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Readers Write: Connecting the Divide between Inpatient and Outpatient Care

October 4, 2013 Readers Write No Comments

Connecting the Divide between Inpatient and Outpatient Care
By Michelle R. Troseth, MSN, RN, DPNAP, FAAN

10-4-2013 4-26-01 PM

Premier Healthcare Alliance’s spring 2013 Economic Outlook predicts a major shift in admissions from inpatient to outpatient settings. With such predictions, healthcare organizations must connect episodes of care, closing the gap between inpatient and outpatient care. Only then will healthcare develop integrated networks that include hospitals, health systems, ambulatory care centers, community clinics, long-term care facilities, home care agencies, and medical groups, that can work together to coordinate care and share accountability for quality, cost, and outcomes.  

Accountable care demands the reform of healthcare delivery. The key to successful clinical integration is to build high-performance organizations of physicians, specialists, hospitals, and others that are willing to adopt and use information technology and innovative care systems to prevent illness, enhance safety and quality, and coordinate and integrate care. In the process, these organizations become accountable for the quality and cost of care delivered to a defined patient population.     

Equally relevant to closing the inpatient/outpatient divide are the escalating requirements of Meaningful Use, as well as clinical integration, which demands information systems designed to provide clinicians with access to meaningful, actionable information at the point of care decision making. 

The great challenge to achieving new ways of thinking and practicing in the midst of the shifting landscape remains in the how to best create integrated healthcare systems.  While an interoperable technology platform is unquestionably needed, so is an interoperable practice platform to expedite the seamless transition of care between inpatient and outpatient. 

In developing a common practice framework that can be embedded in any technology platform, the following components have been validated as essential for high-quality seamless care:

  • Shared purpose and values 
  • Dialogue skills
  • Polarity thinking skills
  • Competency in full scope of practice
  • Integrated competency to halt duplication of services
  • Partnerships to support networking across the continuum
  • Evidence-based tools to develop individualized, interdisciplinary, integrated plans of care
  • Integrated documentation that reflects the patient’s story, plan, progress and outcomes across the continuum
  • Exchange processes and handoffs that ensure safe, quality care

If providers hope to close the gap between inpatient and outpatient care, they should adopt such an infrastructure that supports continuity of care. Among the most essential steps are: 

  • Provide teams with interprofessional, evidence-based tools
  • Implement integrated clinical documentation
  • Engage patients and family members
  • Insist on interoperable HIT systems
  • Develop professional exchange/ handoffs processes that ensure safe, quality, coordinated care
  • Allow professionals to practice to their full scope of practice

We can bridge the gap between inpatient and outpatient care if we remain aware of the shifting demands of accountable care, population health management, clinical integration and collaborative, coordinated and consistent care by government, payers, patients, and provider partners. Instead of another high-tech fix, implementation of a comprehensive practice platform that blends evidence-based tools with team competency and compassion should be considered. 

Just as important is the investment in smart content that supports integrated documentation, patient engagement, interoperable systems, professional exchange, advanced practice professionals, and intentionally designed tools to support coordinated, collaborative care.    

Michelle R. Troseth, MSN, RN, DPNAP, FAAN  is chief professional practice officer of

Readers Write: The Changing Physician-CIO Relationship: Do You have a Strong Partnership?

October 4, 2013 Readers Write 1 Comment

The Changing Physician-CIO Relationship: Do You have a Strong Partnership?
By Rob Culbert

10-4-2013 4-21-46 PM

Building a relationship is hard. Managing a successful and long-term partnership is even harder.

That’s what most healthcare chief information officers (CIOs) are finding out as they examine their rapport with physicians. Productive relationships take effort and a commitment to change. Successful healthcare organizations can strengthen the physician-CIO dynamic by making a concerted effort to involve physicians in their technology adoption efforts.

Consider these questions as you determine how your organization stacks up in fostering positive interactions with your physicians and what you need to do to build a stronger physician-CIO partnership.

What’s driving the changing relationship between your CIO and physicians?

In most healthcare organizations, physician and CIO responsibilities have historically been siloed—the CIO drove technology, physicians drove clinical care. Now the relationship is changing as physicians expect the hospital to provide greater technology support, which in turn allows the physician to provide higher quality care. More than ever, physicians demand a system that provides full access to both ambulatory and inpatient clinical data.

Yesterday’s hands off approach with physicians no longer works. Healthcare CIOs must employ an intentional strategy to involve their physician partners and meet their new requirements for support and information.

What specific roles are physicians playing in your technology deployment?

Technology is becoming more directly linked to patient care, so much so that physicians now expect systems that seamlessly support their work and improve efficiencies. This is even more the case with younger physicians, who grew up using technology and can’t imagine delivering care without it.

To capture physician opinions and requirements for technology, organizations may want to create a physician steering committee, which involves physicians in major decisions about system design, functionality, and content. Organizations are using these committees to fix and improve specific technology. For example, working as a subset of the steering committee, a physician ICD-10 committee may focus on the required workflow changes and corresponding system changes needed to support a smooth implementation of the new code set. After implementation, physician practice user groups can be leveraged to educate physicians on advanced features and to gain feedback for system adjustments.

Are you providing opportunities for physicians who don’t want to be heavily involved in technology?

It’s a fact: some physicians simply want to be doctors, not IT gurus. Yet, they still can provide a wealth of information through their frontline system knowledge. Avenues for feedback include physician surveys, informal focus groups, or even hallway conversations. Site visits to physician practices can clearly reveal how the system is being used and highlight opportunities for improvement. Garnering involvement and feedback from as wide an audience as possible leads to a healthy and dynamic physician-CIO rapport.

What benefits can your organization realize through physician-CIO alignment?

Perhaps the biggest benefit of physician-CIO alignment is that it’s just good for business – for the physician and the healthcare organization. Most practices don’t have the resources for a sophisticated IT structure with 24/7 support, clinical system protection, disaster recovery, and guaranteed uptime performance. However, healthcare organizations often have extensive IT capabilities and can provide the needed support and resources at a reasonable cost.

Healthcare organizations benefit because strong alignment between physicians and technology leaders can ultimately improve patient care and foster greater efficiency. In addition, it can positively impact a physician’s choice where to practice. Because most physicians want to partner with an organization that is responsive to physician involvement, this strengthened relationship allows organizations to be more competitive in recruiting and retaining physicians.

Strong physician-CIO interactions can also help a healthcare organization strategically position itself for quality improvement and agility with the coming healthcare legislation, ultimately improving payment and reimbursement rates for both parties.

Establishing and maintaining strong partnerships between physicians and technology leaders is essential to navigating the evolving healthcare landscape. As information technology becomes more critical to care delivery, the strength and resiliency of the physician-CIO relationship will determine your organization’s ability to successfully deliver quality care and maintain financial viability.

Rob Culbert is president and CEO of Culbert Healthcare Solutions.

