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News 12/27/13

December 26, 2013 News 11 Comments

Top News

12-26-2013 7-01-06 AM

CMS adopts final rules that extend the Stark exception sunset date from December 31, 2013 to December 31, 2021. The amendment allows healthcare entities to continue subsidizing physician purchases of EHRs and includes additional rule modifications, including:

  • The exclusion of lab companies from donating EHR items and services
  • The elimination of the e-prescribing capability requirement
  • Updates to the interoperable provision
  • Clarification of the requirement prohibiting any action that limits or restricts the use, compatibility, or interoperability of donated items or services.

HIStalk Announcements and Requests

inga thumb   Mr. H whisked away Mrs. H for a little holiday this week, but he should be back this weekend. We’re about to be in the midst of the pre-HIMSS fury so I am glad he took time for R&R with Mrs. H before the craziness begins.

inga thumb  News was slow on HIStalk Practice this week but you’ll want to check out the letter Dr. Gregg sent to Digital Santa before St. Nick jumped on his sled.  Thanks for reading.

Acquisitions, Funding, Business, and Stock

The HIMSS Foundation and the National eHealth Collaborative merge their organizations and announce plans to create the HIMSS Center for Patient- and Family-Centered Care and to integrate NeHC’s educational and HIE programs with existing HIMSS resources.

PM and RCM service provider Medical Transcription Billing files a registration statement for a proposed IPO.

12-26-2013 12-51-39 PM

The Singapore government invests $500,000 in Ring.MD, a telehealth startup focused on improving access to high-quality physicians in Asia. The company was founded by Justin Fulcher, a 21-year-old entrepreneur who has been coding since he was seven and started his first business as a preteen.


12-26-2013 2-40-26 PM

Big Bend Hospice (FL) selects Allscripts Homecare software.

12-26-2013 2-42-49 PM

CareTech Solutions will provide consulting services to Medicine Bow Technologies (WY), which is developing a disaster recovery plan for services impacting Invinson for Memorial Hospital.



12-26-2013 2-46-03 PM

Cerner names former Indiana governor/current Purdue University president Mitch Daniels to its board of directors.

12-26-2013 12-42-09 PM

Family Health West (CO) hires Pam Foyster (Quality Health Network) as clinical informatics director.



Announcements and Implementations

Jamaica’s minister of health says his country will being implementation of an $50 million EMR system for hospitals and primary care clinics during the first quarter of 2014.

12-26-2013 2-47-16 PM

Maine Medical Center will increase its Epic EMR investment from $145 million to $200 million and dedicate about two-thirds of the funds for additional employee training. Health system officials admit they originally underestimated the resources required for training and may have made a mistake by starting the implementation at its 6,000-employee Maine Medical Center, rather than a smaller pilot facility. Earlier this year the hospital’s CEO said the Epic rollout and incorrect billing issues contributed to a $13.4 million loss in the first half of its 2013 fiscal year.

12-26-2013 2-48-59 PM

Weems Memorial Hospital (FL) goes live on its $450,000 EMR from CSS.

Sagacious Consultants launches Sagacious Analytics to help hospitals improve reporting and make better use of EMR data for performance measurement.

Vermont Information Technology Leaders makes radiology and transcribed reports from Fletcher Allen Health Care available to providers via the state’s Medicity-powered HIE.


Government and Politics

CMS announces the formation of 123 new accountable care organizations, bringing the total number of established ACOs to more than 360.


Innovation and Research

A new influenza forecasting method developed by Columbia University’s Mailman School of Public Health is proving almost twice as reliable as traditional approaches that rely on historical data. The system combines real-time estimates from Google Flu trends and CDC surveillance programs.




12-26-2013 2-55-33 PM

Apple secures a patent for an embedded heart rate monitor for smartphones.



A USA Today article looks at how the adoption of HIT and preventative care are improving healthcare and lowering costs. David Blumenthal, MD highlights areas requiring more work, including moving from fee-for-service payment models to risk-sharing or team-pay systems; improving care coordination through the use of IT; educating consumers on how to choose better care based on quality and lower costs; and, increasing the use of standards to lower administrative costs.

Mount Sinai Hospital (NY) reports a 40 percent decline in its sepsis mortality rate since implementing an early warning system within its EMR. The system triggers an alert whenever staff enter vital signs that match the criteria for early sepsis.

