Readers Write: Digital Patient Engagement Tools to Achieve “Top Box” Medication-Related HCAHPS Scores

Digital Patient Engagement Tools to Achieve “Top Box” Medication-Related HCAHPS Scores
By David Medvedeff, PharmD, MBA

Improving HCAHPS performance is a never-ending struggle for hospitals, one that has taken on greater urgency as results are linked to CMS’s Hospital Value-Based Purchasing (VBP) program. The HCAHPS Survey is the basis of the “Patient Experience of Care Domain” under VPB, which makes up 30 percent of a facility’s total performance score.

A particularly thorny problem has been improving patient communications regarding medication, which is measured based on HCAHPS responses to three questions:

1. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?
2. Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand?
3. When I left the hospital, I clearly understood the purpose for taking each of my medications.

In the most recent published results, 36 percent of reporting hospitals failed to achieve “top box” scores, which reflect the most positive responses to questions related to patient experience with communications about medications. Improvements in patient education and health literacy can go a long way toward boosting these scores, as well as medication adherence post-discharge.

Consider this: a study by the National Assessment of Adult Literacy found that just 12 percent of the more than 19,000 respondents demonstrated proficient health literacy. Another study, published in the Journal of General Internal Medicine, found that 79 percent of patients misinterpreted one or more of the 10 most common prescription label instructions they encountered.

To combat the grim reality of poor health literacy, hospitals must account for all aspects of medication adherence. For example, the CDC highlights the “access to care and patient education material” as two of the largest problems in medication adherence, as well as the “inability to access or difficulty accessing the pharmacy.”

Digital patient engagement solutions address these issues by delivering medication information to patients when and where they most need it. For example, videos outlining proper usage, expected benefits, and potential side effects can be embedded into the hospital’s website. Links to prescription-specific videos can then be sent to patients via text or email for viewing on any computer, tablet, or smartphone. Videos can also be supplemented with text reminders to take or refill prescriptions to further enhance compliance.

It is crucial that video content be comprehensive and current to ensure all pertinent information is included. Content should also be based upon trusted information, such as guidelines from the Food and Drug Administration (FDA) as well as patient packet inserts, medication guides, and consumer medication information.

Ultimately, digital patient engagement solutions remove the barriers that complex text often puts in the way of comprehension and medication adherence. Convenient access via multiple channels also means patients are never without the information they need to successfully and properly administer their medication, improving HCAHPS scores while reducing the risk of medication error and improving care outcomes.

David Medvedeff, PharmD, MBA is CEO of VUCA Health of Lake Mary, FL.

Readers Write: The Elephant in the Room: Provider Validation

The Elephant in the Room: Provider Validation
By Miranda Rochol

I’ve seen and heard a lot of discussion about EHRs and identity proofing – the process of verifying that a provider is who he or she claims to be. Identity proofing has been a hot topic in healthcare for years, starting with the Medicare Modernization Act (MMA) of 2003, when e-prescribing was promoted as a vital part of reducing prescription errors and enhancing patient safety. Prior to that, e-prescribing was a novel concept. 

Today, the majority of office-based physicians (73 percent) send e-prescriptions and nearly all community pharmacies (95 percent) receive them. This wouldn’t have been possible without EHRs or identity proofing. Equally important but less talked about is the critical step of provider validation, which happens before identity proofing.

The concept of provider validation grew in importance when the DEA issued an Interim Final Rule (IFR) and made legal the electronic prescribing of controlled substances (EPCS). Strict regulation of controlled substances now means that validation of DEA numbers is more than just protocol — it’s critical. Because some providers are only authorized to write prescriptions for certain controlled substances, EHRs must ensure that their systems are equipped to validate provider DEA (and other credentials) in real time.

The most logical time to validate a DEA number is when a provider actually writes a prescription for a controlled substance. Since DEA numbers expire or become invalid, a provider’s DEA number should be verified each time he or she writes a prescription. This is the most effective way to ensure compliance with federal regulations and verify that a prescriber is legally authorized to write prescriptions for particular substances.

Failure to validate providers for e-prescribing of controlled substances is serious. EPCS is subject to the same laws that govern written, oral, and faxed prescriptions of controlled substances. Providers who illegally distribute or dispense controlled substances could have their license suspended or revoked and are subject to imprisonment for 5-15 years and fines from $100,000-$2 million.

EHRs should care about this for a number of reasons. The EHR space has become incredibly crowded and competitive. Adoption rates have skyrocketed, but customers have more vendor choices. What’s important to healthcare providers and organizations today are cost, usability, and compliance. Provider validation is a vital part of the compliance equation.

Beyond meeting Meaningful Use requirements, EHR companies must also start thinking strategically about their customers’ long-term needs and how to elevate their position from “vendor of the day” to “services partner of tomorrow.” This is where providing value-added services like provider validation and partnerships with data providers are key.

Lastly, EHRs with provider validation and other functionalities that meet both clinical and compliance needs could attract new fans among hospitals and health systems. Having an EHR that meets both clinical and compliance needs is one way healthcare organizations are attracting physicians, whose adoption of new technologies is integral to improving patient outcomes and public health.

Miranda Rochol is VP of product and strategy for Healthcare Data Solutions (HDS) of Irvine, CA.

Morning Headlines 10/21/14

Tech firms vie for $11 billion military healthcare contract as deadline looms

The DoD has extended its EHR RFP deadline by one week, to October 31. The deadline was already extended by two weeks earlier this month. There are currently four EHR vendors known to be competing for the deal: Epic, Cerner, Allscripts, and VistA via Medsphere.

Healthcare IT Leaders Embrace Federal Interoperability Plans

CHIME and HL7 announce that they will partner to lobby for the inclusion of API-based interoperability standards in Meaningful Use Stage 3.

New Affordable Care Act initiative to support care coordination nationwide

CMS announces the ACO Investment Model, a $114 million initiative aimed at providing rural ACOs upfront funding to help them implement advanced health IT systems.

Morning Headlines 10/20/14

A Letter To Our Community

Texas Health Resources takes out a full page ad in the local paper in part to regain the trust of its community. A separate article mentions that patient volumes have plummeted at THR, with ED wait-times at zero minutes.

athenahealth’s (ATHN) CEO Jonathan Bush on Q3 2014 Results – Earnings Call Transcript

Jonathan Bush leads Athena’s Q3 earnings call, where discussions ranged from improving Epocrates-related earnings to increasing enterprise sales.

Hospital Nurses Forced to Develop Creative Workarounds to Deal with EHR System Flaws; Outdated Technologies and Lack of Interoperability, Reveals Black Book

A new Black Book report surveys 14,000 RNs and finds that 92 percent are dissatisfied with their inpatient EHR systems and that 88 percent blame hospital administrators and CIOs for selecting poor performing EHRs based on price rather than quality of care.

Monday Morning Update 10/20/14

Top News

Texas Health Resources takes out full-page ads in local newspapers to bolster its community image, with CEO Barclay Berdan admitting that “we made mistakes” and adding that Thomas Duncan’s travel history was documented in the EHR but “not communicated effectively among the care team.” 

Meanwhile, the cruise ship passenger that triggered an Ebola scare at sea (for questionable reasons) that resulted in the ship’s return to port has been identified as the lab director of Texas Health Presbyterian Hospital Dallas where Thomas Duncan died. The lab director voluntarily quarantined herself in her ship’s cabin and has since been found to be free of the virus.

In the aftermath of its mistakes (of both clinical and public relations varieties), Texas Health Presbyterian Hospital Dallas  is reported to be a “ghost town” with two-thirds of its 900 beds empty and its average 52-minute ED wait time down to zero. THR spokesperson Dan Varga, MD states that doctors whose offices are near the hospital are having up to 60 percent of their appointments cancelled as patients refuse to get close to hospital property, treating it as though it were Chernobyl instead of the building that previously housed a contagiously sick patient as it does 365 days per year. The economic impact will probably be significant.

Reader Comments

From British Bulldog: “Re: Ascribe. The UK-based company’s CEO and founder, Stephen Critchlow, has resigned, almost a year since Ascribe was acquired by EMIS. Rumour has it that this could spell the end for Ascribe’s Health Application Platform, its flagship software platform.” The company announced Critchlow’s departure to devote “more of his time to his other business interests” on September 29, 2014, while the rest of the statement is unverified.

From Government Mule: “Re: ONC chief medical officer. Jon White from AHRQ took the job according to his LinkedIn profile.” Actually he lists his position as interim CMO (at least in the current version of his profile), which was announced early this month as a part-time commitment while the search is underway.

From GoVols: “Re: [company name omitted]. The CTO resigns, then gets talked out of it by board member. Sales, marketing, and BD team, once 15 strong, is now down to just a few and more layoffs are rumored. No significant sales this year and the fourth sales VP was recently fired. Everyone still here wonders what the BOD is thinking.” I’ve removed company and executive names since no company is going to confirm statements like these, but I’ll keep an eye on what happens there.

