices on board. “It’s been a great experience, it’s very refreshing to see all of these large organizations that are not competing around the ‘this is my data and you can’t have it’ concept, but rather the ‘let’s compete around quality of care and let information freely flow’ concept. That’s been quite refreshing, and moving forward we’re looking at the next tier of smaller physician practices,” Ator says.

LACIE further attempts to make the exchange process more doable by not charging organizations a fee to connect. “We have always believed in connecting to other HIEs, be it community, regional, or state. But we don’t pay other organizations to connect nor do we charge others to connect to us,” Dittemore says. “LACIE is a public type of entity. We think that’s why it’s here, for the spirit of moving information regardless of where they reside. We have been adamant about that, but not all facilities feel the same way. So that’s been a barrier,” Dittemore notes.

Making HIE Valuable

Currently, LACIE is consistently seeing 100,000 queries per month going through the HIE, and according to Dittemore, one of the things that really helps provide value to its providers is getting robust information trading rather than just checking a box. “If checking a box is what you want, our HIE won’t be for you. We’re about the meaningful trading of information,” he says.

To this end, all of LACIE’s connected providers are encouraged to share radiology reports, discharge reports, clinic visits, and any summaries, Dittemore adds. “What we have found is that when you have that type of information above and beyond the continuity of care document (CCD) or consolidated-clinical document architecture (C-CDA), it really provides a great platform for providers to go in and look at the information and find out what is really going on with patients in those last visits,” he says. “We want to try to get rid of the fax machine, or reduce its use by as much as possible. Having this robust information available does help providers to move onto other duties like taking care of patients. They become valuators rather than investigators,” says Dittemore.”

Expanding on the notion of meaningful data exchange, Ator notes that fax machines are how providers are doing HIE right now, and what’s more is that Direct also has issues with people’s addresses as well as its own technological problems. “I am an Epic customer at KU, so we have a number of Cerner operations in town as well as Epic operations, and when you log into Epic for instance, we can go out to the HIE and search for a patient, at which point a very robust matching algorithm kicks in and we get textual documents presented in reverse chronological order. Operative notes, progress notes and discharge summaries are all within Epic without a separate log-in,” Ator explains. “Our providers don’t have to dig through exchange formats such as CCDs and CCDAs to see it in a meaningful manner. And that’s Cerner shop looking at Epic and vice versa,” he says.

Value to providers is further seen in the form of impacting patient outcomes. According to Ator, the strongest use case now is in the ER. “The patients here in a big city circulate around the EDs, and it’s fabulous to have the notes as it was was signed from an organization right down the street that a person might have checked into,” he says. “So we have seen improved outcomes around the ED, and the literature backs that up. I think that it is clear there is benefit in ED world, but rest is bit too soon to call,” Ator says.

Dittemore also says that value has been seen on the care management side. Kansas City has multiple medical facilities and acute care facilities, but even more non-acute facilities, he says. Just because a patient happens to go to a provider or an urgent care clinic that they have affiliation with, they might not go there for all care, and that’s something that needs to be seen in the HIE, he says. Also with specialists, making sure to ensure patients have done the appropriate follow up and have been to specialists allows care managers to see if that has happened and if not, find out why, Dittemore says. “Was it a transportation problem, an illness or what? It gives them something to go off of when they reach back out to the patient. Care managers have seen great value in this to manage that care between multiple facilities that might not be financially related to one other. That’s been rewarding,” he says.

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Cedars-Sinai goes all-in on Apple HealthKit

Cedars-Sinai goes all-in on Apple HealthKit | Healthcare and Technology news |

Cedars-Sinai Medical Center in Los Angeles has become the latest provider organization to link its electronic medical records system to Apple's HealthKit software.

CIO Darren Dworkin, speaking to Bloomberg Business, said that information from HealthKit now will appear in health records for more than 80,000 patients. Several other hospitals, including the Mayo Clinic in Rochester, Minnesota, and New Orleans-based Ochsner Health System, as well as Stanford University Hospital and Duke University, also integrate with HealthKit.

"This is just another set of data that we're confident our physicians will take into account as they make clinical and medical judgments," Dworkin said, who added that use of HealthKit will be a learning experience.

"We don't really, fully know and understand how patients will want to use this," he said.

Dworkin added that HealthKit will be available for all patients throughout the system to use as they choose. 

"The opt-out is just don't use it," he said.

At the Healthcare Information and Management Systems Society's mHealth Summit in the District of Columbia last December, Ochsner Chief Clinical Transformation Officer Richard Milani and Duke Medicine Director of Mobile Technology Ricky Bloomfield shared insight into their respective organizations' HealthKit integrations. Both facilities use Epic's patient portal, MyChart.

Milani said the amount of data patients could generate that could then go into their records was pretty small; he said about 50 to 60 discreet elements such as weight, sodium intake and blood pressure could be entered. Bloomfield, however, said that based on conversations with Apple healthcare executives, he expects that number to grow.

Bloomfield added that HealthKit integration will help to transform the use of EHRs for providers.

"This was finally something we could give them that would live up to the promise of what EHRs can provide, and what having access to this kind of data can provide," Bloomfield said at the Summit.

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A brief history of the EHR

A brief history of the EHR | Healthcare and Technology news |

So far, 2015 has been a busy year for reflecting on the use of electronic health records (EHRs). CMS just released its proposed rules for meaningful use stage 3. One might say that “MU 3” supports the belief that the sequel is never as good as the original (though the original might not have been that good either). Earlier, the Office of the National Coordinator for Health Information Technology (ONC) issued its “interoperability roadmap.”

While I welcome ONC’s highlighting the importance of interoperability, I thought that waiting until now to create a roadmap is like getting your TripTik two days into your cross country road trip (after discovering that you are 500 miles off course). Dr. Bob Wachter’s book and its behind-the-scenes look at the digitization of medicine is also getting people talking. (It’s on my iPad but I haven’t started it yet.)

In February, the Annals of Internal Medicine published Clinical Documentation in the 21st Century: Executive Summary of a Policy Position Paper From the American College of Physicians, which summarizes many of the problems with documenting care using EHRs. The paper includes proposed solutions for addressing many of the deficiencies in the electronic clinical record.

All of this activity and many conversations with colleagues and patients got me thinking more about what went wrong and what went right with EHRs. I started using an EHR in 2006 BE (Before Everything) and led my practice’s selection committee, which started its search a couple of years earlier. “Before Everything” means before the CMS EHR incentive, PCMH, Meaningful Use, PQRS, ACOs, and many of the other programs, initiatives, and acronyms that we now associate with EHRs. In fact, in 2006 BE, the government was minimally involved in EHR adoption. Much of it was driven by small private practices.