Readers Write: The Increasing Enforcement of HIPAA and What It Means To You

September 25, 2013 Readers Write 1 Comment

The Increasing Enforcement of HIPAA and What It Means To You
By Kent Norton

9-25-2013 6-35-21 PM

Since the inception of HIPAA and its enforcement, there have been nearly 100,000 cases or complaints investigated. Among those, many have resulted in fines ranging from thousands of dollars to more than two million. Today the fines have a cap per penalty and per calendar year, restricting the fines to $50,000 per penalty and $1.5 million per calendar year.

Fortunately, the Office for Civil Rights has allowed entities to correct the aberrations of noncompliance within 30 days if the failure to comply was not willful neglect. The likelihood that your organization is audited is small when considering that in 2012 only 150 entities were scheduled to take place. The main issue of concern is that a patient, for whatever reason, will file a complaint about HIPAA noncompliance.

With the addition of the HITECH amendments in 2009, HIPAA enforcement has been on the rise, with more than five times as many cases settling after 2009 than before 2009. HITECH has certainly done more to change the face of protected health information or PHI than HIPAA originally did.

For most organizations the first thing that should be scrutinized when considering HIPAA and HITECH compliance is a risk analysis. This is a terribly large task especially when your IT department must do their analysis while still fielding their daily IT requests. Because of the large strain this puts on an organization, a new section in the IT industry has come about to do this type of risk analysis and HIPAA/HITECH compliance implementation. It may be wise to consider employing an IT risk analysis and implementation team in order to help your organization become HIPAA/HITECH compliant as quickly as possible.

The second thing to examine about your PHI is the defense your IT department has against attacks from both internal and external fronts. An efficient and effective PHI defense needs not only intelligent, self-aware, and careful staff and policies, but also complete control of physical data and data transfer. Once these are in place, your IT department can look at how PHI is accessed and the possible avenues hackers would use to bypass the security measures that are in place. One of the most subtle possible leaks of physical data or PHI is often overlooked and that is personal mobile devices. Developing controls and checks to keep PHI from being transferred, copied, or changed via a personal mobile device can greatly improve an organizations risk of noncompliance.

Lastly, inspecting the systems you have in place in order to determine the necessary frequency of periodic risk evaluations and assessments and to develop a monitoring and security mitigation plan. Having these two systems in place will help keep your organization compliant as the IT industry evolves with the changes in health care and technology.

As enforcement of HIPAA continues its upward trend, more and more organizations will need to take a better look at how they have implemented their compliance programs. They’ll need to make sure that they have taken the right steps in order to be safe from the steep fines and penalties that could come as a consequence.

Kent Norton is a HIPAA security analyst with HIPAA One.

Readers Write: Nay for CMS Proposed Rules on ED Facility Fees

September 25, 2013 Readers Write No Comments

Nay for CMS Proposed Rules on ED Facility Fees
By Robert Hitchcock, MD, FACEP

9-25-2013 6-28-00 PM

The calendar year 2014 Outpatient Prospective Payment System Proposed Rule (CMS-1601-P) proposes several changes that I believe will negatively impact emergency departments (EDs).

The two proposed changes in particular that have me concerned are:

  • Consolidation of the five ED facility level evaluation and management (E&M) codes into a single code
  • Packaging of add-on services

Consolidation of facility level codes

Without clear facility level guidelines, determining accurate codes is challenging for hospitals and potentially responsible for the recent media stories suggesting that upcoding is occurring. Despite repeated requests for CMS to develop guidelines and much industry input and willingness, no action has been taken. I’m concerned that the proposed consolidation is a substitute for clear facility level guidelines. The methodology for determining reimbursement amounts for the proposed codes are unclear and no impact analysis on hospitals has been performed, or could be from the data presented.

The logic currently used by most hospitals to determine facility E&M codes for ED visits relies on evaluation of the resource requirements to care for the patient during the visit. In many cases, the distribution of patient complexities, and thus facility codes, is often a result of multiple factors – many of which the hospital has no control over.

For example, hospitals in areas where Medicare patients have limited access to primary, preventive, and specialty care may see patients with poorly managed chronic diseases who are more complex and resource intensive. These hospitals may well experience a significant decrease in reimbursement, which may negatively affect their ability to continue to provide healthcare services. In addition, increasing the number of lower acuity Medicare patients treated in the ED will significantly increase total federal healthcare expenditures for unscheduled care.

A tiered structure is essential to the financial stability of hospitals and would help protect against shifting care patterns that could unnecessarily raise healthcare expenditures. Clear, concise guidelines should be developed that allow hospitals to accurately and reproducibly assign the appropriate tiered services code for a particular visit. If simplification of coding guidelines and reimbursement is a main goal, I would suggest one approach would be to shift from five tiers to three. This will allow the healthcare system to continue to track and manage the resources required to provide unscheduled care.

Packaging of add-on services

The proposed packaging of add-on services has a commendable goal of simplifying reimbursement and encouraging hospitals to seek efficiencies in the care they provide. However, some of the proposed packaging involved are for specific therapeutic services that are often required to provide high quality care. I believe that the broad brush of unconditional packaging of all add-on services is inappropriate and could lead to circumstances that are directly detrimental to patient care.

The packaging of add-on services in certain circumstances would be beneficial, such when the provision of the service is not directly related to therapeutic delivery of care, especially medications. For instance, providing additional intravenous doses of an identical medication are often required to provide optimal care (e.g., analgesic administration for pain control or additional intravenous hydration for dehydration). There’s really not much opportunity for improving efficiencies here; either we provide appropriate pain management, or not. The concern lies in that packaging these services may create situations where optimal patient care is pitted against the financial pressures of the hospital.

Preservation of EDs

I believe that the proposed modifications to these two areas would have a negative impact on both national healthcare costs and quality of patient care delivered. As a safety net for healthcare in the US, the preservation of EDs is critical.

The final rule is expected around November 1 and will take effect January 1, 2014.

Robert Hitchcock, MD is chief medical informatics officer of T-System Inc.

Readers Write: Meaningful Use to the Maximum: Keeping the Focus on the Patient

September 18, 2013 Readers Write No Comments

Meaningful Use to the Maximum: Keeping the Focus on the Patient
By Gary Hamilton

9-18-2013 6-33-03 PM

Across the country, healthcare organizations are evaluating their ability to meet the Centers for Medicare & Medicaid Services (CMS) Meaningful Use (MU) requirements. Data recently released by CMS revealed that more than 23,000 family physicians became first-time “meaningful users” last year, a 180 percent increase from 2011. At the same time, CMS data showed a 21 percent drop in the retention rate of attesting physicians.

Although these statistics reflect one portion of the physicians seeking to attest for MU, they point to a bigger issue among all entities involved in this effort. While MU Stage 1 attestations are up, the number of providers dropping out of the program before reaching Stage 2 is also on the rise.

The question is: Why?

One contributing factor may be the lack of focus on “meaningfully” using technology. As physicians and hospitals embark on the MU journey, they often focus their attention on technology purchases and upgrades, losing sight of the true intent of the government’s program—to improve patient care.

In fact, some organizations have been so preoccupied with the technical components of their IT systems and how they meet Stage 1 requirements that they fail to realize their current technology is not capable, or does not have the necessary certifications, to help them meet Stage 2. As organizations become increasingly concerned with Stage 2’s escalating requirements, some providers are deciding it is easier to drop out of the MU process than to continue to the next level.