12-26-2013 10-25-15 AM

Over two-thirds of HIT professionals participating in a HIMSS compensation survey report receiving a salary increase in 2013; the average reported salary was $110,269.  Almost half of the 1,126 survey participants also received bonuses with the median bonus equal to three to four percent of annual salaries.


Sponsor Updates

  • NextGen posts its January webinar schedule.
  • Optum opens an on-demand health and wellness clinic in  Overland Park, KS.
  • Imprivata hosts its second user conference HealthCon 2014 May 4-6 in Boston.
  • Forbes profiles Ping Identity founder and CEO Andre Durand.
  • As the industry shifts to P4P and ACOs, API Healthcare VP of nursing Karlene Kerfoot predicts a shift in healthcare jobs from hospitals to home care agencies, outpatient surgery centers, and urgent care clinics.
  • Info-Tech Research Group names Informatica a Champion in its Data Integration Tools Vendor Landscape.
  • EDCO posts a video highlighting its point of care scanning process for clinical staff.

EP by Dr. Jayne

It’s a very slow week here since a good portion of our department took vacation days around the Christmas holiday. I’ve enjoyed the relative quiet and am glad to see that people are staying off of email. CMS shared some holiday cheer by emailing providers to remind them that if they didn’t e-prescribe in 2012 or 2013 they will receive their penalty in 2014. I don’t know why they insist on calling it a “payment adjustment” rather than a penalty. Penalties related to Meaningful Use will begin on January 1, 2015 so if you’re going to avoid them you need a solid strategy now.

I’m keeping my eye out for exciting opportunities in the New Year and was interested to see a couple of CMIO postings pop up at organizations that haven’t had a CMIO previously. Although it may be exciting to be the first CMIO and to be able to define the role, I don’t envy anyone taking a job at an organization that is just now figuring out they need one. A couple of the job descriptions were nebulous to the point where I’m wondering if the hospital even understands what they are looking for.

Medical Economics recently did a piece on the survival of the doctor-patient relationship. Physicians cite administrative burdens as the highest threat (41.9 percent) followed by EHR at 25.8 percent. I’m glad the article makes the point that some of the tasks could be assigned to other office staff members. I still struggle with physicians who insist on doing work that could be done by support staff including printing lab requisitions, tracking down test results, processing refill requests, and dealing with insurance paperwork.

The article addresses the EHR challenge more specifically – citing anecdotal stories of physicians who spend 10 minutes of a 15 minute appointment typing. I’m continually surprised by the number of my peers who refuse to learn to type. If you’re going to use free-text rather than structured documentation, typing skills are essential. I remind our physicians that if they mastered biochemistry and tying surgical knots they can learn to touch type but they still resist. I’ve even tried a games-based approach to try to harness their competitive natures, but haven’t had a lot of success.

Another physician states he spends “eight to 10 minutes per chart entering information not directly related to patient care, mainly tied to quality metrics.” Based on conversations with some of our providers I’d have to challenge that statement. We have a large employed provider base and it’s always a shock when someone thinks that a particular clinical quality element is “not my problem” especially in the ACO environment. We’re fortunate to have an EHR where the quality metrics are baked into the documentation – there’s not a lot of extra work to do. I know many sites don’t have this advantage but for us there’s no excuse.

I recently went a couple of rounds with a surgeon who said the patient’s morbid obesity was “not my problem.” I countered that if he plans to do any procedures on her, it certainly is his problem because of the risk of complications directly related to the obesity, not to mention the need to find out if there is diabetes related to the obesity because that alone can complicate wound healing. The same thing applies to our orthopedic surgeons who don’t want to check blood pressures. Fortunately our organization has made measurement of vital signs part of the required elements for physicians to receive bonus payments, so it makes it easier for me to push back at them.

I know there are a lot of EHRs out there where the documentation isn’t so simple and having used a couple of them I’d encourage physicians to look for alternate strategies to make it easier. I did a stint as a locum tenens where the physicians dictate using voice recognition and then staff post-loads the discrete data elements that the system doesn’t recognize. It worked well and the physicians had a high level of satisfaction. Essentially the extra two patients a day they could see by using voice recognition allowed them to pay for the extra staff needed to load the data. It was revenue neutral but the physicians felt better not clicking as much as they used to.

I think the key to managing quality indicators is having a plan on when they are going to be addressed. I see a lot of physicians struggling to try to address every indicator at every visit and it’s just not necessary. My EHR allows me to filter and only see those items that are due in the next three months, six months, etc. so that helps somewhat. Our group also has policies about when the indicators are to be addressed. For example, patients in for an annual preventive visit should have all preventive services due during the next 18 months addressed. This covers them for the next year and a little bit extra should their return appointment be delayed.