So if we had to pay for it ourselves and didn’t need it for reporting or earning bonuses, why did we go electronic in 2006 BE? We thought it would help us take better care of patients through improved access to legible and complete records, allow us to start measuring how we delivered care (in a basic way, but anticipating what was coming), make us more efficient, and improve the bottom line. I’ve addressed many of these goals and how things turned out in my earlier “report card” columns (2012 and 2014).

We wanted an EHR that let us enter data however we wanted — check lists, templates, typing text, dictating, with keyboard, with handwriting recognition, or various combinations — and could meet future needs such as integrating outside data and communicating with other EHRs. And while today’s critics call it out as unimportant and even corrupting, the ability to document in a way that would support the level of coding mattered to us because we believed  that many of us were being overcautious and undercoding in our paper records.

That is what we were looking for. That is pretty much what we got.

Then the world started to change, rather rapidly when you think about it. In 2009, HITECH and its incentive payments expanded the market and introduced requirements for “certified EHR technology.” More entities needed things tracked and counted for a long list of quality activities and “pay for performance” programs. Interoperability, which people thought was a “nice thing to have” in 2006 BE, was all of a sudden a “must have.”

Vendors responded by adapting their products to meet these new needs, and not surprisingly, it got messy at times (and expensive). Upgrades to add new “features” that would meet the latest requirements often broke the “old” new features added in the previous upgrade. Sometimes the upgrade process itself disrupted the work of the practice. With each “enhancement,” the code got bloated, the number of threads, pings, and server hits grew, and the EHR slowed down. It was no longer enough to have the information in the record. It had to be in the right place, in a “structured” field, all too often entered manually with a box click, so the physician slowed down along with the EHR.

It’s as if one bought a compact car to drive to work and take an occasional highway trip out of town but was now forced to use it for off-road driving and to tow large trailers into the mountains. It could be done, but very slowly and with frequent breakdowns. The Feds’ “hands off, let the marketplace take care of it” approach sounded very American and was politically easier than the alternative, but assumed that vendors would listen to their customers, and if not, that changing EHRs was as easy as switching from a compact car to a four-wheel  drive SUV. The difference, of course, is that the compact car has trade-in value that offsets some of the cost of the SUV, one doesn’t have to take driving lessons all over again to change vehicles, and you don’t have to pay thousands of dollars to move your belongings from the glove compartment and trunk of your old car to the new one.

Despite my cynicism, I do not think that all is lost. The collective discontent is getting louder. More practices and health care organizations are replacing or considering changing EHRs. The pressure is mounting on vendors to think less about their proprietary interests and more about the needs of their customers.

The ACP position paper has good recommendations for EHR system design. In a future post, I will discuss my “wish list” for the EHR of the near future. I invite you to share your ideas as well.

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Military or Civilian Sphere, the Healthcare IT Challenges Look Equally Systemic

Military or Civilian Sphere, the Healthcare IT Challenges Look Equally Systemic | Healthcare and Technology news |

It was an honor and a privilege to be named Summit Chairman of the 12th Annual Health Information Technology Summit, the healthcare IT section of the World Health Care Congress, held March 22-25, at the Marriott Wardman Park Hotel in Washington, D.C. At the Health Information Technology Summit, so many healthcare IT leaders shared so many insights in the panel discussions and presentations, that it really did provide attendees with a very strong sense of where healthcare IT is headed these days, and what the deep challenges and broad opportunities are for our industry.

And I was privileged to be asked to moderate one of those several panels myself, held on March 23, under the heading, “Adopt Technology as an Engine for Health Care Advancement.” I was honored by the presence of my three co-panelists, David Bowen, CIO of the Military Health System, and director, health information technology, at the Directorate for the Defense Health Agency; Richard Skinner, chief information and technology officer at the University of Virginia Health System; and Manish Vipani, vice president, enterprise architecture, at Kaiser Permanente.

Not surprisingly, given that we had a mix of military and civilian healthcare IT leaders, we found ourselves engaged in quite a lot of discussion of the contrasts between the challenges facing the military and civilian healthcare systems when it comes to IT.

“We're in the process of creating a true system,” Bowen of the Military Health Care System said. “We're trying to get the services to do things the same, because they've run things in a stovepipe manner. Our budget for healthcare last year cracked 10 percent of the military's budget in toto, and that got a lot of attention,” he noted. “And,” he said, “I stood in front of our leadership, and asked, if we were a Fortune 500 company, how big would we be? And it turns out we'd be 53rd” largest Fortune 500 company. “And I asked, how would we be perceived by our board? And one of our senior leaders said, we'd all be fired, because we've run things in such a fragmented way. So I've been helping to lead a lot of business and cultural transformation,” he reported. “And we're implementing a system-wide EHR [electronic health record], which has gotten a lot of attention as well. I tell people I'm a cultural anthropologist.”

It was refreshing to hear such a level of candor from someone working within the military healthcare system; and rather validating in a certain way to hear that many of the core challenges facing military healthcare leaders are the same ones facing their civilian counterparts.

Indeed, when it comes to thinking about how the U.S. healthcare system must better serve the needs of its clinician end-users, whether civilian or military, the University of Virginia’s Skinner said that the biggest challenge facing him and his colleagues lately has been “how to put ourselves in the customers' place. You shadow a nurse on a inpatient unit and watch her trying to navigate all these complex systems,” he said, and it becomes clear how very unfriendly to end-user clinicians the clinical information systems they are compelled to use, really are. “So for us in the IT world,” Skinner said, what is very important “is seeing things through the customer's eyes, seeing how things look to the person actually using these [systems].”

Part of the solution, Kaiser’s Vipani noted, will be the coming of “the marriage of the internet of things into healthcare. Building a hospital in Dan Diego with smart lightbulbs, and with hand hygiene dispensers with sensors to document net individual use,” are examples of ways in which technology implementation will help to transform processes in healthcare. “I think the internet of things will fundamentally change health care,” he added.

The sentiment has sometimes been expressed in healthcare that it would be great to have all of a patient care organization’s clinicians be salaried staffers, as is true in the U.S. military, as well as in a number of foreign healthcare systems. Yet the reality is that the armed forces already have that advantage, and yet continue to struggle to overcome siloing and communication gaps, as the Military Health Care System’s Bowen noted.

Still, Bowen and his colleagues are moving with alacrity to break down the silos and evolve the military healthcare system forward towards greater integration and customer-friendliness (whether the customers be clinicians or patients). As he noted, “We’re looking at six areas of the country where we’ve got multiple facilities for multiple services in the same communities, and are finding how we can best serve patients. We might send an Army soldier to an Air Force facility, for example,” or shift individual facilities from serving only one branch of the armed forces to serving military personnel from all branches. “As we move forward,” he said, “we’re focusing on the whole idea of systemness, and doing what’s best for everyone in the system.”