For those physicians and hospitals that do decide to forge ahead, it’s imperative not to lose sight of the intent of MU: a better patient experience both in terms of outcomes and satisfaction. To do this, healthcare providers must go beyond merely viewing MU attestation as a “check the box” exercise; instead, they must take a more strategic approach that puts the patient at the center of the process.

Here are some key questions to keep in mind when developing a MU strategy that maximizes the “meaningful” in Meaningful Use.

1. How would you use technology to improve patient care if the government’s incentive program didn’t exist?

Elevating patient care and making it more patient-centered cannot be viewed as a separate initiative from MU attestation. To keep the patient firmly at the forefront of MU efforts, an organization first must consider how to foster patient-centered care and then think about the technology that will best enable the work. Many MU standards represent activities that organizations should be doing to make the care experience more patient-driven, regardless of the decision to attest. These efforts can also streamline operations, enhance workflow ,and facilitate strong care coordination. For instance, patient-focused organizations should consider implementing technology that enables electronic scheduling and appointment reminders as both a convenience for patients and a time-saver for staff. Or, electronic forms should be used to speed new patient registration, eliminating the need to scan or key paper documents and control delivery.

2. Is the technology you’re considering “smart” for your organization and your patients?

For technology to be beneficial, patients and providers must fully embrace and use it. To realize this level of interaction, an organization must consider both patient and provider needs and workflows when selecting technology. Getting a firm grasp on this information may require an organization to conduct focus groups, interviews, or surveys to learn more about both groups’ needs and how the technology can best meet those needs. Things to look at include how the technology can improve convenience, enhance information sharing, further efficiency, and foster communication. By taking the time to fully appreciate and respond to patient and provider input, an organization can ensure the selected technology is appropriate and “smart” for the organization.

3. Is your patient-centered approach enabling the transition to MU Stage 2 and beyond?

MU Stage 1 requires organizations to prepare to involve patients in their care by providing patients the ability to request and view an electronic copy of their health information. Beginning in 2014, a key Stage 2 objective will require at least five percent of a health organizations’ patient population to download, view, and transmit health information. When organizations attest for MU Stage 1 with an eye toward patient-centered care and strong information sharing, they not only meet MU Stage 1 requirements, but also lay the groundwork for MU Stage 2 and beyond, progressing toward the next stage faster and more efficiently. More importantly, they are able to maintain greater patient focus and foster satisfaction because patients are interacting with the technology in a way that is both convenient and enhances the care experience.

Successfully meeting MU criteria requires patient-centered care to remain the central focus, regardless of the stage. Without maintaining this attention, an organization can quickly get lost in the weeds of technical specifications and lists of requirements. By intentionally selecting technology that keeps the patient at the forefront, organizations can provide a positive patient experience while bolstering patient loyalty. Engaging this approach can effectively underpin efforts to not only meet the MU criteria, but also put the “meaningful” back in Meaningful Use.

Gary Hamilton is president and founder of InteliChart of Fort Mill, SC.

Readers Write: Healthcare Talent Shortages: So Where Are All the Mentors?

September 18, 2013 Readers Write 2 Comments

Healthcare Talent Shortages: So Where Are All the Mentors?
By Helen Figge, PharmD, MBA, CPHIMS, FHIMSS

9-18-2013 6-22-19 PM

Healthcare is a business from every angle, and from each of these angles there is a need or a demand for something, whether it is a skill or some other attribute. It’s all about supply and demand. The age-old problem in healthcare of finding qualified staff never seems to land on a solution. It is now pointed out in virtually every article of why milestones are missed or professional burnout occurs.

Even a new survey from SSi-Search reports, for example, that the CIO is now more than ever under pressure to perform and execute day-to-day issues and processes to move their institutions to the next level. In this recent study, it was again pointed out that CIOs are finding it hard to find qualified help to diffuse the pressures being felt on them and their IT teams in order to execute the various technology projects within their organizations.

Most of these pressures being discussed and felt firsthand reportedly are mapped back to the HITECH Act of 2009 and healthcare reform in general. In the end, to add to the conundrum, these various healthcare reform changes are all dependent on technology enablers and qualified help to use these technologies to support the various healthcare programs being implemented in the institutions. Alas, potential full circle turmoil.

This particular survey even catalogued the “standard” CIO as a “highly educated male, who has served in the role for 10 years and earns $286,000.” Approximately 178 individuals responded to the survey, probably even adding to their stress load of the day. The study also presumed that increased responsibilities would result in greater compensation, but the findings did not support this line of thought. In the end, workload was viewed as not being compensated compared to job responsibility and stress of performing.

But when all was said and done, the CIOs queried really focused on having the right teams in place to support the ability to continue to deliver good quality results. Those who answered the survey wanted “more and/or better qualified resources." What is a CIO, or for that matter anyone, facing this issue in healthcare today possibly doing to resolve this?

Not sure, but one suggestion: create a mentoring program and create others who “grow up to be just like you.” The gaps we are seeing in healthcare today will never be filled by “Stepford wives” or cookie cutter personnel. These individuals just don’t exist and probably never did or will. But the healthcare IT roles in particular out there today can be filled with those in the lower ranks of many organizations. If these individuals have the base skills and degrees required and then get groomed and cultivated by those who have been there and done that, we might be surprised just how effective this approach might be filing the healthcare IT void once and for all.

Early in American history we had apprentice programs for virtually everything from growing crops to shoveling coal in the coal mines. These industries survived and flourished. Why not create the same programs in healthcare IT and address the workforce shortage once and for all? Besides, there are some really great CIOs out there (and they know who they are) who have lectured, cultivated, mentored, and even picked up the phone to answer a question from a nobody like me to offer up guidance, patience, and direction to help the cause. These are the true leaders out there today and we need them now more than ever.

I say create a true mentoring program with these individuals (and not all are male or award winners) and create bonds between a these giants of healthcare IT industry ( the mentor) and the “I want to be a CIO someday” (the mentee). This in turn can create an opportunity to train by example of what needs to be done and the necessary steps involved in making things happen in healthcare IT.

Be a mentor, personally achieve some personal growth and career satisfaction, learn more about yourself as a human being, and really make a difference in your life and those you touch. This approach might not help the healthcare IT shortage immediately, but within three to five years if we have enough good mentors training mentees, this conversation would most likely be not worthy of much discussion.

Helen Figge, PharmD, MBA, CPHIMS, FHIMSS  is advisor, clinical operations and strategies, for VRAI Transformation.

Readers Write: Provider Charges: An Excellent Start

September 18, 2013 Readers Write 1 Comment

Provider Charges: An Excellent Start
By Data Nerd

9-18-2013 6-04-20 PM

Any data nerd worth his or her salt will tell you that a thorough analysis starts with vetting, mining, scrubbing, and purging compilations of data. Most of my time on any analysis project is spent understanding the context and cleansing data to the point that I can work with it confidently. So, when I came across this Medicare and Medicaid Research Review article, I wanted to bring it to the HIStalk readership’s attention as an excellent methodology for doing meaningful cost analysis across the country.