From Insidehr: “Re: athenahealth’s Ebola screening tool. Good to hear the athena clients are ready to treat those Ebola patients when they show up for the primary care visit. Sometimes that group would benefit from the concept of less is more.” It’s interesting that everybody is rushing to cobble together electronic tools that perform the most basic function – display a warning if a feverish patient says they’ve been to Africa lately. I think we can assume that even the least-competent nurse in America would go on alert in that case even without an EHR prompt, so its main value isn’t evaluating the patient’s response, it’s reminding someone to ask them the question in the first place, which is also probably not really necessary.

Additionally, the value of crude tools like online questionnaires will be eliminated if the virus starts spreading from people who haven’t traveled but instead were exposed to someone else who has, perhaps unknowingly. It’s like those early HIV/AIDS questions that asked about same-sex contact, blood transfusions, or exposure to prostitutes –  they helped make a few diagnoses in the absence of anything more accurate, but the real accomplishment was developing specific lab tests since patient reports aren’t always reliable, symptoms are vague, and other transmission methods may be involved. A lab person can jump in, but I think the ELISA test works for both HIV and Ebola, the main difference being that a two-day wait time for positive diagnosis is OK for HIV but potentially disastrous for Ebola. When it comes to stopping pandemics, it’s at least equally important to develop diagnostic as well as therapeutic technologies.

HIStalk Announcements and Requests

More than two-thirds of poll respondents don’t like idea of an ONC-run health IT safety center. Reader lgro said in a comment that ONC struggles with the logistics of its current areas of responsibility and worries about another HIPAA-like program that doesn’t add value, while Doug points out that the health IT safety center was proposed as a public-private partnership rather than an ONC-controlled body and may provide value in preventing FDA from stepping in due to lack of progress. New poll to your right or here: should the names and medical details of Ebola patients be divulged publicly?

Last Week’s Most Interesting News

• The American Medical Association sends CMS a blueprint for a redesigned Meaningful use program, adding its criticism of document-based interoperability protocols such as C-CDA.
• Several groups add to the drumbeat urging CMS to slow down the Meaningful Use program and to refocus certification on interoperability, privacy and security, and quality reporting.
• Texas Health Resources executive Daniel Varga, MD says the organization modified its Epic setup and workflow after Ebola patient Thomas Duncan was discharged from one of its EDs, adding little clarity to the original report and subsequent denial that the nurse’s documentation was missed because of an EHR setup problem.
• A paper from the National Bureau of Economic Research says that HITECH was largely ineffective for spurring hospital EHR adoption since most hospitals were already using them.
• HITPC agrees that current document-based interoperability approaches should be replaced by programming APIs provided by vendors of certified EHRs. That would be a dramatic shift, especially if ONC requires such access for EHR certification.
• California HealthCare Foundation releases a report covering health accelerators, find that they are excessive in number, unproven in benefit, and potentially harmful in hyping startups that have a minimal chance of market success.
• Alameda Health System (CA) says a disastrous $77 million Siemens Soarian-NextGen implementation has exhausted its cash and available credit.

Webinars

October 21 (Tuesday) 1:00 p.m. ET. Electronic Prescribing Of Controlled Substance Is Here, What Should You Do? Sponsored by Imprivata. Presenters: William T. “Bill” Winsley, MS, RPh, former executive director, Ohio State Board of Pharmacy; Sean Kelly, MD, physician, Beth Israel Deaconess Medical Center;  David Ting, founder and CTO, Imprivata. Providers are challenged to use EPCS to raise e-prescribing rates for MU, improve physician productivity, reduce fraud and errors, and meet New York’s March 2015 e-prescribing mandate. Hydrocodone painkillers such as Vicodin have moved to Schedule II, with the higher CS prescribing volume adding another reason to implement e-prescribing. This webinar will describe why organizations should roll out EPCS, presented from the perspectives of pharmacy, compliance, physicians, and technology.

November 5 (Wednesday) 1:00 Eastern. Keeping it Clean: How Data Profiling Leads to Trusted Data. Sponsored by Encore, A Quintiles Company. Presenters: Lori Yackanicz, administrator of clinical informatics, Lehigh Valley Health Network; Randy L. Thomas, associate partner of performance analytics, Encore, A Quintiles Company; Joy Ales, MHA, BSN, RN, senior consultant, Encore, A Quintiles Company. Data dictionaries, organizational standards, and pick lists for data entry fields may describe the intent of a particular data field, but don’t guarantee that the data captured in the source system actually reflects that intent. Data profiling is the statistical analysis and assessment of the data values in source systems for consistency, uniqueness, and logic to ensure that the data landing in a data warehouse or analytic application is as expected. Attendees will learn which projects benefit from data profiling and the resources needed to accomplish it.

Acquisitions, Funding, Business, and Stock

From the athenahealth earnings call:

• Jonathan Bush says the company is growing, but with growing pains.
• Epocrates is a turnaround in progress and it’s taking longer than the company expected to improve the situation due to major cultural and technical issues.
• Epocrates is moving toward “more of an edutainment relationship where we’re constantly rotating through a set of FDA-approved and clinically appropriate messages for doctors that makes a business act more like a recurring venue business and one-off.”
• The company added 2,800 athenaClinicals physician users, but at a high expense.
• Bush says the challenge of the Enterprise business – which he calls “bipolar” since the company never knows when a big organization will finally sign up – is that internal hospital departments aren’t nearly as interested as the outpatient areas in opening up patient access.
• Bush says it’s hard to sell to academic medical centers: “Nobody gets fired in academic medical. There is no financial mandate. They have got many, many revenue sources, many, many reasons for revenue — the research, the teaching. So that clarity of bottom line is not there. There is somebody in charge of the bottom line who is very clear, but they have grown up an institution that is used to money showing up … an open healthcare network doesn’t help you if you happen to have the highest rates in town … You are not thrill that the doctor and the patient can see the other ones, click on it and rob you of that high-margin encounter … the guys who resist us the most are institutions like Partners, Mass General, where they have historically high rates … and they are terrified of being picked apart.”
• “We are right now in the midst of trying to seed a couple of the major national consulting firms with the idea that its time to change lily pads. That you don’t want to be the last strategic consultant that advise the board of directors to plump down $0.5 billion on a closed system. The problem is there’s a lot of revenue that goes to those firms that way and so we have been working it.”
• Bush expresses frustration in working with (and ultimately bypassing) hospital CIOs, declaring, “Typically the CIO has worked very hard to build board-level access and a great huge budget surrounding the idea of his own data center and his own servers and his own programmers. He is sort of craft brewing milky beer and doesn’t want anybody to compare him with the pros from Dover.”

Above is the one-year share price chart for ATHN (blue) vs. the Nasdaq (green).

People

University of Virginia Health System hires Michael Williams, MD (North Shore-LIJ Health System) as its first CMIO.

HealthMEDX names Chris Dollar (Henry Schein) as COO.

Government and Politics

A HIMSS response to NIST’s cybersecurity RFI says healthcare providers are too focused on HIPAA compliance and should evaluate their overall security instead, adding that NIST should publish a target state for providers to measure themselves against.

Former National Coordinator David Blumenthal, MD says that Texas Health Resources, in first stating but then denying that an EHR flaw caused it to discharged Ebola patient Thomas Duncan, is part of an “inglorious pattern in human behavior” that causes providers to seek scapegoats when something goes wrong. He also says EHRs are the lightning rod for provider challenges because they use them constantly in daily work while other problems seem to be “distant thunder,” but he adds that users are justifiably frustrated with EHR usability and interoperability.

Other

I don’t automatically believe reports from Black Book Rankings, especially when they don’t itemize their methodology, but their survey of 14,000 RNs who use hospital EHRs claims the following results that I don’t doubt a bit:

1. Hospital nurse EHR dissatisfaction stands at 92 percent.
2. EHR workflow disruption reduces job satisfaction, according to 84 percent of respondents.
3. Nine of 10 nurses say CIO and their executive peers choose EHRs based on price or Meaningful Use performance rather than their usefulness to nurses.
4. Nine of 10 nurses say the EHR interferes with nurse-patient interaction and 94 percent say it hasn’t helped nurses communicate with other clinicians.
5. Three-quarters say the EHR has failed to improve the quality of patient communication.
6. More than two-thirds of RN respondents label their IT departments as “incompetent” in their EHR knowledge.
7. A hospital’s EHR is one of the top three criteria for choosing a workplace according to 79 percent of respondents, with top-rated systems being Cerner, McKesson, NextGen, and Epic. The lowest satisfaction scores were for Meditech, Allscripts, eClinicalWorks, and HCARE. This statement alone raises a red flag given that eCW doesn’t offer an inpatient EHR, HCARE is (I believe) HCA’s implementation of Meditech, NextGen’s EHR is used mostly by very small hospitals and isn’t likely to have had enough respondents to be judged on inpatient use alone, and McKesson’s users weren’t broken out among Horizon, Paragon, and its other products. The survey’s biggest flaw is not breaking out practice site – ED, ICU, surgery, ambulatory, general med-surg nursing, etc., all of which use broadly (and often incorrectly) labeled “EHR” systems differently.