So, as we all move forward in U.S. healthcare, it will continue to be very important, and extremely helpful, to have discussions like the one we held last week in Washington, D.C., in which leaders from every sector within U.S. healthcare share with other leaders from other sectors, how we can all best move forward. Because when it comes down to it, most of the fundamental challenges we face are present across healthcare industry sectors. And when we discuss the issues at a strategic level, as we did last week, the potential for strategically driven change that can fundamentally transform U.S. healthcare, can only become more and more possible and likely going forward.

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How New Prices and Payments are Changing the Way We'll Receive Healthcare under the Affordable Care Act

How New Prices and Payments are Changing the Way We'll Receive Healthcare under the Affordable Care Act | Healthcare and Technology news |

In the wake of the recent King v. Burwell Supreme Court decision to uphold subsidies for the 34 state health insurance exchanges under the Affordable Care Act, it's worth understanding why losing them would've made insurance for nearly 6.4 million Americans unaffordable. It boils down to two numbers: the cost of delivering care and the rate that hospitals are paid to do so.

Most physicians are currently paid under a 'fee-for-service' model, a flat sum for each individual test or procedure provided to a patient. It's no surprise then that the number of prescribed tests has skyrocketed over the past two decades as hospitals attempt to increase revenue. For any given condition, the United States both orders and spends more on unnecessary screens and treatments than any other country on Earth, often with no better outcome for the patient. An MRI in the United States costs five times as much as the same MRI in France.

Most countries negotiate with healthcare providers to set rates at acceptance levels. Prices are either directly set by the government or are negotiated upon by providers and insurers prior to delivering care. In both instances, the price of healthcare is generally much lower than that of the United States, where, outside of public programs like Medicaid and Medicare, providers can usually charge whatever they can get away with to make up for the high costs of pharmaceuticals and medical devices. Furthermore, the amount paid for a given service is identical regardless of whether the outcome is good or bad. Imagine going to a restaurant and paying the same amount for a meal that left you satisfied and another--that you likely didn't order but were given anyways--that gave you food poisoning. That's how fee-for-service works.

The lack of accountability on the quality of care compounded with a healthcare financing model that rewards hospitals for increasing volume, not value, was a recipe for disaster, causing healthcare spending to jump to nearly 20% of GDP, but left the rate of increase in life expectancy in the dust compared to Europe and Japan.

The U.S. first tried to address rising healthcare costs in the 1990s through a model known as 'global capitation'. Providers were paid a single pre-defined sum to cover all treatment for each patient. If a physician or healthcare organization delivered care to a patient at a cost less than the sum it received, it turned a profit. If it overshot the sum, it lost money. While this model rewarded physicians for spending less, it did nothing to reward physicians for improving outcomes. As a result, physicians had a financial incentive to avoid expensive treatment plans and costly patients, resulting in poor quality care.

In 2012, as an extension of the Affordable Care Act, the Obama Administration launched the Pioneer Accountable Care Organization (ACO), a 'global payments' model that rewards hospitals that deliver quality care at costs lower than a pre-defined benchmark and punishes hospitals that overspend. If hospitals in the program spend below expected costs, they keep 70% of the savings; the other 30% goes to the federal government. If they spend more than expected, they pay the federal government the difference.

Some policymakers and physicians worry that the Affordable Care Act's global, or bundled, payments model is simply disguised capitation. Although bundled payments have a cost control structure similar to global capitation, they have been flexibly designed to avoid its pitfalls by rewarding value-based patient care. Physicians are paid for each patient based on how much treatment would cost for a given clinically defined episode of care. This risk adjustment allows for variability in global payments based on the illness burden of a provider's patient population. Additionally, unlike capitation, providers are directly rewarded for improving patient outcomes, incentivizing consistently-measured, high-quality care. Some global payment models do not involve any punishments for overspending, as opposed to the Pioneer ACO, but continue to reward strong physician performance.

Over the last two years, the Pioneer ACO program has saved $384 million in healthcare costs. In combination with the Medicare Shared Savings Program (MSSP), another global payments initiative, it has contracted with 154 organizations in forty states. All hospitals involved showed improved performance quality measures, readmission rates, and cholesterol level monitoring. Furthermore, patients gave similar rates of satisfaction compared to previous models of care and even reported better access to physicians. The end result is higher quality care at a lower cost for patients.

While Pioneer is illustrative of a step towards progress in managing healthcare costs, it hasn't been perfect. Most 2012 Pioneer participants were large, sophisticated hospital networks with the capability to rapidly change their method of delivering care, very different from the public hospitals that serve the populations that need health reform the most. Of the 32 hospitals that registered for Pioneer in 2012, 13 dropped out and 14 failed to produce any substantial savings. However, most dropout hospital networks still plan to pursue less-aggressive value-based payment models, such as MSSP, and found their experience with Pioneer to be an effective transition for both patients and providers to the global payments model. Additionally, the practice of measuring and collecting data on physician performance and patient outcomes will give both the federal government and providers a more transparent understanding of what treatments work, providing evidence-based information to set prices based on the value of individual treatments. If there's any one change that will reduce U.S. healthcare costs in the long term, it's lowering prices.

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CVS Health Announces New Clinical Affiliations with Four Leading Health Care Organizations

CVS Health Announces New Clinical Affiliations with Four Leading Health Care Organizations | Healthcare and Technology news |

CVS Health (NYSE: CVS) announced today it has entered into new clinical affiliations with Sutter Health in California, Millennium Physician Group in Florida, Bryan Health Connect in Nebraska and Mount Kisco Medical Group, PC in New York. These affiliations will help enhance access to high-quality, affordable health care services for patients.

Through these clinical affiliations, CVS Health will provide prescription and visit information to the participating health care organizations by enabling communication between our secured electronic health record (EHR) systems, which will help enhance clinical care for patients served by the partnering organizations. In addition, patients will continue to have access to clinical support, medication counseling, chronic disease monitoring and wellness programs at CVS/pharmacy stores and MinuteClinic, the retail medical clinic of CVS Health.

"In this era of health care reform, we are pleased to work with these health care organizations to develop collaborative programs that enhance access to patient care, improve health outcomes and lower health care costs in the communities they serve," said Troyen A. Brennan, MD, Chief Medical Officer, CVS Health. "By allowing our electronic health records and information systems to communicate and share important information about the patients we collectively serve, we will have a more comprehensive view of our patients, which can aid in health care decision making and help ensure patients adhere to important medications for chronic diseases."

CVS/pharmacy currently has more than 7,800 retail pharmacy locations across the U.S. where CVS pharmacists provide counseling to patients to help them be adherent to their chronic disease medications. In addition, MinuteClinic also plays an important role by providing patients with timely, affordable and high-quality walk-in health care. There are nearly 1,000 MinuteClinic walk-in medical clinics available at CVS/pharmacy retail stores. MinuteClinic locations are open seven days a week, offering evening hours with no appointment necessary and most health insurance is accepted. The clinics are staffed by nurse practitioners and physician assistants who provide treatment for common family illnesses and administer wellness and prevention services, including health-condition monitoring for patients with chronic diseases. 