Remember earlier this summer when CMS unleashed the tip of the kraken with average DRG charges for hospitals? I say the tip of the kraken because (1) it was really a minute slice of a much larger pie, and (2) the data was sliced, diced, and visualized to a bloody pulp and although we haven’t seen a new release of data to confirm, we certainly aren’t hearing about any major price shifts in the market. As a similar release for individual providers is being considered, here is something meaningful we can do to actually understand and do something about real price variation.

Adjusting for acuity and policy factors that influence prices is essential to understanding why one provider charges more than another. Just like it was insufficient for CMS to release DRG data with average charges when patients could be treated for up to 25 diagnoses and 25 procedures in the same charge amount, it will be meaningless to release individual provider charges without the context of treatment.

Usually, I’m the first to ask for atomic “Collect Once Use Many Times” data elements (hard numbers on which to base other calculations), but in this case, relative weights really are more meaningful if you want to scout out the root of price differences. Are abnormally high salaries driving price? Supply chain inconsistencies? Medical errors? If you really want to know why one provider charges more than another, you need to hold all things constant, and the methodology outlined in this paper is an excellent start.

What do you think? Is it more meaningful to look at hard numbers (Hospital A charges $x vs Hospital B charges $y) or a relative weight holding wage and policy initiatives constant? Do relative weights obstruct meaning or provide a lens through which we can view data more clearly?

Readers Write: Big Data – The Next HIT/EMR Boondoggle?

September 9, 2013 Readers Write 5 Comments

Big Data – The Next HIT/EMR Boondoggle?
By Frank Poggio

Here we are on the back side of the HITECH wave. EMR vendors can see that the government-sponsored manna will soon end, so IT marketers have been prospecting for the next gold mine. They found it and it’s called “Big Data and Analytics.”

It really makes perfect sense. After they install the deca-million dollar EMR systems that capture and track mountains of healthcare operational data and send it to the government, what else are can they do with it? Analyze it! Analysis for clinical and administrative purposes, analysis for planning, analysis for diagnosis, for prognosis, for best practices, for financial management, growth strategies, market penetration, and more. To paraphrase an old cliché, “There’s got to be a pony in all that data somewhere.”

It is often repeated and rarely challenged that healthcare providers are a decade behind commercial industry when it comes to IT tools and implementation. That clearly is the case when we look at Big Data (BD). But before healthcare jumps into this numerical ocean, maybe we can learn something from commercial industry and bypass many of the hurdles and errors private industry hit during its initial foray into the world of analytics.

First, a little history. Today it’s called Big Data and Analytics, but in the 1960s it was called Operations Research, Management Science, or Quantitative Analysis. Operations research was actually an outgrowth of World War II. The Defense Department asked mathematicians to identify more effective and efficient methods for bombing the enemy. The British used modeling and data analysis to improve submarine warfare.

After the war, these sophisticated mathematical tools were applied to volumes of operational data captured by many business transaction systems of the 1970s. The focus was on optimizing production and improving forecasting in order to reduce the risk embedded in strategic decision making. The former used mathematical models such as linear programming and queuing theory aimed at maximizing throughput and minimizing costs. The latter was typically done with regression analysis, probabilistic models, and Monte Carlo simulation to assess and minimize risk. In the 1980s and 1990s, more sophisticated tools such as random walks, chaos theory, and fuzzy logic were developed and applied to financial and other business problems.

Today the thinking in healthcare is that with our ever-expanding sea of Big Data, we should start applying these same tools to help address the healthcare cost crisis. Not at a bad idea. But before we spend billions searching for our “pony,” we should at least learn something from the sins of our brothers in the commercial world.

During the ’70s and ‘80s, commercial industry spent billions trying to apply these concepts with only marginal benefit. It has only been in the last 10 or 15 years that analytics in commercial industry has really paid off with leaps in improved logistics and productivity, while the jury is still out on management, strategic, and predictive applications. It took decades for commercial industry to see measurable benefits from BD. Here are two of the reasons and their implications for healthcare.

Bad or insufficient data. Thirty years ago when commercial firms crunched big wads of financial data, they found that there were significant problems correlating econometric data with accounting data, and more so with tax and government data. Earlier in my career I worked for GE in one of their OR groups. We found that merging or correlating the data originally captured for the different audiences rendered unusable results. Much time and effort had to be spent reclassifying financial data to make it sync properly with econometric and government data. In addition, we came to realize that volume and statistical data not captured at the source was fraught with errors and misclassifications. Thousands of hours were spent normalizing, scrubbing, and disaggregating data before we could make reliable correlations for decision making.

Healthcare has some very similar challenges. The issue with accounting data versus econometric data is the same, but the disparities between reimbursement data (tax) and business operation or econometric data is far greater. As an example, commercial industry had to invest billions in sophisticated product/service costing systems, while today in healthcare, many institutions still rely on Medicare cost analyses, which any financial manager would classify as nothing better than gross approximations.

Many of the BD analytics will incorporate and be driven by cost comparisons. Medicare cost analysis is a long way from a true product/service cost accounting system.

Merging clinical data and financial data is currently the rage, but another big hole will be using billing documents, charges, or RVUs as a basis for analysis. Provider charges are not related to service cost because they have been warped by decades of government policy and payment nuances. They are as far from financial reality as we are from the sun. In addition, the coding and classifications embedded in billing documents have been twisted to meet the objectives of payors and payment rules. Everybody agrees that ICD-9 coding is inadequate if not inaccurate, yet no doubt it will be a core element in many of the BD analytics clinical  / financial models.

Reality versus the “model.” After several decades, commercial firms came to realize that many of the mathematical models they employed only loosely fit the real world. Models are far simpler representations of the real world and typically model builders fill in the blanks and more complex parts with assumptions.

The real world keeps changing. Yet many of the predictive tools we use such as regression analysis are based heavily on past performance and have limited ability to reflect change. Medicine is in constant change. Hardly a week goes by without a new research report that retires an old protocol and replaces it with a new one, while new drugs, modalities, and technologies are introduced almost every day.

The practice of medicine is both science and art. It is difficult to properly model the science part, let alone the art component. The same can be said for management: science or art? It took decades and millions of dollars before commercial industry realized the limitation of many of the predictive models they applied and how sensitive the predictions were to the underlying assumptions. Correctly modeling the subjective judgment component of management and medical decision making will be a very expensive task.

Clearly the old GIGO rule applies to Big Data as much as it applies to our day-to-day EMR transaction systems. The significant difference will be in the investment needed for BD just to get past level one GIGO. When we implement a transaction system we can see if it works effectively or has bugs in a matter of days. With Big Data and Analytics measuring the efficacy and impact can take years, be very expensive, and a financial boondoggle for vendors.

Next up: five things to check before diving into the Big Data ocean.

Frank Poggio is president of The Kelzon Group.