An interesting article by Clinovations SVP Steve Merahn, MD says that “unstructured” is a bad term when referring to data because it contains the built-in bias that all data should be structured, when in fact the only reason “structuring” data into convenient pigeonholes is necessary is because our ability to analyze information is otherwise limited. He draws a parallel to earlier observations about Internet content vs. data, which is similar to EHR-contained checkbox results vs. useful clinical information:

• Content has a voice. It is written to communicate ideas, make a point, convince. It is personal.
• Content has ownership. Someone created the note from their perspective of authorship as defined by their levels of authority and responsibility.
• Content is intended for a human audience, for human senses to process.
• Content has context. Even the most objective content contains lexical, syntactic, and semantic clues about where the reader should focus their attention — what was important and what was not.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 10/17/14

Examining The US Public Health Response To the Ebola Outbreak

Dr. Daniel Varga, the chief clinical officer for Texas Health Resources testifies before the House Subcommittee on Oversight and Investigations regarding THR’s handling of Thomas Duncan, the hospital’s initial Ebola patient, and the subsequent spread of the disease to two of the hospital’s nurses.

athenahealth, Inc. Reports Third Quarter Fiscal Year 2014 Results

athenahealth reports Q3 results: revenue was up 26 percent to $190 million, but the company posted an overall net loss of $1.6 million. Adjusted EPS $0.27 vs. $0.29. Epocrates-related sales dropped 27 percent during the quarter, bringing in $9.8 million.

Coalition letter requesting changes to meaningful use for greater systems interoperability

Premier, the American Academy of Family Physicians, AMA, MGMA, and several other organizations and health systems send a letter to CMS urging it to slow the pace of Meaningful Use and refocus it to make gains on interoperability, security, and quality reporting.

News 10/17/14

Top News

Dan Varga, MD, chief clinical officer of Texas Health Resources, testifies to a House subcommittee inquiring into its handling of Ebola patient Thomas Duncan that THR has changed its screening procedures to ask travel-related questions first thing in the ED and to make the patient’s travel history available to all caregivers. THR modified its Epic configuration to (a) make the Ebola screening tool more visible; (b) to ask more Ebola-related screening questions; and (c) to display pop-up instructions if any of the screening questions are answered positively. The wording of his statement suggests (in my interpretation, anyway) that the original problem wasn’t because the ED doctor couldn’t see the patient’s nurse-captured travel history, but that the questions weren’t asked at the proper time.

Due to a high volume of Greenway PrimeSUITE customers using the new cloud-based reporting / dashboard solution through our PrimeDATACLOUD, we’ve seen dashboard service disruptions that have impacted a small number of our customers. To meet customer requirements for Q3 attestation, the cross-function Greenway Meaningful Use Service Team worked with customers and supplied them with the information needed to attest for the Q3 90-day attestation period. To prepare for a higher volume of customers planning to attest in Q4 and in 2015, we’re currently making enhancements and performance improvements to the PrimeDATACLOUD environment. This maintenance window is expected to last until the end of October. During the maintenance period, we’re making the MU Dashboards available on a regular basis to all customers using the system, enabling them to track their progress towards attestation goals. In addition, we continue to on-board customers who need to attest for Q4 as well as 2015. The Greenway MU Service team continues to engage directly with all affected customers to provide updates as well as help guide them through the MU process. Greenway Health is committed to ensuring that all eligible providers using our solutions who are planning for MU attestation have the required information in time.

 

HIStalk Announcements and Requests

This week on HIStalk Practice: athenahealth creates an Ebola risk assessment algorithm for its EHR. Palmetto Primary Care Physicians taps eGroup to help it install IT in South Carolina’s first gigabit community. ONC adds a dozen primary care physicians and administrators to its Health IT Fellows Program. Ability Network acquires MD On-Line Inc. See our Must-See Exhibitors Guide for MGMA 2014. Thanks for reading.

This week on HIStalk Connect: Dr. Travis explores the potential ROI that can be generated from implementing online self-scheduling tools for patients. Patient engagement startup Welltok raises $25 million of a planned $37 million Series D. The NIH announces $32 million in grant awards that will be used to further big data research in healthcare.

Welcome to new HIStalk Platinum Sponsor FormFast, the leading provider of process automation solutions for hospitals (electronic forms and signatures, workflow, and content management) that integrate with existing systems to add functionality and streamline processes. FormFast has been providing electronic workflow solutions since 1992 with 1,000 hospital customers that are gaining efficiency, improving task coordination, reducing supply costs, and eliminating errors (webcasts and case studies are here). Thanks to FormFast for supporting HIStalk.

Webinars

October 21 (Tuesday) 1:00 p.m. ET. Electronic Prescribing Of Controlled Substance Is Here, What Should You Do? Sponsored by Imprivata. Presenters: William T. “Bill” Winsley, MS, RPh, former executive director, Ohio State Board of Pharmacy; Sean Kelly, MD, physician, Beth Israel Deaconess Medical Center;  David Ting, founder and CTO, Imprivata. Providers are challenged to use EPCS to raise e-prescribing rates for MU, improve physician productivity, reduce fraud and errors, and meet New York’s March 2015 e-prescribing mandate. Hydrocodone painkillers such as Vicodin have moved to Schedule II, with the higher CS prescribing volume adding another reason to implement e-prescribing. This webinar will describe why organizations should roll out EPCS, presented from the perspectives of pharmacy, compliance, physicians, and technology.

Acquisitions, Funding, Business, and Stock

Revenue cycle solutions vendor Ability Network will acquire competitor MD On-Line.

Athenahealth reports Q3 results: revenue up 26 percent, adjusted EPS $0.27 vs. $0.29, meeting expectations for both. The company’s $293 million Epocrates acquisition from January 2013 continues to drag down the bottom line as the unit’s quarterly revenue dropped 27 percent to less than $10 million.

Analytics vendor Viewics raises $8 million in funding.

Telepharmary kiosk vendor MedAvail completes $30 million in Series C funding.

Consumer rewards-based wellness platform vendor Welltok raises $25 million of a planned $37 million funding round.

Sales

Marin General Hospital (CA) chooses MModal for clinical documentation software and services.

People

James R. Boldt, chairman and CEO of Computer Task Group, died unexpectedly on October 13 at 62. He led CTG into the healthcare IT provider services market after taking the role in 2001.

Just-resigned GE Healthcare CEO John Dineen is named fund advisor to private equity operator Clayton, Dubilier & Rice.

Paul LaVerdiere (Iron Mountain) joins ESD as regional VP.

Announcements and Implementations

Elsevier launches Mosby’s Home Health Care, which provides content for home health nurses. The company also announces that it will provide free access to its ClinicalKey reference site to healthcare and disaster aid workers battling the Ebola outbreak in Liberia, Nigeria, Sierra Leone, and Guinea

Regional Medical Imaging (MI) goes live with Merge Notifi for patient appointment reminders.

Predixion Software releases Predixion Insight 4.0.

Evangelical Community Hospital (PA) goes live with Nursenav Oncology’s patient navigation workflow system. The company offers patient tracking, assessments, reporting, and a patient portal.

HIPAA compliance platform vendor Catalyze puts its 25 model HIPAA policies for “a modern cloud healthcare company” online as open source.

DrFirst announces October 28 availability of its electronic prior authorization service Patient Advisor ePA+SM, which will integrate multiple sources starting with CoverMyMeds.

Government and Politics

A paper from the National Bureau of Economic Research says that HITECH was largely ineffective for spurring hospital EHR adoption, having fast-forwarded usage by only two years at a cost to taxpayers of $48 million per new EHR-using hospital (as opposed to the majority of hospitals that earned HITECH payouts for just using what they already owned). I wasn’t willing to pay $5 to read the full paper, especially since it’s a draft version, but I suspect I would have issues with its methodology even though its conclusions seem reasonable. Paying hospitals  (and doctors, which the report didn’t cover) to keep using systems they had already purchased was of questionable taxpayer value, but then again much of the $787 billion ARRA program was equally iffy from a value perspective.

Organizations including the AMA, MGMA, and Premier urge HHS to refocus Meaningful Use certification on interoperability, quality reporting, and privacy and security. The groups also want HHS to slow the Meaningful Use program down and to encourage innovation and the development of new clinically-focused healthcare technology.  

The Treasury Department is trying to fix an HHS-created technical mistake that allows employers to offer employee health insurance that doesn’t cover hospitalization.

Technology

Apple announces that OS X 10.10, also known as Yosemite, is available as a free upgrade to MacBook users.  