Affiliates' health care providers will receive data on interventions conducted by CVS pharmacists to improve medication adherence for their patients. The affiliation also encourages collaboration between the health care providers and MinuteClinic providers to improve coordination of care for patients seen at MinuteClinic locations.

Through this collaboration, the affiliate organizations and MinuteClinic practitioners will also work together on planning strategies around chronic care and wellness. If more comprehensive care is needed, patients can follow up with their primary care provider and have access to the services at the health care provider as appropriate. For those patients who do not have regular access to health care, MinuteClinic provides information to help patients in finding a primary care physician and a greater opportunity for continuity of health care services.

MinuteClinic, CVS/pharmacy and the participating health care organizations will begin to work toward streamlining and enhancing communication through their EHR systems. This will include the electronic sharing of messages and alerts from CVS/pharmacy to the health care organizations' physicians regarding medication non-adherence issues. In addition, MinuteClinic will electronically share patient visit summaries with the patient's primary care physician when they are part of an affiliate organization and with the patient's consent. MinuteClinic will continue its standard practice of sending patient visit summaries to primary care providers who are not affiliated with one of these participating health care organizations via fax or mail, with patient consent.

The new affiliations announced here bring the total number of clinical collaborations for CVS Health and MinuteClinic to nearly 60 major health systems and health care providers across the country.

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Health IT Certification Policies Affect Healthcare Reforms

Health IT Certification Policies Affect Healthcare Reforms | Healthcare and Technology news |

Over the last five years, healthcare providers have had to pay greater attention to policy changes,meaningful use requirements, and ongoing ICD-1o transition delays as the nation worked toward reforming the medical sector to greater benefit patients and everyday citizens. Specifically, EHR implementation has been a great focus of the healthcare industry. Health IT vendors as well as federal agencies have focused on developing certified EHR technology through the Health IT Certification Program.

The Department of Health and Human Services (HHS) has recently issued a document detailing the submittal of test procedures and data under the Health IT Certification Program established by the Office of the National Coordinator for Health IT (ONC).

In early 2011, HHS established a certification program for health IT systems and EHR technology. In September of 2012, the program was renamed the “ONC HIT Certification Program.” At this point in time, HHS proposes to change the name of the program once again to the “ONC Health IT Certification Program.”

Over the last several years as the program operated, health IT designers have proposed that “testing efficiencies” could be garnered if the ONC Health IT Certification Program took advantage of operational testing including e-prescribing network testing.

“The National Coordinator is open to approving test procedures, test tools, and test data that meet the outlined approval requirements above for an applicable adopted certification criterion or criteria,” the HHS document proposal stated. “By way of this document, we strongly encourage persons or entities to submit such test procedures, test tools, and test data to ONC if they believe such procedures, tools, and data could be used to meet ONC’s certification criteria and testing approval requirements. We also note that there is no programmatic prohibition on the approval of multiple test procedures, test tools, and test data for a certification criterion or criteria.”

Along with the health IT certification program, some other new proposed guidelines on healthcare reform include the modified Stage 2 Meaningful Use requirements. As providers began moving toward attesting to Stage 2 Meaningful Use regulations, federal agencies began to see certain missteps with the requirements, which led them to modify the rulings.

Currently, the Centers for Medicare & Medicaid Services (CMS) has announced that public comments to the proposed Stage 2 Meaningful Use modifications are due by June 15, 2015. The proposed ruling changes certain requirements between the years 2015 to 2017 for those eligible professionals attesting to meaningful use under the Medicare and Medicaid EHR Incentive Programs.

Public comments can be submitted to CMS electronically, by courier, and by regular or express mail. Anyone interested in more information about the proposed ruling are encouraged to read themodifications to Stage 2 Meaningful Use requirements and view a factsheet on the CMS website.

As the healthcare industry continues toward a path of reform, federal agencies will likely continue developing new regulations and policies that will aim toward improving the quality of patient care, boosting health outcomes, and reducing medical spending.

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Partners Goes With $1.2B Epic Installation

Partners Goes With $1.2B Epic Installation | Healthcare and Technology news |

After living with varied EMRs across its network for some time, Boston-based Partners HealthCare has decided to take the massive Epic plunge, with plans to spend an estimated $1.2 billion on the new platform. That cost estimate is up from the initial quite conservative spending estimate from 3 years ago of $600M, according to the Boston Globe.

As is always the case with an EMR install of this size, Partners has invested heavily in staff to bring the Epic platform online, hiring 600 new employees and hundreds of consultants to collaborate with Epic on building this install. The new hires and consultants are also tasked with training thousands of clinicians to navigate the opaque Epic UI and use it to manage care.

The move comes at the tail end of about a decade of M&A spending by Partners, whose member hospitals now include Brigham & Women’s Hospital, Massachusetts General Hospital, the Dana-Farber Cancer Institute, McLean Hospital, Spaulding Rehabilitation Hospital and the North Shore Hospital.

The idea, of course, is to create a single bullet-proof record for patients that retains information no matter where the patient travels within the sprawling Partners network. Partners can hardly manage the value-based compensation it can expect to work with in the future if it doesn’t have a clear patient-level and population level data on the lives it manages.

Even under ideal circumstances, however, such a large and complex project is likely to create tremendous headaches for both clinical and IT staffers. (One might say that it’s the computing equivalent of Boston’s fabled “Big Dig,” a gigantic 15-year highway project smack in the middle of the city’s commuting corridor which created legendary traffic snarls and cost over $14.6 billion.)

According to a report in Fortune, the Epic integration and rollout project began over the weekend for three of its properties, Brigham & Women’s, Faulkner Hospital and Dana Farber. Partners expects to see more of its hospitals and affiliated physician practices jump on board every few months through 2017 — an extremely rapid pace to keep if other Epic installs are any indication. Ultimately, the Epic install will extend across 10 hospitals and 6,000 doctors, according to the Globe.

Of course, the new efforts aren’t entirely inward-facing. Partners will also leverage Epic to build a new patient portal allowing them to review their own medical information, schedule appointments and more. But with any luck, patients will hear little about the new system going forward, for if they do, it probably means trouble.

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Electronic Health Records: Their Time Has Come

Electronic Health Records: Their Time Has Come | Healthcare and Technology news |

In 1991, when portable computers were the size of sewing machines and the World Wide Web was aborning, the Institute of Medicine proposed a plan for how emerging technologies could be used to improve medical recordkeeping. The plan highlighted the potential of health information systems in general, and computer-based patient records specifically, to support health care professionals as they make decisions at the point of care. It also called for developing a national health information infrastructure. The goal was to achieve ubiquitous use of such patient records by all U.S. health care delivery organizations by 2001.