Readers Write: Seize the Opportunity: Making Your Meaningful Use Meaningful

September 9, 2013 Readers Write 1 Comment

Seize the Opportunity: Making Your Meaningful Use Meaningful
By Linda Lockwood, RN, MBA

9-9-2013 5-58-47 PM

In recent weeks, countless stories have appeared in healthcare-industry publications touting the complexities of Meaningful Use (MU) Stage 2 and the challenges ahead. While MU Stage 2 is no walk in the park, turning these challenges into an opportunity to establish the proper foundation at the outset goes a long way to setting up an organization for continuing success throughout the course of the EHR Incentive Program.

A strong MU program is also the basis for long-term quality and performance improvement that goes far beyond MU compliance. Viewed as strategically foundational, it can help health systems survive and thrive in today’s shift from volume- to value-based care delivery and reimbursement models.


Successfully meeting Meaningful Use requires more than just taking on another IT project, checking off boxes, and receiving incentive payments. Rather, a compelling case can be made for adopting a strategic and programmatic approach to enable ultimate success over progressive MU stages. It requires implementing a program with consideration of standardization, improved workflows, documentation at the point of care, interoperability, eCQMs as defined by multiple quality programs, and an auditable defense portfolio that provides evidence of the provider’s compliance and intent.

A full lifecycle looks beyond the initial incentive payments. It employs a comprehensive approach that closes the loop on every aspect of the program. It also establishes the culture and business plans that support improved patient care outcomes and efficiencies necessary to survive in the new, fee-for-value healthcare world.

Taking a programmatic approach to achieving meaningful use can provide foundational benefits in the long run. As we look back at the journey already traveled and ahead to MU Stage 2 and beyond, it is clear that the organizational approach to MU directly impacts future success. Organizations that chose the “easy way out” as a path to financial gain are now facing Stage 2 with increased thresholds, a focus on sharing data and engaging patients, increased emphasis on eCQMs, and realizing that they have significant work ahead.

Organizations that “seized the opportunity” at the outset and invested the time, money, and resources to set the proper foundation for value-based performance improvement are now in the lead with regard to successfully meeting the MU Stage 2 requirements.

If your MU approach was not robust enough, is all lost? Absolutely not. At the heart of every successful MU journey is an organization with a commitment from the top to view MU as a foundational strategy to improve quality and support the goals laid out by CMS. Much has been said about the transitions of care, patient engagement, and quality reporting issues, but what many don’t often talk about is how to position an organization for success. Some key points to consider include:

  • Identify and act upon lessons learned
  • Embrace a big vision; leverage the MU effort
  • Understand the scope and level of effort required; don’t underestimate Stage 2 challenges – thresholds, interoperability, and patient portal and engagement
  • Include all stakeholders; align with quality and performance improvement
  • Develop program management and governance
  • Focus on adoption and change management
  • Understand vendor approach; challenge and verify
  • Create an auditable defense portfolio and an audit plan
  • Budget for upgrades, software and services; understand how this will affect the timeline
  • Establish a comprehensive portal plan to include security, access, outreach, content, policies and procedures
  • Pay special attention to the Summary of Care – the complexities and the content to include physician documentation for care planning.

Meaningful Use is truly a journey that must be embraced beyond the IT department. To be successful, organizations must employ proactive executive sponsorship that supports the long-term, value-based, performance-improvement vision. Realization of the vision depends on developing and delivering a well-structured program. Organizations that adopt this approach will be aligned for success; they will be the frontrunners in this new world of value-based payment and performance improvement.

Linda Lockwood, RN, MBA is the partner of advisory services at Encore Health Resources of Houston, TX

Readers Write: Be the One

September 4, 2013 Readers Write 1 Comment

Be the One
By Daniel Coate

9-4-2013 6-01-52 PM

Amidst all the paperless aspects of our world, last year I subscribed to the New York Times Sunday edition on paper. I really enjoy the old-school nature of waking up Sunday morning, walking down my driveway to pick up the paper, and spending a couple of hours with a cup of tea or coffee reading the in-depth analysis of the week’s news.

I was taken by an article in the December 8, 2012 edition of the paper entitled, “Billion-Dollar Flop: Air Force Stumbles on Software Plan.” I’ve had it on the corner of my desk since and am just now thinking I should write about it.

The bottom line is that the Air Force is canceling a six-year modernization effort of its logistics systems and processes. On the technology front, they were attempting to convert from custom legacy logistics systems developed in the 1970s to an Oracle ERP system. The six-year track of the project cost “them” $1 billion (oh, and when I say “them”, I really mean “us”). By the time the Air Force canceled the project, it had realized it would cost an additional $1 billion just to achieve one-quarter of the capabilities originally planned. As a reminder, one billion is a big number – if you were to start counting right now at a rate of one number per second, you’d get to 1 billion in 2045 (32 years).

In analyzing the reasons for this colossal failure, many contributing factors were identified, such as starting with a big bang approach that tried to put every possible requirement into the program, making it very large and very complex.

However, the main reason identified was, “…a failure to meet a basic requirement for successful implementation: having ‘a single accountable leader’ who ‘has the authority and willingness to exercise the authority to enforce all necessary changes to the business required for successful fielding of the software.’”

As we all know, there are a number of exciting developments and converging forces changing the healthcare industry right now. With these converging forces, healthcare organizations are under tremendous pressure to address a number of priorities simultaneously:

  • Reduce operating costs while driving value
  • Implement and realize the full benefit of electronic health records
  • Transition from volume to value and plan for the accountable future
  • Harness the power of data and analytics to drive a data driven culture
  • Enable the connected community across the care continuum
  • Achieve Meaningful Use and complete ICD-10

While it seems like a tidal wave, these initiatives are aimed at paramount goals: better care, better health, and lower per capita costs. It’s essential that we as an industry heed lessons learned like this example from the Air Force to avoid similar stumbles or flops. While it’s never a comfortable position to be that single accountable leader, I think it’s important that as we all do our day-to-day work, we look for ways where we can either assume that leadership or recommend that a specific person assume that position. It is a key way to drive value from investments in information technology, operations and process improvement, and change leadership.

Daniel Coate is principal and co-founder of
Aspen Advisors of Pittsburgh, PA.

Readers Write: Paper Bills Can Be Hazardous to Your Practice’s Health

September 4, 2013 Readers Write 5 Comments

Paper Bills Can Be Hazardous to Your Practice’s Health
By Tom Furr

Every time I go through a healthcare facility I am struck by all the paradigm shifts, inflection points, and market disruptions glistening under the bright lights alit in examination rooms, labs, and other clinical areas.

It truly astounds me that there is such a yawning chasm separating the business office from the clinical side of the practice. It hits me all the more when I pause to consider most of what’s going on in medical practice management revolves around how a doctor will get paid for services provided.

This is part of the fundamental changes needed in the business office that requires a massive disruption to the way patients get billed, payments are secured, and – yes – the embrace of productivity- and profit-improving technology.

In fact, the MGMA states that today practices need to send out an average of 3.3 paper statements to secure payment. It’s not a great leap of logic to add bill issuance and bill pay to a practice’s online capabilities if it’s already “forced” to make patient clinical information available online. What’s more, the need to issue multiple paper statements that can cost around $0.70 to get paid is reduced, if not eliminated.

So be honest — what’s the hurdle that is keeping you from making a change? Are there several cases of paper invoices sitting on a shelf and you feel compelled to use them for fear someone will call you a money waster?