Sponsor Updates

• HCS is sponsoring and exhibiting at the LeadingAge Annual Meeting in Nashville October 19-22.
• SCI Solutions launches a company blog with an introductory post by CEO Joel French.
• HIMSS Analytics says in its latest “Essentials of the US Hospital IT Market” that computer-assisted coding applications will experience increased hospital growth.
• Vishal Agrawal, MD, president of Harris Healthcare Solutions, will participate as a panelist on “innovations in Access and Population Health” during the Scottsdale Institute 2014 Fall Forum.
• Clinovations interviews Will Hodges regarding service line management vs. physician employment.
• BlueTree Network challenges Vonlay-Huron to a food drive challenge to see who can raise the most meals or funds for meals from November 5 through December 3.
• Levi, Ray & Shoup will participate in the 2014 SAP TechEd && d-Code event in Las Vegas October 21-23.
• Imprivata reports that 100 European organizations have confirmed rapid adoption of virtual desktop infrastructure for single sign-on.
• NoteSwift announces availability for Allscripts TouchWorks EHR.
• NTT Data is named to the Winner’s Circle in the 2014 SAP Services Blueprint Report.
• The Advisory Board Company discusses the threat of Ebola to healthcare workers in a recent blog.
• Lifepoint Informatics unveils its patient access portal this week at G2 Lab Institute 2014.
• HTMS, an Emdeon Company, launches Coverage Scout to assist in calculating health plan rates and federal subsidies.
• Ingenious Med announces that three members of its mobile development team took first place in the Mobility Live Hack-Back Invitational.
• The keynote address of eClinicalWorks CEO Girish Navani will be streamed live from the 2014 National Conference on October 17.
• Louis Stokes VA Medical Center (OH), Orange City Area Health System, (IA) and Mercy Hospital Fairfield (OH) are live with Extension Engage to manage clinical alarms, alerts, and patient-centric text messaging.

EPtalk by Dr. Jayne

My apologies for not mentioning eClinicalWorks in my recent shout-out of fall conferences. Their National Users Conference kicks off October 17 in Orlando. From the pictures of last year’s event, it looks to be a lot of fun. If you’re attending, we love a good party, so do tell how it’s going and share your photos.

I received a fair amount of reader response (and a handful of vendor solicitations) after this week’s Curbside Consult on transitioning to mandatory e-learning as part of EHR implementation. We already went live, so I’m not looking for a vendor (although you can bet I’m going to file your contact information away in case our system tanks and we need a replacement). Others wrote about their own experiences. The general consensus is that short segments with focused content are best and that unless mandated, user adoption can be less than stellar. E-learning seems to be most popular for workflows that aren’t overly complex but require more than a PDF to explain. So far we haven’t had any major glitches and people are logging on and completing the curriculum, so I’ll remain cautiously optimistic.

The most intriguing healthcare IT tool I’ve seen recently is called The NNT. For readers who are not statisticians, NNT is the “number needed to treat” and represents the number of patients who would have to use a treatment for one person to benefit. If the NNT is low, that means you don’t have to treat a broad population to deliver benefit. If it’s high, the likelihood of the patient in front of you benefiting is low. In addition to providing NNT data, the website also uses a color-coded header bar to indicate treatments that make sense and those that don’t. Thanks to Wired for profiling the site.

It’s not exactly healthcare IT, but it does involve health care and IT giants. Several colleagues asked my opinion of Facebook and Apple offering egg-freezing as part of their benefits plans. Having cared for many women during their pregnancies, I can tell you that freezing eggs and using them later doesn’t change the other risks that pregnant women face when they’re older. Regardless of their motives, I’m glad it’s available for people who need it for medical reasons, such as young women undergoing cancer treatments. On the other hand, I’m still waiting for my own company to cover services many people take for granted, so I’m a little jealous.

A shout-out to Dr. Travis and his recent mention of startup Thync, which aims to develop a device that can aid in shifting the wearer’s mood. Since it is worn on the head and uses ultrasound waves to trigger brain changes, I’m not sure I’d be a fan. For mood-altering wearables, I prefer the sparkly kind.

What kind of wearables alter your mood? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 10/16/14

Subsidy program for EHRs ineffective, draft report argues

A draft report from the National Bureau of Economic Research analyzes pre-ARRA EHR adoption trends and concludes that ARRA incentive payments only expedited EHR adoption by two-years. The report also says that ARRA incentive payments cost taxpayers an average of $48 million per implementation.

ID System Reduces NICU Errors

Montefiore Medical Center (NY) tests a new positive patient identification step in its CPOE workflow that help neonatologists ensure they are placing orders in the correct chart when caring for babies in the NICU that have not yet been given a name. Adding this step reduced wrong-patient orders by more than 50 percent in the unit.

MIT and MGH form strategic partnership to address major challenges in clinical medicine

A new partnership between MIT and MGH will form research teams focused on improving the prevention, diagnosis, and treatment of a variety of diseases.

CIO Unplugged 10/15/14

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

The Hands of God

“Will I die?”

My nurse checked my vitals on the evening prior to my operation, a surgery to correct a birth defect. Even at eight years old, I was acutely aware of the possibility of going asleep and not waking up.

I’ll never forget what happened after I voiced my fear. Sitting on my bed, the nurse drew me close and wrapped her arms around me. “Little boys don’t die,” she whispered. Nurse Beata’s verbal medicine soothed my anxiety. I woke the next morning confident and excited about getting a new ear.

Nurse Practitioner Pinkerton shed a tear of joy and gave my wife a hug when Julie showed delight upon hearing that we were indeed going to have a baby. As the primary caregiver at the student medical clinic at Colorado State University, Nurse Pinkerton shared that students usually expressed sorrow over an unwanted pregnancy. Julie was the first student that year to be happily pregnant. I was especially pleased that Brandon’s due date was after graduation.

A few years after our son was born, we had a daughter, Talitha. She pent the first eight days of her life the NICU. Our precious baby, her life in the balance, was loved on by nurses’ caring hands.

About a year ago, Tali and I dropped in on them to say hello and let them see the fruit of their labor. They studied the strong woman that frail baby transformed into. Tali had a chance to say thank you to the nurses who had watched over her like angels two decades prior.

Early in my healthcare career, I worked with nurses in the OR. Oh, the things I witnessed! So hard to express in words. The love. Compassion. Humility. The hours and dedication. The passion and the tears. The smiles. The joy. The healing. I hated leaving that environment and culture, but my calling lay elsewhere.

As I became involved with technology, I remembered the nurses. I consistently position nurses on my team and I’m proud of all of them, especially those who have become CIOs. At last count, roughly 25 percent of my teams have been certified clinicians of one sort or another. They understand workflow and the culture. You match this education and experience with technology and boom! I exhort my fellow IT leaders to embrace nurses.

OK, not all of my nurse experiences were positive. My only bad nurse encounter happened when I was 15. While riding my bike to school, I was struck broadside by a truck that pushed my face and body into the asphalt for about five yards. Much of the skin on my face was roughed up.

An ambulance rushed to the ER, and the triage nurse gawked at me and winced. That was not a good signal for an insecure teenager in shock. But to his credit, he did take good care of me and stopped wincing after painstakingly pulling every bit of gravel out of my face. I forgave him.

My point? I’m thankful for nurses. They don’t win Emmys or Heismans. Fearful patients chew them out, yet they extend mercy. They sooth your worries. They help facilitate healing. They make health information technology successful.

One last thing, something we rarely acknowledge. They put their lives and health at risk for us.

They are the hands of God.

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

Readers Write: Harnessing Data to Support Population Health Management and the Evolution of Next-Gen Population Health Management

Harnessing Data to Support Population Health Management and the Evolution of Next-Gen Population Health Management
By Larry Schor

Accountable healthcare delivery is in the midst of a three-stage evolution as organizations increasingly turn to the promise of health IT and data to improve patient care and the bottom line.

First-generation accountable care is all about meeting process quality measures and closing gaps in care. At this stage, provider compensation is loosely tied to compliance with standards of care and protocols for specific common conditions, such as immunizations or screenings for diabetes and glaucoma. However, during this phase, financial rewards predominantly come in the form of bonuses for achieving quality measures with little or no downside financial risk.

As the industry currently evolves from first-generation toward middle-generation accountable care, new complexities are emerging. As such, healthcare organizations must manage clinical risk and begin assuming limited financial risk for identified patient populations.

Because both upside bonuses and limited downside financial risks exist at this stage, it is imperative that patients are clinically well controlled. Clinical data, therefore, becomes increasingly important for understanding risk. The historic reliance on claims data will no longer suffice. It is at this second stage of maturity that next-gen population health management becomes a critical strategy for managing population health because it effectively blends clinical and financial data.

Once healthcare organizations achieve next-gen population health management, mature accountable care — which is characterized by high-performing networks operating under full global risk arrangements — can be realized. This advanced care delivery model focuses on optimization and lowest total cost of care, achieved through high patient engagement as the result of personalized outreach and full next-gen population health management. The benefits of this stage of maturity will be realized through more comprehensive and precise analytics to personalize patient care, especially for those with chronic conditions.

While national initiatives are encouraging the forward momentum of accountable care, a bird’s eye view of the industry reveals that most healthcare organizations are in the very early stages of this cultural shift. Despite evolving reimbursement models that are gradually incentivizing quality outcomes and efficiency, organizations still must invest in the necessary infrastructure and embrace new workflows.

Electronic health record implementation provides one example. To date, even the most sophisticated EHRs usually are implemented as little more than electronic versions of existing processes and workflows. What is needed instead are more comprehensive and precise analytics to segment patients and personalize patient care.