The goal was overly ambitious. But the proposed plan proved to be an important milestone in the evolution of thinking about patient data and the health information infrastructure needed within organizations and the nation. And such thought is now turning into action. In early 2009, with passage of the American Recovery and Reinvestment Act, the government committed its first serious investment in electronic health records (EHRs) and in developing a national health information infrastructure. The act calls for achieving widespread use of EHRs by 2014, and it provides $36 billion to support the use of EHRs in clinical settings and another $2 billion to coordinate their implementation.

EHRs are much more than computer-based versions of paper medical records or stand-alone data repositories, and their successful implementation is not without challenges. Indeed, the federal government’s newly appointed national coordinator for health information technology, David Blumenthal, said in his first public statement that technical assistance is a “critical factor” in advancing EHRs to reduce health risks.

As an illustration of how EHRs and EHR systems may bring about multiple benefits in medicine, consider how two other industries have used similar technologies to provide convenient, efficient, and customer-centered services. In the banking industry, automatic teller machines and online Web sites provide customers with ways to conduct their banking when and where they choose and with confidence that their personal information is protected. Banks also provide alerts to customers about sensitive activity in their accounts and reminders about payment deadlines. These easy-to-use tools depend on a secure, seamless information infrastructure that enables data to cross organizational and national lines. In the online retail industry, companies such as not only offer convenience in shopping but also provide personalized shopping recommendations based on past purchases or selections made by other customers who have shown similar interests. This feature depends on the ability to capture and analyze data on individual and population levels. Amazon also provides a mechanism for used-book sellers to offer their products via its Web site—a process that is possible, in part, because there is a shared format (technically, interoperability standards) for the information presented to customers.

Now consider how data, information, and knowledge could securely and seamlessly flow through health care organizations. As a case in point, begin with a patient who has a chronic condition and is tracked by an electronic record of her health history, including any unusual symptoms, an accurate list of numerous medications, and reminders of when lab work is needed to ensure that the medications are not causing kidney damage. Lab results are forwarded directly to her electronic health record, which is maintained by her primary care clinician. If lab results are outside of the normal range, the physician receives an alert and, in turn, sends the patient an e-mail requesting that she repeat the lab work and schedule an appointment.

During the appointment, the physician has a comprehensive view of the patient’s health history and receives a reminder that the recommended protocol for treating her condition has been changed. After reviewing options with the patient, the physician prescribes a new medication, and the prescription is sent directly to the patient’s preferred pharmacy and to the patient’s EHR. The physician also recommends increased physical activity, and so the patient elects to receive weekly exercise programs and commits to recording her daily exercise in her health record.

After the visit, selected data elements without personal identifiers are automatically forwarded to a larger population data set maintained by the health organization in which the physician works. The organization can use the data to compare outcomes for its patients to regional or national benchmarks. For example, a hospital may learn that its post-surgery infection rate is higher than the national trend and then compare its practices to those used by other organizations with lower infection rates. Or a physician practice group may learn that its outcomes for a particular diagnosis meet national norms, but that there are less expensive alternatives that yield comparable results.

On a broader scale, outside authorized users—say, university researchers—can access the population data in conducting clinical research. Pooling data from an entire region or state, or even nationwide, will enable more comprehensive and efficient research on the effectiveness of treatments and clinical processes. For example, bioinformaticians might benefit from using large data sets as they seek to advance the intellectual foundation of medicine from its current focus on organs and systems to one based on molecules. Public health professionals can use the data to monitor health trends across various populations. Further, selected EHR data elements may flow into biosurveillance systems so that analysts can detect new outbreaks of disease, whether due to natural infections or bioterrorism.

For the full impact of EHRs and EHR systems to be realized, the results from these studies, when fully verified, must flow back to clinical professionals and patients so that they can base their decisions on the most current knowledge available. This cycle of using knowledge to support decisions, capturing data on the outcomes of those decisions, analyzing the data, and using insights gained to refine the knowledge base is the essence of how to develop a “learning” health care system that is safe, timely, efficient, effective, equitable, and patient-centered. EHRs are the beginning and end of that cycle. Each time that an EHR is used, there is an opportunity to enhance current and future decisions. But EHRs are only a part of the complex infrastructure that is needed to enable learning cycles within health care organizations across the country.

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The Mobile Patient: How mHealth Tools are Paving the Way for Better Care Management

The Mobile Patient: How mHealth Tools are Paving the Way for Better Care Management | Healthcare and Technology news |

In the new healthcare, one which emphasizes comprehensive, team-based and accessible care, provider organizations will need to make concerted efforts to become more patient-centered.  For many providers, patient engagement is no easy task, but it’s certainly at the top of mind for healthcare CIOs.

Indeed, according to findings of the 26th Annual HIMSS Leadership Survey, sponsored by the Chicago-based Healthcare Information and Management Systems Society (HIMSS) and released at the annual HIMSS conference this past April, patient satisfaction, patient engagement, and quality of care improvement have raced to the top of healthcare CIOs’ and senior IT executives’ agendas in the past year, a stark change from previous years which found that health IT leaders were more focused on business and financial goals. Nonetheless, it’s been a struggle for physicians to truly engage their patients, especially the 45 percent of U.S. adults with at least one chronic condition.

Enter the world of mobile health (mHealth) to help with care management and patient engagement, a growing trend in healthcare. In fact, another recent survey from HIMSS found that more than 90 percent of survey respondents are utilizing mobile devices within their organizations to engage patients in their care. The fourth annual HIMSS mobile survey, which included more than 200 healthcare provider employees, revealed that 73 percent of respondents believe the use of app-enabled patient portals has been the most effective tool in patient engagement to date.

Further, when asked about patient-generated health data (PGHD), 14 percent reported that all or most data generated by mobile devices is integrated into the electronic health record (EHR), while 52 percent reported that some data has been integrated into the medical record. “mHealth continues to evolve as a tool to drive healthcare efficiencies. The proposed meaningful use Stage 3 rule realizes this with the concept of application program interfaces (APIs) and patient-generated health data, and this year’s survey showed that the wide spread availability of mobile technology has had a positive impact on the coordination of patient care,” said David Collins, senior director of the HIMSS mHealth community.

Analysts do predict that the wearables market will grow tenfold to $50 billion over the next three to five years. So undoubtedly, putting personal devices in the hands of patients has begun to change the way patients and physicians communicate with each other. And for each of the major smartphone operating systems, there is now an app for almost every conceivable healthcare need.

What’s more, there are policy implications to consider as well. As HIMSS’ Collins mentioned, the recent meaningful use Stage 3 proposal that calls for more that 15 percent of patients to contribute PGHD or data from a non-clinical setting into the certified EHR technology during the EHR reporting period, will put the onus on providers to collect information from patients, often captured from exercise or fitness devices or recorded on mobile apps.