If you truly want to cut costs and improve profitability, throw away those paper bills and all the time consuming, error-producing manual processes associated with that antiquated and expensive process.

To be fair, the tumult of change is daunting for medical practices, but it doesn’t need to be destructive. Embrace change and employ innovative online patient billing and balance management that can be easily embedded into practice management software.

One key pressure medical practices are feeling which will make the change more palatable is the rise of patient accounts receivables; a reflection of the inexorable march from the simplicity of co-pays to high deductible health plans. One industry expert notes that, “It wasn’t that long ago that health plans covered 87 percent of medical bills. Now they cover 65 percent.” According to Aon Hewitt’s 2013 Private Exchange Survey, growth rates of high deductible health plans (HDHPs) has been averaging 10 percent per year, and as more employers promote the plans, the growth rate is accelerating.

If you still need motivation, let me share with you some research findings on consumer behavior when it comes to paying bills.

  • The people who stack up their bills once or twice a month and write checks are far and few between.
  • Folks who get bills in paper form tend to delay paying them versus those that arrive digitally.
  • Medical bills are often not paid because they are complex and confusing and the hassle to find out what the charges are for and what’s owed translates into…delayed payment.
  • Even the US Postal Service, that organization that depends on your paper bills as the bulk of what makes up first class mail today, has come to realize that 60 percent of consumers prefer to pay bills online, the result of a survey they conducted among people just like your patients.

Take a break from reading of the latest diagnostic breakthrough in a medical journal. Look at your practice’s balance sheet, particularly the A/R line. Before market forces push you to sell or close up your practice, embrace change in patient billing and balance management. Go away from paper and move toward better, more manageable profitability with online billing methods.

Tom Furr is founder and CEO of PatientPay of Durham, NC.

Readers Write: Natural Language Processing: Putting Big Data to Work to Drive Efficiencies and Improve Patient Outcomes

August 26, 2013 Readers Write 1 Comment

Natural Language Processing: Putting Big Data to Work to Drive Efficiencies and Improve Patient Outcomes
By Dan Riskin, MD

8-26-2013 6-26-06 PM

Natural language processing (NLP) is increasingly discussed in healthcare, but often in reference to different technologies such as speech recognition, computer-assisted coding (CAC), and analytics. NLP is an enabling technology that allows computers to derive meaning from human, or natural language input.

For example, a physician’s note may state that a patient “has poorly controlled diabetes complicated by peripheral neuropathy.” When notes are analyzed through an NLP system, coded features are returned that can:

  • Suggest codes such as ICD-9 or ICD-10 that may feed a CAC billing application;
  • Classify a patient according to applicable quality measures such as poorly controlled diabetes mellitus, to support a reporting tool;
  • Populate a data warehouse;
  • Feed analytics applications to support descriptive or predictive modeling, such as the likelihood of a patient being readmitted to a hospital within 30 days of discharge.

Healthcare is data intensive from both clinical and business perspectives. While the industry’s transition to electronic data collection and storage in recent years has increased significantly, this has not actually forced physicians to code the majority of meaningful content. Eighty percent of meaningful clinical data remains within the unstructured text, as it does in most industries. This means that it remains in a format that cannot be easily searched or accessed electronically.

NLP can be leveraged to drive improvements in financial, clinical, and operational aspects of healthcare workflow:

For financial processes, automating data extraction for claims, financial auditing, and revenue cycle analytics can impact the top line. NLP can automatically extract underlying data, making claims more efficient and offering the potential for revenue analytics.

For clinical processes, automatically extracting key quality measures can support downstream systems for reporting and analytics. NLP can infer whether a patient meets a quality measure rather than requiring individuals to manually document each measure for each patient.

For operational processes, descriptive and predictive modeling can support more effective and efficient operations. NLP can extract hundreds of data elements per patient rather than the 2-4 codes listed in claims, producing better models and supporting business insight and diversion of resources to high risk patients.

So, NLP is a powerful enabling technology, but it is not an end user application. It is not speech recognition or revenue cycle management or analytics. It can, however, enable all of these.

There is a battle underway that is increasingly recognized in the healthcare space. Individual hospital divisions seek turnkey solutions and frequently purchase NLP-enabled products. But at a broader level, health systems as a whole do not want to pay repeatedly for similar technology. They seek best-of-breed infrastructure, wanting a combination of electronic health records, data warehouses, NLP, and analytics.

This battle will increasingly highlight best-of-breed data warehouses, data integration vendors, and natural language processing technologies as health systems search for a scalable, affordable, and flexible healthcare infrastructure to feed a suite of clinical, operational, and financial applications.

Dan Riskin, MD is CEO of Health Fidelity of Palo Alto, CA.

Readers Write: Bridging the Divide: Can Clinicians and CFOs Speak the Same Language?

August 26, 2013 Readers Write No Comments

Bridging the Divide: Can Clinicians and CFOs Speak the Same Language?
By Nick van Terheyden, MBBS

Pity poor Henry the VIII. Historians still argue over his medical records. Though his was the most scrupulously documented medical history of his age, burning questions remain. Did he suffer from syphilis as believed for centuries? More likely he had familial diabetes, which better explains his symptoms – including his well-documented inability to heal from wounds.

Imagine if Henry’s physicians were also tasked with assigning codes and complying with the clinical documentation requirements of today. The Tudor dynasty might have had some reimbursement issues. Heads would have rolled.

Sure, bloodletting is no longer an accepted therapeutic modality. But have we really come that far in bridging the divide between the clinician’s responsibility for care and the CFO’s responsibility for financial performance? Or do finance and quality continue to be involved in a forced marriage of sorts?

Clinicians are focused on their patients. While they understand the importance of billing, they need to put their energies into diagnosing and treating patients to ensure positive outcomes. And they’re overwhelmed with data – patient test results, clinical studies, guidelines, protocols – much of which they have to sift through to find relevant, critical information. Add to that, they have the burden of learning the new coding requirements under ICD-10, with the deadline approaching around the corner.

CFOs, of course, are also focused on quality but, at the same time, must juggle that priority with issues related to reimbursement, their bottom-line and ever-changing and expanding compliance requirements. They’re continually seeking out and analyzing solutions that may be able to improve both patient health and revenue performance. At the same time, they also recognize that without physician buy-in, they cannot meet any of these goals; therefore, they are looking for meaningful ways to bring them along, without disrupting their workflows.

Information that’s deemed crucial for the clinician may not be deemed useful by the CFO, and vice-versa.

Yet finding ways to break through this language barrier between the clinical and financial perspectives will be a critical success factor for healthcare organizations in the years ahead. It’s more than just a communications issue. It’s a strategic imperative aimed at translating the narrative of care into an actionable piece of information that aids in care coordination, while also ensuring appropriate reimbursement and minimizing the potential revenue leakages that keep most hospital CFOs up at night.

Clinical documentation is at the heart of plugging these revenue leakages while also meeting quality standards. Instead of finding one-stop solutions to prevent leakages across the revenue cycle, it is much easier to build accuracy from the start rather than trying to fix the problem after the train has left the station and the process is in motion.