The article also cites the amount of time needed to have a conversation with the patient about screening services as a barrier. We provide extensive training to our medical assistants (no nurses in our world) on how to address preventive services with patients during the intake and rooming process so that the patient knows it will be a topic of discussion. The staff can provide educational materials for the patient to read before the physician enters the room, which can make some of those conversations easier and faster. Additionally, providers are not expected to address all preventive services on acute visits. We rely on our automated outreach mechanisms to catch those patients who don’t come in for preventive visits or who have lapses in care. This has been a major physician satisfier because the acute visits remain fairly quick and they don’t have to spend time worrying about patients falling through the cracks.

Having policies on when to address what kinds of services doesn’t have anything to do with the EHR – we actually had these policies in place in the paper world – but they’ve made a great deal of difference. We also provide training for support staff on completing pre-authorizations and pre-certifications so that work can be handed off even in a small office that doesn’t have dedicated referral staff. Looking at the operational workflow and staff training has helped physician satisfaction and hopefully will be one of the things bolstering the patient-physician relationship in our organization. Does your organization have any secret recipes for success? Email me.


Mr. H, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis, Lorre

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11 Responses to “News 12/27/13”

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  1. 11
    Re: Lessons Says:

    A few of my opinions (strong emphasis on the ‘my’ and ‘opinion’ part) on your question about turnover and other factors from my view of the project.

    Some of the turnover on the Epic side seemed to be standard issue company departures of employees around the 3 year mark who were burnt out as well as the newbies who became burnt out after learning their job would require 60+ hour work weeks in addition to traveling more than they were initially told about. Other departures ranged from freak accidents (the sudden death of a 22 year old new hire) to MaineHealth not feeling an Epic person was the right fit and having them removed from the project. On the MaineHealth side, a number of people came and went on the project team as we discovered that Epic training and certification didn’t actually prepare us for what we needed to do, or that some people were selected for the project based on knowledge of how the system ‘should’ work, but not any knowledge about technology or how to build a new system.

    Actionable lessons learned or suggestions about avoiding burnout and putting the right people on the team: Epic is hard. Learning Epic is harder. Learning how to customize and build an Epic system is the hardest. If I were building a new hospital-side project team for an Epic project, I’d be looking for the best and brightest of my staff that is technologically savvy, NOT the people in my organization who know the most old clinical workflows, old billing procedures, or registration workflows. Installing Epic is not a simple copy/paste job and will require intensive logic and operational thought processes as you rebuild the END PRODUCT of your old system. Note the bold words. One of the problems we ran into at MaineHealth was that we rebuilt the old system in the new system, but this time around it didn’t account for all of the bandaids and patchwork solutions that were apparently happening as data flowed across each of the legacy systems.

    As for training related topics recently discussed by MaineHealth leadership and on this site – it is true that MaineHealth did not give the right priority to training during the installs. On the Epic side of things, it was very clear that training was an afterthought by the Epic ACs as they became more and more overworked with their three different customers. On the MaineHealth side, there were a number of trainers that came and went over the years. From what I have gathered most assumed we were using standard Epic Model workflows and didn’t customize very far from the Epic ‘Training Wheels’ material. Instead we did very little that was ‘Epic Model’.

    Actionable lesson learned: Integrate your trainers into your integrated testing, unit testing, and bring them to project team meetings when applicable. Do not isolate them. Make them familiar faces with your operational leadership. MaineHealth made the mistake of hiring and finalizing its trainers much later into the install when some of these things weren’t possible.

    Other thoughts: Despite what you may read on this website’s comments section, Epic DOES know what they are doing and many of their recommendations come from years of its success AND failures. We made a decision years ago to have multiple service areas across each of our physical locations. We then decided to bring everything under a single service area right before a go live and had to delay as a result. They told us the implications of each option and let us make the decision, but didn’t completely stand in our way and stop us from making a decision that would ultimately get in our own way. We did eventually make a choice that they recommended, but after it was too late. There are other instances during the course of the install that are very similar. Epic attempted to keep a strict schedule for us with the build of our CDM, but as we debated and discussed just how many organizations we were consolidating from, the deadline was pushed further and further back. No CDM, no Build. No Build, no Testing. No Testing, no Integrated Testing. No Integrated Testing, no Training. Some of the dominos that fell after go live were placed many many years before anyone actually saw the action.

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