Traditional analytics match demographic and claims data against quality measures, but engage all patients with similar conditions in the same manner. All patients identified with Type 2 diabetes, for instance, might be offered the same form of educational outreach. While EHRs today offer transactional clinical decision support at the point of care—some even are even adding managed care modules—they lack the capability to support the data-driven workflow of a distributed care coordination team. They are not designed to ensure top-of-license performance by all participants in the cycle of care, whether they are charged with managing a patient’s financial, clinical, or social welfare.

With new analytics, however, healthcare organizations can begin to offer a more tailored approach to care based on reviewing more comprehensive claims, clinical, and psychosocial data. As such, future success with population health management requires a data management infrastructure designed to capture an exploding volume and variety of data in real-time, much of it outside the claims stream.

Going forward, the strongest organizations will be those that most effectively harness, integrate, and analyze multiple types of data to inform the care of patient populations at the point of care. For example, claim clickstream data may reveal what treatments patients were provided in the past, but not necessarily whether they worked. Psychosocial data—such as whether a patient drives or has adequate social support—can have a massive impact on the success or failure of care, but is often embedded within provider documentation. Pharmacy, lab, and real-time clinical biometric data from devices such as wireless glucometers and scales is essential to effective care management.

Simply put, a real-time, 360-degree view of the patient, plan of care, evidence-based guidelines and psychosocial data results in more targeted, effective population health management, which in turn leads to better, more accountable care.

Effectively improving population health and the bottom line will require that data be translated into structured content readily available for analysis. Healthcare organizations today must take advantage of technology that allows storage and maintenance of data at its finest-grain level. It is no longer adequate to extract data, drop it into a data warehouse, and run pre-defined reports. This solution simply isn’t agile enough to answer new questions or handle increasing data volumes.

Instead, data must be conditioned, as data hygiene is extremely important for effectively using data out of the chute. Moreover, natural language processing also is becoming increasingly valuable for extracting actionable data from physician notes.

Cloud-based storage strategies, however, have proven most effective for supporting greater volumes of new data. Cloud environments offer an on-demand infrastructure capable of finding the right signals through the data noise that is expanding as the velocity, volume, and variety of data increases. Overall, healthcare organizations must employ technologies capable of clearly identifying relevant data and revealing that data at the point of care in a way that is quickly and easily consumable by providers.

Information is becoming a driver of consumer and clinical value in healthcare. In the near future, the use of data to enable effective population health management will align healthcare organizations with the cost and care quality goals so vital under accountable care reimbursement models. The most successful healthcare organizations, therefore, will be those that find new ways to use technology to leverage a wide range of patient data to improve both the bottom line and patient care.

Larry Schor is SVP of Medecision.

Readers Write: Are You a “Check the Box” Executive?

Are You a “Check the Box” Executive?
By Dana Sellers

Over the Labor Day weekend, CMS released an update for Stage 2 Meaningful Use that provides some relief to providers struggling to fully implement the 2014 requirements. That’s great, but here’s the problem: Meaningful Use is not just an exercise to check some boxes off.

It’s more than implementing CPOE. It’s more than getting your physicians to use a problem list. It’s more than the incentive dollars. It’s about getting value beyond the implementation.

If your organization attested in 2012, you have been continuously collecting discrete standardized and coded data for close to two years. You’ve done the heavy lifting and you’re continuing to do so for Stage 2. Now you have a foundation that provides a common data platform across the organization with standardized vocabularies, regardless of different EHRs or other operational systems.

While you may be awash with all kinds of data, Meaningful Use provides specific clinical data that you can focus on. You have a means to ensure that all parts of the organization can begin to measure the same things the same way.

In a recent project, we turned our new cadre of Quintiles researchers and biostatisticians loose on a bunch of clinical data. We imposed one important ground rule: we limited the data to things that were already being collected for Meaningful Use. We asked if they could find anything interesting. In a matter of weeks, they discovered significant findings that relate directly to outcomes and cost.

Here’s the cool part. Every organization that has attested for Meaningful Use has the data needed to do the same kind of study.

Are you looking at Meaningful Use as a check-the-box exercise, or are you looking to drive real value? Have you considered the possibilities of using your current data foundation in order to improve workflow and processes?

For example, changing how the patient intake process occurs, not only for better collection of data, but also for safety and care coordination. Can you move beyond monitoring clinical process measures to conducting analytics that will drive insights for better care and outcomes?

It takes the organization thinking about Meaningful Use as a foundation for value. It requires change.

• Break down organizational silos. No single department owns the challenges facing organizations around quality, cost, and performance. Yet multiple departments and stakeholders often try to answer the same types of questions, resulting in inefficient processes as well as conflicting answers. Create cross-departmental, multi-disciplinary teams to address these challenges.
• Get data governance in place. Information transformation requires that data is consistent, accurate, and timely. This foundational data is a start, but still requires an organizational structure and process to provide direction and decision-making to create common definitions and apply common standards across multiple stakeholders and departments.
• Start with the foundation. There is tremendous value in the foundational MU data. Begin to explore beyond the standard Meaningful Use process objectives. Use this foundation to evaluate how well standards are applied. Explore for other clinical insights like impacts of the use of evidence-based orders on specific disease-based populations in this data set.

Meaningful Use is not an IT project or task to cross off a project list. It is a foundation for an information journey to value.

Dana Sellers is CEO of Encore, A Quintiles Company of Houston, TX.

Readers Write: What to Ask When Deciding to Take the CMS 68 Percent Settlement Offer

What to Ask When Deciding to Take the CMS 68 Percent Settlement Offer
By Bill Malm

The October 31 deadline for providers to decide whether or not to take the 68 percent settlement offer from CMS is quickly approaching. This settlement enables any provider to withdraw their pending inpatient appeals in exchange for a timely partial payment which equals 68 percent of the net allowable amount. CMS is offering this settlement in order to reduce the volume of inpatient status claims currently pending in the appeals process and to alleviate the administrative burden to both providers and Medicare.

Many healthcare organizations have already submitted their request to take this agreement, but if your hospital is still weighing the pros and cons of doing so, some key factors for consideration include the following.

• Does your hospital have significant dollars at risk or a high volume of outstanding appeals? Hospitals with a large number of appeals and/or a significant amount of revenue tied up in the appeals process may benefit from seeing the appeals through the ALJ process. Interest payments alone could outweigh any reason to settle.
• Was your hospital’s appeal strategy based on an internal review process that appealed only strong cases, writing off weaker cases? Hospitals that had a denial review strategy and chose to appeal only those cases with a reasonable likelihood of success may not want to agree to a 32 percent reduction in payment and forfeit the Limitation on Recoupment 935 interest. On the other hand, hospitals that appealed cases indiscriminately are promised 68 percent of the net payable amount. In the end, this may result in a higher payment for these organizations.
• What was your hospital’s recoupment strategy? Is the expected interest on a successful appeal financially substantive or marginal? If your facility allowed immediate recoupment of overpayments following receipt of Demand Letters, then your claims are not subject to 935 interest. Conversely, 935 interest is owed when claims were involuntarily recouped and you prevail at the ALJ level. For claims that wait years for an ALJ hearing, this payment could be substantial.
• How badly do you need your money? This may seem like a silly question, but keep in mind that strong appeals and long wait times will likely result in payments with greater than 100 percent value, but it may be a very long time before you see that money. Can you afford to wait? Hospitals that accept the settlement can expect reimbursement within 60 days of a fully executed agreement.
• What is the cost associated with pursuing your appeals? Hospitals with high costs associated with the pursuit of appeals may want to consider the settlement.  Those costs might include consultants, attorneys, and expert witnesses. The cost of internal personnel time and resources should also be considered.

Deciding whether or not to take this settlement depends on a variety of circumstances. The final decision should be based on a position of financial strength and a strategic choice rather than a short-term stopgap out of necessity.

Bill Malm is senior manager of revenue integrity communications at Craneware.

Morning Headlines 10/15/14

AMA Provides Blueprint to Improve the Meaningful Use Program

The AMA publishes a wish list of Meaningful Use Stage 3 criteria as part of a letter to CMS. Within the list, AMA calls for more flexibility on threshold measurements, reduced penalties for those that fail to meet criteria, and improved interoperability standards.

Joint HIT Committee Meeting

The ONC’s HITPC workgroup will present its conclusions after analyzing the 2013 JASON report that was highly critical of the interoperability plan being pursued in the US. The group will propose an API-based interoperability approach as a path forward.

Highmark-UPMC split raises health records concerns

Pennsylvania state representative Dan Frankel questions whether UPMC, which uses Cerner, will be able to send patient records to other health systems once it severs ties with Highmark Insurance and those patients move on to new care providers.