Regardless of the tools used, clinical documentation addresses the most important concern for both physicians and CFOs: ensuring that the most useful information is captured accurately and is made readily accessible to the decision makers (and systems) who need it. At the end of the day, we all know that quality leads to a win for all.

Nick van Terheyden, MBBS is CMIO of Nuance.

Readers Write: Fund Healthcare Modernization and Innovation – Retire Legacy Applications

August 21, 2013 Readers Write 7 Comments

Fund Healthcare Modernization and Innovation – Retire Legacy Applications
By Julie Lockner

8-21-2013 6-36-17 PM

The American Recovery and Reinvestment Act of 2009 (ARRA) provided the healthcare industry incentives for the adoption and modernization of point-of-care computing solutions including electronic medical and health records (EMRs/EHRs). Now that these funds have been allocated and invested in new information systems, hospital and patient care provider CFOs are checking in on the return on those investments. Many are coming up short.


These mega EMR/EHR applications are taking longer than planned to implement leaving a number of legacy applications running in parallel. In addition to hardware and software maintenance costs for both environments, costly resources with skills to maintain aging technology platforms drain IT budgets – funds needed to support new systems.

This challenge is not unique to the healthcare industry. A recent survey [1] of companies with over 50 IT staff shows that on average, 70 percent of the IT budget is spent on existing systems. If half of the applications are redundant, this represents a major opportunity for cost savings or reinvestment.

Why are so many legacy systems still running? An industry research report [2] indicates the #1 reason is that users still want to access data. As creatures of habit, many hospital staff continue to use familiar systems to look up patient information and records out of convenience. Unfortunately, this comes at a cost.

Another reason is because entire legacy data sets are not always migrated to new systems. Data with assigned records retention schedules require collaboration between stakeholders and compliance teams. Without a programmatic approach, application retirement projects can be significantly hampered.

Many providers have overcome these hurdles and successfully implemented an application retirement strategy while migrating to a new system saving millions.

For example, the nation’s largest children’s hospital expects to save $1.8 million annually from retiring legacy applications. Their IT modernization program replaced applications running on aging platforms such as HP Turbo Image, SQL Server, Oracle, and MUMPS with an EPIC implementation. Patient clinical data needed to be retained for compliance reasons, so they deployed an application retirement strategy that allowed them to keep that data and eliminate dependencies on legacy systems and applications. Hospital staff was given online, convenient access to data in a secure archive and compliance teams could track retention.

Key to success, they claim, includes a platform with the following capabilities:

  • Archive support for a variety of data types, systems and platforms
  • Automated validation to confirm data had been completely and correctly archived
  • Ability to assign retention policies during or after the archive process
  • Automate data purge workflow when retention periods expires with legal hold support
  • Mask sensitive data in case a clinical trial is reopened

[1] NCC survey companies with over 50 IT staff

[2] Enterprise Strategy Group Research Report, Application Retirement Trends, October, 2011

Julie Lockner is vice president of product marketing for

Readers Write: Good Product Design is Preventive Medicine for your Software

August 21, 2013 Readers Write No Comments

Good Product Design is Preventive Medicine for your Software
By Ryan Secan, MD, MPH

As a practicing hospitalist physician, I see many patients with untreatable or difficult-to-treat disease that could have been prevented with care before their illness took root. From the lifelong smoker with emphysema who might have quit smoking to the patient with end-stage colon cancer who should have had a screening colonoscopy, dealing with the issue before it started would have potentially prevented their problem.

As a practicing informaticist, I also see parallels between the preventive situations described above and common issues that I’ve faced in healthcare IT. When it comes to healthcare IT, it seems that like patients, too many companies are ignoring preventive care for their product.

As an employed physician, I have limited to no choice regarding what software I use for clinical care. Even as an informaticist, I have inherited my share of decisions regarding software that took place before I had a chance to offer input. Often these software choices that my colleagues and I are forced to use appear to be designed without ever considering the workflows of the clinicians who would use them. It just doesn’t seem possible that any physician involved in product development would allow something this difficult for a clinician to use to be rolled out.

One simple example involves ordering medications in an unnamed product. After typing in a medication name, clicking on it to select it, clicking on a prepopulated order string, and clicking OK (already too many clicks), the pop-up window cycle starts. A click to confirm that I understand that the medication requires dosing based on kidney function, a click to confirm that I know that the kidney function is X (or unable to be calculated), and another click to confirm that the appropriate dose for this level of kidney function is Y (it remains unclear why all of these notations couldn’t be in one window).

Worst of all, if the correct dose is different from what I’ve ordered, it doesn’t offer to change the order or allow me to cancel my already entered order. I need to cancel the old order and order the medication again, remembering the correct dose, and once again going through the multiple windows telling me that the medication must be dosed for kidney function, etc. This is a completely absurd process and a missed opportunity.

Instead of having unhappy customers and trying to repair the damage after the fact, HIT companies need to invest the time and effort in product design. Seek advice from experts (you know, the people who will be using your product) and make sure your product fits into your clients’ workflow. Build customization into your product so it can be adapted to the particular workflows of your individual clients, and make the customization more than just cosmetic. When you get feedback from one client regarding problems, make changes for all of your clients so your entire user base can benefit from each other’s experience.

This preventive medicine will prevent difficult (or impossible) to fix problems down the road.

Ryan Secan, MD, MPH is chief medical officer of MedAptus.

Readers Write: Connecting the Industry: Behind the Scenes of the New Healthcare Triangle

August 14, 2013 Readers Write No Comments

Connecting the industry: Behind the Scenes of the New Healthcare Triangle
By Gary Palgon

8-14-2013 6-14-18 PM

The days of patients accepting the decisions and information provided by their physicians – no questions asked – are in the past. Today, patients are in the driver’s seat, participating in discussions about their care and making crucial decisions based on information from all members of their care teams. The movement from a linear form of communication between a single physician and a patient has changed into a multi-dimensional conversation that includes a variety of healthcare providers and patients.

Patients have always trusted physicians to provide the best care for them as individuals. Yet few realize until they become ill that historically there has been little exchange of information between all points of care. A patient who first visits an urgent care center, for example, then sees a primary care physician who refers him or her to a surgeon expects their health information to follow from place to place.

Fortunately, technology now supports the exchange of health information among disparate sources so that a patient’s longitudinal record is accessible. This not only prevents the need for the patient to repeat information at each point of care, it also ensures the accuracy of the information on which all of the providers base their treatment recommendations.

Better exchange of health information among providers and patients has led to a more collaborative approach to developing the best possible treatment plans. While providers and patients make up two important points in the communications continuum, however, there is a third important point in the healthcare communications triangle that must not be overlooked – pharmaceutical organizations.

Access to the most current medications and treatment protocols requires an exchange of information among patients, physicians, and pharmaceutical organizations. Searches for clinical trial information can be initiated by patients or physicians, as each seeks the best care for a specific condition.

Nevertheless, patients expect physicians to have greater access to clinical trial information, as well as the ability to qualify them for participation in trials. This increased awareness of the benefits of clinical trials brings the healthcare industry face to face with a longstanding challenge: how to give pharmaceutical companies access to patient information for research while still respecting patient privacy where desired.