What does all this mean? For forward-thinking providers, it’s about getting patients to use mHealth tools for more effective care management. Mobile health tools have the potential to create a low-cost stream of highly actionable clinical data, using readily available cloud-connected sensors, ranging from glucose meters to heart monitors to asthma tools. To this end, all sorts of vendors in the market place are working on using mobile devices to get first get patients to track their own data, with the eventual goal to get said data into the EHR. For most vendors and provider organizations though, as noted in the HIMSS mHealth survey, this concept is a novel one.


According to Ken Kleinberg, director of health IT membership service at the Washington, D.C.-based The Advisory Board Company, mHealth vendors are now making it easier on patients to track and share their data than ever before. “These apps are now designed for a small device. You’re no longer trying to open a browser on a tiny screen, but instead you’re looking at an app designed just for that platform, so the data entry and reminders are pretty straight forward,” Kleinberg says. “You may get text message reminders, for example, and these are simple mechanisms that don’t require complex hardware,” he says. Kleinberg adds that there is also a trend involving smartphones with medical devices, where asthma patients, for instance, can have their inhaler with an attachment to it that keeps track of every time the inhaler is used. “This way you can sit down with your provider or look at the data yourself, and sit down and figure out trends,” he says.

To this end, at this year’s HIMSS conference, the Durham, N.C.-based Duke Medicine shared the experience it has had thus far with Apple’s HealthKit, a framework designed to house healthcare and fitness apps, allowing them to work together and gather their data under the Health app. Since HealthKit’s launch, many notable healthcare organizations, including Stanford Medicine, Cleveland Clinic, and EHR vendors like Epic, have all partnered with Apple to work in their own patient-generated data applications.

At Duke, Ricky Bloomfield, M.D., director, mobile technology strategy, has led the effort to integrate Apple’s HealthKit. For providers at Duke, the first step to getting the data integrated with their medical records involved asking patients if they want to share their information, says Bloomfield. Such data, which goes into the EHR via the patient portal, can be from activity trackers, blood pressure devices, glucose monitoring, and many other devices. But then there are limits, he adds. “Patients cannot unilaterally enter their data into the EHR, and that’s by design. There simply is no way for providers to handle that mass intake of data right now,” he says. As such, the provider enables Apple’s HealthKit for patients right now, and the provider has a flow sheet that keeps the patient-generated data separate from other data in the system, Bloomfield says. This way, you can still do analytics on it, but it’s separate from other clinical data, he says.

Across the country, providers are handling patient-generated data in the same manner. In Palo Alto Calif., Stanford Health Care recently released its MyHealth mobile app that will allow patients to review test results and medical bills, manage prescriptions, schedule appointments, and conduct video visits with a Stanford physician.  The app also connects directly with Epic’s EHR system and with Apple’s HealthKit. The idea behind this integration, according to Aditya Bhasin, executive director of software at Stanford Health Care and part of the team that built the app, was to get both doctors patients to be looking at exactly the same sources of truth.

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ICD-10: Reality and rhetoric

ICD-10: Reality and rhetoric | Healthcare and Technology news |

For healthcare executives and political aficionados following the latest proposed legislation that could affect ICD-10’s fate, it’s time to recognize three critical facts.

First, the proposed bills — one of which aims to kill ICD-10 outright while the other advocates a transition period — are both longshots. Second, and perhaps more important, the previous two fashions in which ICD-10 was delayed were also once considered quite unlikely. And third: Even though another delay could happen, it would be dangerous for payers or providers to bank on that and backburner the conversion.

That’s the reality. Even still, the mere mention of adjusting the ICD-10 compliance deadline sparked a real mess, rhetoric-wise, concerning the transition these past couple weeks.

Incoming president, Steven Stack, MD, trimmed the American Medical Association’s sails last week to steer AMA toward ICD-11 horizons, to which the Advisory Board Co.’s director of revenue cycle solutions rebutted: "a push to go to ICD-11 is really a push to not change at all for at least another five to seven years and most likely longer than that," Healthcare IT News sister site Healthcare Finance reported.

And then there’s the Heritage Foundation. The conservative Washington, D.C. think tank wrote a scathing response to what it considers "weak arguments for ICD-10" and essentially wrapped that around a recommendation that the U.S. "delink the disparate goals of research and reimbursement, and develop a more appropriate coding system that makes the billing process less, not more, burdensome."

Given that Republican Louisiana Senator Bill Cassidy, MD, publicly suggested to Health and Human Services Secretary Sylvia Burwell that delaying the ICD-10 penalty phase, which essentially means continuing to pay for claims coded in ICD-9, was the reasonable thing to do, a grace period is not out of the question, either. We witnessed HHS institute one to smooth the transition to HIPAA 5010, after all, proving the feds can be pragmatic when the situation demands it.

The usual suspects of ICD-10 proponents, meanwhile, have been campaigning all along that #ICD10matters, that ICD-9 is antiquated and out of codes, that a dual-coding period would be akin to yet another delay – thus we need ICD-10. Now.

Regardless of what side you’re on, where rhetoric meets reality is in the fact that we’re barely closer to squashing ICD-10 or instituting a sort of dual-coding transition period than before Republican Texas Rep. Ted Poe or Tennessee Republican Rep. Diane Black mentioned their ideas.

Either of those proposals, in fact, would still have to pass the U.S. House of Representatives and the Senate where, it’s worth noting, the Cutting Costly Codes Act of 2013 withered and lay dormant until Rep. Poe brought it back to life. And then be signed into law by President Obama.

The one action hospital CEOs, CIOs and revenue cycle directors can take now: surveillance.

Don’t stop whatever work you have in motion toward the Oct. 1, 2105 compliance deadline but keep an eye on any cues that might emerge from Congress. Summer recess, for instance, kicks off August 10 this year so if neither bill has progressed by then, there would be a short three weeks between our elected officials’ return to work on September 8 and the long-looming deadline.

This one, folks, just might come down to the wire.

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An Appreciation for the Evolving Role of Nurses in Health IT

An Appreciation for the Evolving Role of Nurses in Health IT | Healthcare and Technology news |

It’s National Nurses Week (May 6-12), and before I get into the meat and potatoes of this blog, I’d like to take a moment to thank all of healthcare’s nurses for their continuing hard work and effort day in and day out. I’m someone who usually thinks that there are too many days and weeks devoted to people and groups, but I make an exception for this profession. To use a sports term referring to the most indispensible players on the team, even if not flashy, nurses are the “glue guys” in the healthcare industry.

In health IT specifically, nurses’ roles continue to grow in scope and importance. According to a June 2014 post from Kate Goddard, senior analyst at the Washington, D.C.-based The Advisory Board Company, “Engaging nurses is critical to the success of clinical IT-enabled initiatives. Nurses are often the first and last point of contact with a patient and, therefore, the first and last opportunity to prevent an error. This makes them an enormous asset in ensuring that clinical information systems do no unintentional harm to patients.”