News 10/15/14

Top News

The AMA issues a Meaningful Use blueprint that calls for CMS to:

• Waive penalties for providers that hit a 50 percent threshold.
• Pay incentives for meeting a 75 percent threshold.
• Make three unpopular measures optional: View/Download/Transmit, Transitions of Care, and Secure Messaging (or as an alternative, set thresholds at less than 100 percent).
• Eliminate thresholds and menu vs. core requirements.
• Add Stage 3 measures that are more appropriate for specialists.
• Continue hardship exceptions for anesthesiologists, pathologists, and radiologists given their tiny attestation numbers and their use of systems provided by hospitals that don’t care all that much whether they can attest or not. AMA also wants a hospitalist exemption for those who treat large numbers of observation patients since they don’t qualify as hospital-based EPs in that setting.
• Leave the measures in place that HITPC suggested removing, but allow providers to qualify by meeting any 10 measures.
• Loosen the hardship exception requirements by expanding the definition of “unforeseen circumstances” and exempt hospitalists and physicians who are eligible for Social Security by the end of 2015.
• Revamp EHR certification to cover only interoperability, quality reporting, and privacy and security.
• Eliminate the requirement that only licensed clinicians can enter orders.
• Create standards for electronically passing data between EHRs and registries in a standard format, eliminating the need for middleware.
• Focus Stage 3 standards on coordination of care and new payment models rather than on data collection.

The AMA’s document also calls out C-CDA as causing interoperability problems, saying that ONC mandates its use in Stage 2 even though it has had “very little real world testing, nor was it balloted or approved for standardization by HL7” and therefore is still a draft standard with “wild variation in technology versioning.”  It urges that ONC not repeat the same process of jumping on untested standards starting with Stage 3.

Reader Comments

From Media Horse: “Re: Abraham Vergese, MD’s comments about EHRs interfering with patient care. He was the keynote speaker at athenahealth’s user conference a few years ago. It was a good speech about preserving the patient-doctor relationship, but it’s interesting that he spoke for a company that’s in essence a billing company with an attached EHR. I’m not suggesting that he’s a hypocrite, but I’m sure he was paid well.”

From Number Six: “Re: Health Data Warehousing Association conference in Portland, ME last week. I was impressed by the all-volunteer organization’s conference and the low registration fee of under $500 for 2.5 days. It was held in MaineHealth’s really nice conference center and had about 170 attendees. No vendors, just data people giving concrete details of what they’re working on in their institutions. Utah presented how they incorporate PROs into Epic and Altrius had a talk on predictive modeling, which was then covered in a ‘Sharing’ session on Day 2 since it was obvious that their specs could be implemented at other places. I highly recommend the conference HIStalk readers. Next year’s meeting is in Grand Rapids.”

From Always Be Closing (Offices): “Re: CompuGroup Medical. Closing the Boston office and terminated the sales VP and several sales reps.” Unverified, but the report is from a non-anonymous insider.

Webinars

October 21 (Tuesday) 1:00 p.m. ET. Electronic Prescribing Of Controlled Substance Is Here, What Should You Do? Sponsored by Imprivata. Presenters: William T. “Bill” Winsley, MS, RPh, former executive director, Ohio State Board of Pharmacy; Sean Kelly, MD, physician, Beth Israel Deaconess Medical Center;  David Ting, founder and CEO, Imprivata. Providers are challenged to use EPCS to raise e-prescribing rates for MU, improve physician productivity, reduce fraud and errors, and meet New York’s March 2015 e-prescribing mandate. Hydrocodone painkillers such as Vicodin have moved to Schedule II, with the higher CS prescribing volume adding another reason to implement e-prescribing. This webinar will describe why organizations should roll out EPCS, presented from the perspectives of pharmacy, compliance, physicians, and technology.

Acquisitions, Funding, Business, and Stock

Lifestyle healthcare technology vendor Alphaeon Corp. acquires Utah-based TouchMD for $22 million. TouchMD’s apps allow plastic surgery and OB-GYN practices to educate patients on their services to “increase consultation closings at the time of service and added procedures beyond the consultation, resulting in increased practice revenue.”

Sales

Beaver Dam Community Hospitals (WI) will deploy eClinicalWorks across its eight locations.

People

Andrew Gelman, JD will step down as SVP of corporate development for PDR Network to run a family business, but says he will keep his hand in healthcare with occasional consulting.

Facebook CEO Mark Zuckerberg and his physician wife donate $25 million to the CDC for Ebola control.

University of Arkansas for Medical Sciences promotes Rhonda Jorden to vice chancellor for IT and CIO.

ONC names Lucia Savage, JD (UnitedHealthcare) as chief privacy officer, replacing Joy Pritts, who resigned in July.

Announcements and Implementations

Mobile Heartbeat will integrate EMR and waveform data from AirStrip’s One platform into its care team smartphone app.

Eskenazi Health (IN) will use technology from Indianapolis-based Diagnotes to alert its brain center coordinators when patients are admitted, discharged, or transferred from hospitals as reported to the state HIE.

Personal health records management app vendor Hello Doctor claims it has “gained access to an API” that gives it “access to 52 percent of clinics and hospitals in the US.” That sounds suspicious since there’s no single API out there that covers multiple vendors, leading me to believe that perhaps they’ve connected to Epic in some manner and are using the “52 percent” statement incorrectly to refer to organizations rather than patients.  

Allscripts will offer Shareable Ink’s documentation solution for surgical and clinical documentation for Sunrise.

Government and Politics

Rep. Renee Ellmers, RN (R-NC) issues a statement saying she’s pleased that CMS extended the Meaningful Use hardship exception after admitting that its submissions website wasn’t working correctly, but repeats her request (made via her proposed Flex-IT Act) that CMS reduce its 2015 Meaningful Use Stage 2 reporting period from 365 days to 90 days.

Beth Israel Deaconess Medical CenterCenter John Halamka, MD says the White House should choose someone from DC rather than Silicon Valley in replacing departed US CIO Steven VanRoekel:

I always support the federal government, but bold new ideas get lost in the complexity of procurement, contract management, and getting stakeholders to agree. Navigating the US government is difficult and complicated, and an outsider from Google or Facebook is likely to be eaten alive. Only an insider can navigate the process while offering new ideas and approaches.

HITPC’s JASON Report Task Force will deliver its conclusions today (Wednesday), proposing that current interoperability approaches should be replaced with an API-driven model starting with Meaningful Use Stage 3. It disagrees with the JASON report’s conclusions that such an approach requires new clinical and financial systems, that the market has failed in its failure to advance interoperability, or that a newly mandated software architecture is required. The task force advocates that ONC create a public interoperability API and encourage its use via the Meaningful Use program. 

ONC names 12 providers as health IT fellows. 

Executives of California’s health insurance exchange are questioned about its contracting practices as a state senator claims the organization practiced cronyism in awarding dozens of no-bid contracts, some of them to a company whose owner has close ties to Covered California’s executive director.

The chief of staff of New York City’s medical examiner’s office quits following a $10.9 million no-bid, sole-source contract award to a ICRA Sapphire, whose software has cause bodies to be mishandled or lost. The city has been paying for the system using Homeland Security grants, having awarded what one lawyer called a “lifetime contract with constantly increasing costs and poor results” and hiring the India-based company’s rep as the ME office’s CIO. The previous CIO and his girlfriend were arrested for embezzling $9 million in FEMA grants intended for tracking the remains of 9/11 victims. The just-resigned chief of staff had been promoted to the position even after getting caught stealing an airplane’s exit handle from the 9/11 debris to take home as a coffee table souvenir.

Technology

Philips Healthcare begins Netherlands hospital trials of a wearable COPD monitoring sensor that collects information on physical activity, respiratory indicators, and sleep disturbances.

A reader called my attention to Xenex, whose xenon-powered pulsed UV devices (“Germ-Zapping Robots”) can disinfect hospital rooms in a few minutes, a timely topic given Ebola. Two of the company’s executives hold doctorates from the Bloomberg School of Public Health at Johns Hopkins University, while the other two were involved with Rackspace Hosting.

Google is testing a search feature that would allow people who are Googling medical symptoms to click a “talk with a doctor now” link.

Breathometer integrates its $100 Breeze personal breathalyzer with Apple’s HealthKit.

Other

The Brookings Institution presumably publishes intelligently written and authoritative articles on occasion, but this lame piece called “Could Better Electronic Health Records Have Prevented the First American Ebola Case?” isn’t one of them (maybe Farzad was the only person there who knew anything about healthcare IT). Its insight is zero, its valid points are few, and its flaws are many:

• It doesn’t answer the question its sensationalistic headline asks.
• It is based on a preliminary report that an EHR setup decision caused Texas Health Presbyterian Hospital Dallas to discharge the Ebola patient from its ED, which turned out not to be the case according to the hospital.
• It gets the hospital name wrong even though it’s right there on the page to which the article links.
• It wanders all over the place about EHR privacy, cost, and “voluminous files,” then meanders into healthcare policy issues, health IT competition, and a proclamation that an undefined “many”are skeptical about EHR value and the government should therefore fund outcomes research (which is already underway).

Anna McCollister-Slipp, the co-founder of an analytics company and Tricorder Xprize judge who also has Type 1 diabetes says she’s tired of waiting for digital health to flourish, pointing out that:

• Even hospitals that took Meaningful Use money won’t allow patient-sourced data to be imported into their EHRs.
• Most of the health apps were designed for people who are already healthy.
• Her academic medical center does not offer online EHR access, doesn’t allow electronic communication with its physicians, and won’t provide her endocrinologist with the software that would allow him to load her glucose monitoring data to his computer.
• None of her doctors use electronic scheduling, none offer online lab results retrieval, and only one accepts electronic refill requests.