Concern about patients’ privacy and the security of their data has for many years limited healthcare providers’ willingness to share information, resulting in limited access to it for researchers. Yet de-identified patient information can be tremendously beneficial, helping shorten research timeframes and speeding time-to-market for new treatments. Today, many patients not only understand the importance of their medical data to research, they also want to share it with the general population as a way to help improve care for others suffering with similar conditions. It is, after all, their information to be used as they wish, which includes individuals using such data for future treatment of diseases.

The technology to connect all points of the healthcare continuum is available today. Although not perfect – industry standards are still evolving and interoperability challenges do exist – successful connections being made every day prove that the challenges can be overcome.

Take lab and diagnostic results, for instance. With lab results comprising roughly 70 percent of an average patient record, the ability to see and share lab data electronically greatly improves communication across the continuum of care. Physicians rarely have a laboratory in their own offices, so they rely on technology to share data outside their four walls. The connections among physicians and multiple laboratories or diagnostic services provide a real-life example of the benefits and possibilities of secure data exchange.

A truly connected healthcare industry can be accomplished if the strategy to achieve it is simple, cost-effective and beneficial to everyone. Technology that incorporates use of the cloud to integrate disparate systems, aggregate and harmonize data, and provide access in usable formats addresses these requirements. Not only does this strategy overcome the financial and staffing challenges of industry integration, but it provides enhanced security for health information.

Even though patients are willing to share their health information for research purposes, protocols that authenticate user identities and provide secure access for specific research needs still must be put into place to protect it. Leveraging cloud-based solutions is one way to provide those securities while enabling access to data for multiple researchers working on different studies at the same time.

Easy access to information is part of day-to-day life in the 21st century. In years past, you might have to ask the advice of the local hardware store owner or look through a book if you wanted to fix a leaky sink. Today, a simple Internet search provides hundreds of suggestions and videos showing exactly what to do.

The same concept – easy access to data in a usable format for everyone – applies to the exchange of health information among patients, providers, and pharmaceutical organizations. The benefits include improved clinical trials, appropriate research, faster time to market for beneficial new drugs, and ultimately enhanced population health management.

Just as access to information improves our daily lives, so it does too for patients, researchers, and providers. It is a win-win-win situation for those who rely on shared information to develop new treatments, assess care options, and make the best care choices possible.

Gary Palgon is vice president of healthcare solutions for Liaison Healthcare Informatics.

Readers Write: A Meaningful View of Meaningful Use

August 5, 2013 Readers Write No Comments

A Meaningful View of Meaningful Use
By Helen Figge, PharmD, MBA, CPHIMS, FHIMSS

Meaningful Use has meaning to us all. While we struggle to decide timelines for milestones and determining measured success, we all experience Meaningful Use in our daily lives.

First and foremost, we are all consumers of healthcare living in a society that wants immediate gratification. As consumers, we are being granted instant healthcare gratification through the lens of Meaningful Use. We receive visit summaries, electronic copies of our medical records, and a detailed report of our current medications. Our providers have access to information such as our laboratory reports, X-ray reports, and notes from our specialists. We are encouraged to engage in our own care by having access to our data through patient portals.

We can ask our clinicians new questions based on previous test results, which is great for the patient, but perhaps less than ideal for the clinician (e.g. a TSH ranges from 0.3 to 5.0 – so what is normal for me or for you? Does a low value mean something versus a higher one?) We assume all are equally computer savvy, which in turn creates a potential digital divide. Some more tech-savvy patients “get it” with little prodding, while others finding this new Meaningful Use approach cumbersome, yielding potentially more work for the clinician. 

Maybe to counteract this one potential angst of patient computer illiteracy, should we offer patients a computer literacy course in order to take advantage of the opportunities presented to them by Meaningful Use?

There seems to be a learning curve for us as healthcare consumers. Not only learning the technologies given to us for data access, but also comprehension of the new rules of healthcare engagement. Given that we want it and want it now, Meaningful Use is the lightning bolt needed to energize the healthcare delivery system. Most noteworthy of all, Meaningful Use to a healthcare consumer is invisible, and translates to a meaningful interaction with our healthcare provider with the highest quality of care delivered to us that is coordinated, seamless, accessible, real-time, and complete.

Next comes the clinician, whose perspective is somewhat more sterile. Patient record transparency and best practices yielding to a more informed patient with data in real-time, workflow supportive and organized is the nirvana. But, in reality, the technologies do not always support clinician workflow, hence the angst felt today with the execution of Meaningful Use to some clinicians. Additionally, clinicians have an extra burden to exercise patience with their patients who might overuse or underuse these new approaches for data access.

But if patience is exercised, Meaningful Use will work to transform healthcare the way we all want it to be. It just might take a little more time for some to realize the benefits, lending fuel to the current discussions of some “catching up” with others in the various stages of Meaningful Use. And to compound our “want it and want it now” mentality, don’t forget the Direct Project that if exercised correctly could improve communication across many layers of clinician thought. The problem with that project, however, is the select few who enjoy its rewards as many haven’t caught up to the pack yet for this vehicle offered in healthcare today to work for optimal effect.

Now enter the poor vendor who finds Meaningful Use an opportunity, but also a challenge. The challenge comes not only from the institution that purchased the technology, but the various stakeholders that institution represents. Vendors who can’t keep pace with these demands will now become easily identified, and these vendors in turn will now more than ever experience negative selection because stakeholders will opt for software that supports healthcare delivery.

Vendors also need to contend with clinicians who have the extra burden of now hearing from patients that the technologies are not user-friendly, adding fuel to patient dissatisfaction. This is a double whammy of frustration. Complaints fielded by clinicians are in turn angsts for the CIOs, who then turn their aggressions on the vendor for immediate response and relief.

Rome wasn’t built in a day and neither were software platforms, yet our need for instant gratification overrides the ability to work through issues that otherwise without emotion would be handled quite effectively. Darwinian Theory of evolution plays well here: only the best adapted will survive (the vendor, I mean). The meaning of Meaningful Use to a vendor is twofold: to deliver high quality technology meeting acceptable government criteria and also technology that all stakeholders find acceptable, functional, and timely.

Finally the last group who should or could benefit from Meaningful Use if implemented, accepted, and seamlessly delivered involves insurers (third-party payers) that have been battling the cost containment of healthcare for quite some time. If insurers were really wanting to make a difference in healthcare costs, they would reward more for preventive care and support universally such processes as the Patient Centered Medical Home and also invest in the health of our bodies real time, not years later when we are ravaged by illnesses due to poor lifestyle, poor gene pool, or a combination of the two. In the end, if Meaningful Use is supported by these groups, the insurers will benefit from lower healthcare consumption, more efficiency, and better outcomes.

Meaningful Use has meaning to us all and worthy of support. It just needs to be appreciated and agile enough to survive the need for our society’s immediate need for gratification and be resilient enough to let some play catch up.

Helen Figge, PharmD, MBA, CPHIMS, FHIMSS  is advisor, clinical operations and strategies, for VRAI Transformation.

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