In patient care organizations nationwide, informatics nurses continue to bring great value to the use of clinical systems and technologies at their healthcare organizations, according to the 2015 HIMSS Impact of the Informatics Nurse Survey. The results of the survey, released at the Healthcare Information and Management Systems Society annual conference in Chicago last month, indicated that informatics nurses bring greatest value to the implementation phases (85 percent) and optimization phases (83 percent) of clinical systems process.

What’s more, one-fifth of those survey respondents reported working for an organization that employs a chief nursing information officer (CNIO), a role that’s emerging as a major transformational leader in this era of healthcare reform. To this end, HCI Editor-in-Chief Mark Hagland just recently interviewed Judy Murphy, R.N., who last year became chief nursing officer and director, Global Business Services, at IBM Healthcare. Prior to that, Murphy had been chief nursing officer and director of the Office of Clinical Quality and Safety in the Office of the National Coordinator for Health IT (ONC).  Murphy is extremely well connected in the clinical IT world, and is a prime example of how nurses can be fabulous informatics leaders, a trend that is developing across healthcare organizations.

Indeed, the role of nurses in health IT continues to evolve. Last year, I wrote a story about eICU technology from the Andover, Mass.-based Philips, being deployed at the Baptist Health Eye Center building on the Baptist Health Medical Center-Little Rock (BHMC) campus in Arkansas.  There, the eICU control center acts as an air traffic control center, giving the ICU staff an extra set of eyes and ears, Vicki Norman, R.N., director of eICU care at Baptist Health, told me. At Baptist, physicians and nurses are staffed in the eICU control center and act as additional support to monitor critical care patients, and provide faster response times through use of computer technology as well as audio and video components. Norman said there is a staff of 15 critical care physicians and 25 critical care nurses in the control center, of who average 20 to 25 years of experience.

Similarly, at the Arizona-based Banner Health, physicians and nurses with Banner’s eICU operations center, known as Banner Telehealth, located in Mesa, monitor ICU patients in 430 ICU beds in 20 Banner hospitals across five states. The program has seen a reduction in both mortality and length of stay, Banner officials say. In fact, over the past two years, Banner’s ICU mortality rates have been among the lowest on the country. In 2012, ICU actual length of stay was 20,000 fewer days than predicted, based on patient acuity; and total hospital days were reduced by 49,000. Costs avoided: more than $68 million, say Banner officials.

At Banner, Alice Sneed, R.N., a longtime cardiovascular nurse, decided to become a telehealth nurse eight years ago when she realized that she was getting up there in age, making 12-hour days on the floor very tough on her knees. Sneed has been a critical care nurse for more than two decades, and her role has evolved from being a bedside nurse to the manager of an eICU “central command center,” through which she can now monitor patients and provide insights to nurses who are in six different locations. While a bedside nurse can usually monitor five to six patients at a time, Sneed manages nearly 40-45 patients in several locations across the country.

“My knees were giving out, but knew I needed to do something that would enable me to continue to use brain, experience, and education, and not kill myself. I really like technology, I saw the potential, what it can do, and thought since I like change, new technology, and doing cool stuff, I might like this idea. So I jumped ship,” Sneed told me in a recent interview.

For Sneed, the experience is a far different one than physically being on the floor, and she said that it “takes a special type of nurse.” She said the atmosphere is not as rushed, quieter, and certainly not for adrenaline junkies. “My brain has had to become much more muscular,” she said. “You multitask on the floor, but you’re taking care of one or two patients. I might have 45 patients, but some in the medical ICU, or the neurological unit, or in a tiny unit ICU in Brush, Colorado. I need to think differently about everyone of those patients. I have had to learn, neuro, transplant, and sepsis. But statistically, we’re saving more lives because of the eICU.”

The aforementioned HIMSS survey also found that respondents reported a direct positive impact on the quality of care patients receive as a result of the work of informatics nurses. Specifically, 60 percent of respondents indicated that informatics nurses have a high degree of impact on the quality of care. No question, the work Sneed, Norman, Murphy, and all other R.N.s are doing in clinical IT serve as a great reminder to the power and impact that nurses have on all aspects of the healthcare ecosystem. Happy National Nurses Week!

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Greater Houston Healthconnect Expands Network

Greater Houston Healthconnect Expands Network | Healthcare and Technology news |

GreaterHouston Healthconnect, a regional health information exchange (HIE) in Houston, has just added CHI St. Luke’s Health, a major health player in Texas, to its network.

Houston’s CHI St. Luke’s earlier announced its intention to build a broad network of primary care and specialty physicians to complement its six hospitals, three emergency centers, and other service locations. With population health as a key goal, the CHI St Luke’s network will utilize access to patient health information from any of the participating Healthconnect facilities in order to achieve clinical integration, manage transitions of care, and improve long term health outcomes, its officials say.

“CHI St. Luke’s and our network of partner physicians are endeavoring to reach patients where they are in the community by offering them flexibility of care options and smart information systems to help them stay healthy,” Michael Covert, the organization’s president and CEO, said in a statement. “As part of Greater Houston Healthconnect we’re letting our patients know that we care about them no matter where they had or will receive care in the future. Their medical information should follow them wherever they go―seamlessly. We need a neutral, community-based organization to accomplish that.”

Healthconnect partners with the Texas Health Services Authority (THSA), the statewide body responsible for connecting regional HIEs throughout Texas. Greater Houston Healthconnect currently has agreements with 284 healthcare organizations, representing over 50 percent of area hospital beds and 40 percent of physicians. Millions of patient records are available for query through the exchange and almost all major Texas medical center institutions participate, officials say.

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Health Information Exchange is a Tool, Not a Solution

Health Information Exchange is a Tool, Not a Solution | Healthcare and Technology news |

Health information exchange (HIE) is a key part of ensuring that physicians and other healthcare professionals receive the data they need at the right time in order to improve patient health outcomes.  Earlier this month, the Pennsylvania eHealth Partnership Authority, which runs the HIE system in the state called the Pennsylvania Patient & Provider Network, received a generous donation of $100,000 from Highmark Inc. to further support HIE development throughout the state.

These funds will be used to support patient education, consent management, certification of health information organizations, and other operational processes, according to a company press release. David Grinberg, Deputy Director of the Pennsylvania eHealth Partnership, spoke with to explain some ways that the Highmark donation will be utilized within his organization.

“The authority received a grant from the Centers for Medicare & Medicaid Services that will allow us to give money to the health information organizations operating in Pennsylvania to onboard hospitals and ambulatory providers,” Grinburg said. “There was a match requirement, as the authority has to pay 10 percent of matching funds against that grant. We’re using the money from Highmark to replace money that was taken out of our operational budget to extend that grant.”