A Pennsylvania legislator questions UPMC (PA) about its ability to send records of Highmark insurance patients to new providers when they lose access to UPMC’s hospitals on January 1. UPMC CIO Steven Shapiro says they can transfer records electronically within 24 hours, but Highmark claims UPMC will be sending faxed documents instead. UPMC uses Cerner among its variety of systems, while Highmark-owned Allegheny Health Network is moving to Epic.

Reuters covers the growing telemedicine market in China, which the government is supporting to overcome the rural-urban medical expertise gap. A report says doctors in China spend 13 hours per week online, with 80 percent of them using mobile phones.

CDC and ONC will present a webinar on Thursday, October 16 at 1:00 – 2:30 p.m. Eastern to encourage providers and EHR vendors to work together to develop Ebola screening tools. CDC’s Ebola team will present its detection algorithms and travel history / medical signs checklists.

NBC medical correspondent Nancy Snyderman, MD admits that some of her crew members broke a voluntary Ebola quarantine in going out for takeout food after returning from Liberia, where the group had been in contact with an Ebola-infected freelancer. New Jersey health officials reacted to her admission by making the quarantine mandatory.  She declined to say whether she herself was one of those involved as several locals who spotted her indicated.

Sponsor Updates

• Predixion Software joins the Salesforce Analytics Cloud ecosystem.
• Greenway Health’s SuccessEHS is prevalidated by NCQA to receive 27 points in auto credit toward PCMH 2011 scoring.
• Frost & Sullivan names Validic to its 2014 Best Practices Award for Customer Value Leadership.
• First Databank’s collaborative research paper is selected as a finalist in the Best Paper Competition by the American College of Clinical Pharmacy.
• The Jacksonville Daily News discusses the history of military healthcare IT solutions and calls RelayHealth a “pearl.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headline 10/14/14

Promoting healthy competition in health IT markets

The FTC announces that it will work together with the ONC to ensure that EHR vendors are not restricting interoperability options to gain illegal competitive advantages.

2014 Report to Congress on Health IT Adoption and HIE

The ONC publishes its ARRA-mandated annual progress report on the national rollout of EHRs and HIEs. The report provides an in depth look at ONC’s various initiatives, focusing primarily on the steps that are being taken to overcome interoperability barriers.

Mass. Becomes First State To Require Price Tags For Health Care

A Massachusetts law requiring that insurers publish the prices they pay hospitals and practices for services went into effect last week. To comply, insurers are updating their websites with the once closely guarded pricing data.

NIH Invests Almost $32 Million To Increase Usability Of Biomedical Research Data

The NIH announces a new $32 million grant program called Big Data to Knowledge, or BD2K, that will be used to fund research projects aimed at developing new ways of analyzing large biomedical data sets.

Curbside Consult with Dr. Jayne 10/13/14

We are in the process of adding a variety of self-directed learning options to our EHR training. Up until now, we have had formal classroom training for clinical support staff and practice-based group training for providers.

Although we’ve had good outcomes from training, our paradigm is fairly resource-intensive. Additionally, providers complain about the time they spend in training sessions since it often cuts into their office hours even though we offer sessions before and after typical practice schedules.

One of the advantages of a resource-intensive training program is that it is the resources are intensely involved. When we train in small groups, we can provide individualized attention and can monitor who is catching on and who might be struggling. We can also ensure immediate follow up if attendees don’t pass our competency exam.

In turn, our learners can provide feedback on the effectiveness of our curriculum and presentation style so that we can modify it if needed. This is important when we bring new specialties live that our trainers might not be as familiar with as they are with other specialties.

We’ve had online refresher training for the last several years. It’s largely in the form of recorded web presentations, although we have a number of clips that were done with Adobe Captivate. They’re tied to our learning management system so we can see how many times each piece has been viewed and whether a particular employee is taking advantage of the resources. Managers can access a report of their employees’ activities, but the sessions are not required.

Our goal was to create some 5-10 minute segments that people could watch if they were having difficulty with a particular functionality or a new feature. Feedback has been good.

Given the budgetary pressures facing healthcare organizations, we’ve been asked to enhance our online offerings with a goal of reducing classroom training time. Staff will now be required to view a core set of e-learning offerings and managers will be responsible for tracking compliance.

I’m in favor of e-learning because it can be completed at the employee’s preferred time and location. However, I’m concerned that since reduced training time is the goal, that employees will be shortchanged. I can’t see some of our managers carving out protected training time for new employees. In particular, I know some of them will expect employees to jump right into patient care and learn the EHR on the fly.

Those same managers are likely to expect employees to complete the sessions on their own time even though that’s a violation of company policy. Staff working on uncompensated time might rush the training, or worse, multitask their way through it, diminishing mastery. We have a plan to gather data on whether the new strategy is effective, but based on the number and frequency of new hires, it will likely be six months or more before we know if it’s equivalent to our current platform.

I don’t like the idea of experimenting with our practices. We’ve worked hard to have a successful program and our practices get up to speed very quickly with only rare exceptions. Although we pull new hires out of the office for several days of training, when they return to the practice, they’re able to hit the ground running.

I guess my biggest concern is that there’s really no way to shortcut the material. A trainer — whether in person, recorded, or as part of an e-learning platform — can only impart information so fast. In turn, learners can only absorb so much in a given amount of time.

If this was an experimental drug, we’d first have to experiment on healthy subjects (or those who didn’t really need the training) to make sure it was safe. If it passed those tests, we’d have to experiment on more subjects to determine if it was more effective than placebo. Finally, we’d have to have a limited head-to-head trial against current training standards to determine if we should switch to it or not. Only if it passed certain statistical tests would we use it to replace our current training platform.

Since this is mostly about saving money, you can bet we didn’t have the opportunity to really study the new approach, let alone have an actual pilot or trial. We are being forced to switch everyone over without proof that it’s not going to lead to problems. As normally happens in healthcare IT, we were given a short deadline and limited budget to get it ready.

We’ve been in the business of delivering the impossible for a long time, however, so we’re up to the challenge. As for outcomes, only time will tell.

Have you been able to pare down training and maintain quality? Have great ideas? Email me.

Email Dr. Jayne.

HIStalk Interviews Tim Burdick, MD, CMIO, OCHIN

Tim Burdick, MD, MS is CMIO of OCHIN of Portland, OR.

Tell me about yourself and OCHIN.

I’m a family physician, increasing the amount of my time over the past eight years in healthcare informatics. Currently I’m one day a week in clinic at a rural health clinic as a family physician and four days a week as chief medical informatics officer at OCHIN. OCHIN runs a hosted Epic EHR for 350 clinics. Eighty-four healthcare organizations contract to use our EHR.

Epic gets criticism that its product is a walled garden and it’s not interoperable. What’s your opinion?

I think the interoperability frustrations cross all EHR vendors at this time. I don’t see that Epic is any better or any worse than others.

We’ve had good luck building interfaces and interoperability with other systems, with regional HIEs in and out. We have projects going with the VA, with Social Security Administration, and several HIEs. We do a million CCDA transactions with other Epic shops around the country.

Epic’s increasingly been good about opening their APIs. I’m not sure it’s fair to single out Epic. Certainly with the lack of any kind of national standard on interoperability, there hasn’t been a big push to make it happen.

Will the government every lay down a standard that everybody has to follow?

I think it is changing. Clearly Karen DeSalvo has over and over again said that she’s going to push the interoperability issue, so I see that coming. I think there have been other pressing issues for the HIT community that we needed to address before we could tackle interoperability.

The time has come for us to do it. It just hasn’t happened yet because we just weren’t there yet.

You’ve mentioned the challenge of state-specific interoperability requirements, such as California’s mental health reporting and its requirement that providers review lab results before putting them on the patient portal. Will the states standardize?

I’m not sure I see the states working together to do that. What’s happening, for example, in the case of the California legislation preventing organizations from releasing lab results to patients, as of October 1, federal law allows the laboratory companies to release results directly to patients. As a result of the federal law, state laws like the one in California are now superseded, so that’s no longer an issue for us in California.

It’s going to have to be strong federal lead on this that pulls the states into a common compliance rather than states coming together on things.

Do you have a solution to address the difficulty of connecting to state registries such as those for immunizations?

Again, it’s going to come down to standards. If we have a standard that says, these are the core data elements for an immunization registry. These are the requirements that you need to be able to do to pass that information from the EHR to the registry, from the registry back into an EHR, or from the registry to a patient portal. That will bring everybody along so that we’re not having to individually create 22 different interfaces and standards.

You operate in 22 states, but it could be a 50-state problem.

We could potentially have that problem. OCHIN is expanding. Certainly there are plenty of other large healthcare organizations that are in multiple states and having to deal with this issue as well.

If you look at Meaningful Use requirements around interoperability, if for Meaningful Use Stage 2 and Stage 3, we have to have every single eligible provider using some sort of registry list, immunization registry, or special disease registry, and we have to do one-offs in every single state, that’s not scalable, as I said in the testimony.