Grinburg also discussed some of the activities taking place at the Pennsylvania Patient & Provider Network and the next steps set in place for advancing the health information exchange.

“We really expect the next couple of years to be involved in getting most of the providers out there onboard and onto our network. Up until now, we’ve been working on establishing the network on the technology backbone that allows interoperability between the health information organizations,” Grinburg stated. “In 2015, we are concentrating on onboarding all of the health information organizations that we know about – and with any luck, one or two that we don’t know about yet will emerge – to our network. Then we’ll be working to help them with onboarding individual hospitals and providers to their networks.”

When asked about some of the privacy and security measures taken at the Pennsylvania eHealth Partnership Authority to protect patient data, Grinburg said: “We seek to go beyond basic industry standards in the network that we established. We have deliberately designed a network where there is no centralized storage of patient information.”

“We have a way to index to know where information for a given patient resides but we do not centrally store any of that information. That means that there’s no centralized repository of clinical information for any hacker to attack,” Grinburg stated.

Health information exchange is also an important part of meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs. While the Pennsylvania eHealth Partnership is still reviewing Stage 3 Meaningful Use objectives, the Deputy Director commented on previous meaningful use stages.

“Like anything else, we’re working in a very rapidly evolving industry. When these programs are established, very often the industry evolves to make some things that are in the programs less relevant than they were when the program was first established and other things emerge as more important,” Grinburg explained. “I think that, in general, CMS is doing a very nice job trying to actively incentivize uptake of health information exchange while avoiding an overly prescriptive methodology.”

Grinburg spoke about Stage 2 Meaningful Use requirements in particular and the Computer Physician Order Entry (CPOE) objective, which is a function that was mostly developed by EHR vendors who didn’t take health information exchange into account.

“There’s growing pains [as well]. For one example, when we look back at Stage 2 requirements around CPOE – that’s a function that’s been enabled broadly by EHR vendors without requiring a connection to an HIE to make it happen. Obviously HIE isn’t needed as much for that function. It’s a lower priority,” Grinburg mentioned. “On the other hand, results delivery is critical that it be available via HIE.”

“Making those results more broadly available via HIE means we’ll be able to avoid some redundant testing.  I think the program has been a big plus in helping to encourage and advance the cause. We’re looking forward to a detailed review of the Stage 3 requirements to see where we are.”

“There’s always going to be tension between the community that has to live up to the requirements and the program that’s trying to advance the cause. I think that tension is natural and healthy,” Grinburg stated.

When asked about some of the biggest benefits of health information exchange, Grinburg explained that HIE systems are essentially tools that allow physicians to incorporate strategies toward improved quality of care but do not ensure a full solution to the issues surrounding the healthcare industry.

“HIE is a tool. It is not the solution. It is the tool that can be used to enable the solution to some of the challenges that face our healthcare system,” Grinburg stated. “For example, using HIE, we can make better information available to identify patients who have been recently discharged and identify those situations where the patients are not getting adequate follow-up care and do something about that as a way of reducing readmissions. Making HIE a tool available to identify those cases and actually taking steps to act on them are two different things.”

“That’s why our HIE efforts are so closely intertwined with care reform efforts happening in the marketplace. Those care reform efforts such as accountable care organizations and patient-centered medical homes are really the people who can take advantage of the tools that we are making available to lead to improved outcomes both on the individual and public health basis.”

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Young physicians see promise for fully connected health ecosystem

Young physicians see promise for fully connected health ecosystem | Healthcare and Technology news |

Physicians under the age of 40 are more likely to believe the industry will reach a fully connected technology environment soon, while those older than 40 think that move is at least five years away, according to a surveyby MedData Point.

Of the 171 physicians responding to the survey, 61 percent older than 40 feel a connected environment won't happen until 2020 or later. Sixty-seven percent under the age of 40 said it would happen in the next one to five years.

Other findings the report uncovered include the following:

  • Two-thirds say costs is the biggest barrier to connected health, with 100 percent of dermatologists listing it as the No. 1 issue
  • Forty percent say they are closest to adopting patient portals, with 51 percent of large practices but only 27 percent of small practices saying they will adopt patient portals soon. Patients increasingly look for healthcare providers that offer digital services.
  • Only 29 percent say they are close to adopting interoperable electronic health records. However, interoperability is healthcare's biggest goal currently, and glimmers of hope are on the horizon, writes FierceHealthIT Senior Editor Dan Bowman.

Barriers created by high costs may be shrinking. The confidence of health IT leaders is growing regarding their ability to meet business demands, according to a new survey by Hanover, Maryland-based TEKsystems, a provider of IT staffing solutions. In its survey of CIOs and other health IT execs, 51 percent of respondents said they expect their organization's healthcare IT budget to increase in 2015, down from 68 percent who said so a year ago.

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Banner Health, Cerner Partner for Population Health

The Phoenix, Az.-based Banner Health and health IT giant Cerner (Kansas City, Mo.) are teaming up to leverage new developments in health information technology and population health management. 

According to an announcement from the companies, the multi-year strategic partnership will aim to advance and innovate health and care delivery. This collaboration builds upon decades of prior engagements between the two organizations, including the deployment of the Cerner Millennium electronic health record (EHR) across 26 Banner hospitals that has resulted in 21 of these hospitals being recognized as Healthcare Information and Management Systems Society (HIMSS) Electronic Medical Record Adoption Model (EMRAM) Stage 7 organizations.  

Banner Health and Cerner will continue to roll out Cerner Millennium across all of Banner’s campuses and clinics, which will include a comprehensive strategy to align the provider’s clinic-based record with the hospital’s acute care record, officials say. What’s more, the two organizations will roll out and adopt several Cerner HealtheIntent enabled solutions across the organization. This platform is designed to aggregate the clinical, financial and operational data that occurs as part of care delivery and then normalize the data to allow for deeper insights and interventions for both individuals and entire populations.

Banner, one of the largest healthcare systems in the country, has been recognized nationally for quality outcomes associated with population health management models that involve collaboration between Banner Health Network (BHN) and private and government insurers. In these collaborations, BHN shares the financial risk of caring for and managing patients and members with the insurers. As part of the commitment, key Cerner leaders and associates will relocate and be permanently assigned to Banner’s headquarters in Phoenix. This partnership will include the development and opening of an on-site conference and visitor center that will test and showcase these innovations and their impact on health management resources, officials say.

“At Banner we’re convinced that the transformation of healthcare—better outcomes and enhanced services for less costs—will largely occur through population health management plans that improve usage and management of services in hospitals and clinics,” Peter S. Fine, Banner Health president and CEO, said in a statement. “Effective and innovative electronic solutions will be at the heart of this transformation, and Cerner is an ideal partner as a leading organization in these efforts.”

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