If we can build one interface, either to a federal registry or at least build it at the state level or the regional level or the county level, but know that those interfaces are all going to look the same and have a same standard set of data elements and same transactional messaging processes, then we can scale it up as a healthcare system.

You’ve said that some of those registries are run by drug or medical equipment vendors and charge fees as a for-profit company would. Can you tell me more about what you’ve seen?

ONC keeps a list of all the different registries — who runs the registry, what the quality registry is, whether it’s a diabetes registry or heart failure registry, and the costs associated with sending the data to those registries.

There is not good transparency around how the data are going to be used. If you’re sharing the data with that registry, can the owners of that registry then use that information? Some of it Is PHI. Can they use it for their own research purposes, their own marketing purposes, are they associated with a pharmaceutical or device company?

Some of those are fairly expensive. If you’re a larger organization, it’s going to cost you a huge amount of money to connect to one of those registries, and yet at the same time, there’s a federal mandate that we do connect to registries like those. Though we get some money back in Meaningful Use dollars, the cost of connecting to those registries on a monthly subscription basis is enormous, and frankly prohibitive.

The third piece is that healthcare organizations are hooking up to those registries and sending data just as a check box so that organizations can say, we’re sending data to a registry so we can collect our MU dollars. But the value that those registries provide back to the eligible providers is questionable.

As with most of the Meaningful Use stuff, I believe firmly that the intentions for Meaningful Use are good and that it’s pushed the healthcare industry along in the right direction, but we need to get away from doing it for check boxes to doing it to drive clinical improvement.

That means that we need to value back from those registries to the providers. It needs to be integrated back into the EHR rather than just saying here’s a website where you can go log on to a third-party app where there’s registry data about your patient population that are no way tied back to clinical care in a clinical operations.

I got two types of reader comments when I mentioned that some of the public HIEs are charging full participation prices to providers who just need to submit to public health registries. Some said they need a viable business model and a provider is either in all the way or out, while others said public health requirements shouldn’t force an organization to join as a full participant for that reason alone. What do you think?

I see both sides of that. Clearly if you’re a business and you’re going to stand up some sort of data warehouse and provide some quality metric reporting around that, that’s a difficult technology. OCHIN’s been working on it for several years. It comes at a very real cost to employ the developers and to do that work. I’m fine with organizations charging for that.

The difficulty comes when there’s a federal mandate to do this. As I said earlier, the financial incentives to do it don’t cover the cost of subscribing for these services. The transparency is that if I’m going to be paying hundreds of thousands of dollars to hook my Eligible Providers up to some registry, I need to know very, very clearly who’s collecting that money, what the money’s going to, and what kind of data use is going to happen with that information. I don’t think we have that level of transparency.

I’m not opposed to organizations collecting fees to cover their costs and even making a profit off of that. But we need to know who they are, what they’re doing with the data, and what their intentions are.

In addition, I think it would be great if the CDC, NIH, Institutes of Medicine, some of the other federal organizations could host some federal registries rather than doing it at the state level. Again, coming back to this idea of Eligible Providers in 22-plus states for OCHIN, if I can’t find a federal registry, then I’ve got to start reaching out to state registries.

The other example here would communicable disease surveillance, infectious disease surveillance registries. Those are largely at the state level. It’s just not practical for me to reach out with interfaces to 22 states. But if I can submit diabetes information, heart failure data, infectious disease surveillance data to a federal agency on a federal program at a cost that is subsidized by the federal organizations – ONC, CDC, etc. – then I can scale it up and there is less of an issue of questions about potential profiteering and lack of transparency.

It’s in the interest of organizations like CDC to start developing those federal registries and being able to collect the data and use those for national healthcare initiatives. I see it as a win-win.

Is Meaningful Use Stage 2 causing other unintended consequences that aren’t in a patient’s best interest?

That’s difficult. Yes, there are definitely unintended consequences and negative impacts. I’m firmly committed to the long-term benefits of Meaningful Use. With the significant earthquake changes that things like Meaningful Use bring along, there’s going to be the unintended consequences that we need to work through. But I don’t think that in any way negates the vision of Meaningful Use and HIT improvement processes.

Is it a short-term problem that patients are confused by having to log in to several patient portals, one for each provider, to look at their own data?

I think it’s a medium-term issue. There is a growing market for vendor-agnostic PHRs. HealthVault, Apple getting back into it, Google getting back into it. There are other third-party companies getting into this. Some of those were represented at the ONC patient engagement meetings a couple weeks ago.

I think there’s going to be a competitive market for that type of work. That’s going to drive it pretty quickly. Karen DeSalvo has mentioned at several meetings that I’ve attended that ONC is interested in supporting that process in some fashion or another. I see this issue being a two- to four-year growing pain problem that will have some solutions in the foreseeable future.

What do you think the business model or overall goal should be for public HIEs, or what we would have called a RHIOs in the old days, beyond just letting providers look at information on the screen?

The idea of having either a pass-through model or a data repository where the data are going to be held for a period of time while keeping the data in some sort of separate system … I think that model has not proven value and doesn’t have any long-term financial viability to it, as witnessed by innumerable failures of RHIOs in the past.

From a Triple Aim perspective, what we really need is for the data about a patient to get pushed through to a provider at the point of care within their EHR — whether it’s in an office visit or a care coordinator working on patient population issues — so that if that patient has had a hemoglobin A1C done by an endocrinologist a week ago at a different healthcare facility, the data are actionable in real time within the EHR.
The patient’s data need to move seamlessly across platforms. Care Everywhere works well and there are other things like that, but it still requires me to go out and look for that information and it still doesn’t move easily back and forth, even between EHR systems that are using the same vendor.

We need to get away from that model that a patient’s data exists in different instances separately and move to a place where the patient’s data coexists simultaneously and in real time in any instance of their care. That’s going to allow us to make it actionable to drive clinical decision support, panel management, and population health. That’s going to get us to Triple Aim.

The other thing it allows is on the patient-facing side of things for the patient to be able to see their information in a collated fashion and not in a siloed fashion so that they understand their healthcare picture not from the perspective of, “This is my cardiologist’s view of me. This is my pulmonologist’s view of me. This is my PCP’s view of me,” but, “This is the healthcare system’s view of me as an individual patient.”

Will the CommonWell initiative will make an appreciable difference in interoperability?

I think that’s to be determined.

Do you think Direct messaging will have a significant role or has it missed its opportunity?

Certainly some folks would say that it missed its opportunity, that the concept is so fundamentally flawed that it can never be executed on a large scale.

I don’t think anybody has shown that Direct is not viable, but I don’t think anybody has shown that Direct will work at a large scale, either. The issue of sharing directories and trust bundles across organizations that don’t have close working relationships with each other is unproven at this point.

At OCHIN, we are building out our Direct address directories. We are starting to share those with outside organizations. The uptake is slow on it. Just the mechanics of how to move the data back and forth, integrating that into clinic workflows on the clinic side, as well as how to set up those address within the EHR.

It’s still an early process technically. We’re facing things like that some organizations that we work with want every provider to have their own Direct address. If they set it up that way, then does an inbound message come through directly to that provider’s in-basket? If so, does the provider know what to do with that information and does that information get processed the right way in clinic?

Some organizations want to take the approach where the organization’s going to get a Direct address and the individual providers won’t. Then it will come in and some staff person will process those messages and move them around.

Even just simple questions like which process are we going to through with that organization address or an individual Eligible Provider address. We don’t even know how we’re going to handle that. Until we try those different things for a month or a year, I don’t think we’re going to know for sure what’s going to work in clinics.

If you were king of interoperability for a day, what would you do?

What I would really like to see right away is for the healthcare industry — healthcare providers, payers, federal government — get together a summit of thought leaders and define 30 clinical data elements that are needed to improve Triple Aim, things like hemoglobin A1C levels and left ventricular ejection fraction. Agree that these are just the basic elements that we need to start with in order to improve our Triple Aim outcomes.

Define those at a national level and figure out for those finite number of elements, how is every single EHR vendor going to really easily make that data flow out? How are we going to really easily make that data move in? What role does the federal government have in helping consolidate a national pass-through model that will at least make those common data elements available seamlessly across organizations.

Do you have any final thoughts?

The big issue here is patient matching. It really is going to come down to our ability to match our patients. Until we tackle a patient matching issue, we can come up with standards all day, but if the patient match rate is 20, 30, 40 percent, then we’re not going to get there.

I doubt there’s a political willpower to bring back to the table a conversation about a national healthcare ID. If we’re not going to do that at a federal level, then healthcare organizations and patient advocacy groups need to tackle this issue on a non-legislated fashion.

One of the things that I mentioned in my testimony would be developing a grassroots organization that allows patients to have an interoperability member card. It’s going to have on there the patient’s name the way they want it spelled consistently, down to capitalization and hyphenation. It’s going to have a date of birth, and in the case of patients who were born outside of the United States, we can’t continue to just randomly assign January 1 to tens of thousands of patients whose birthday isn’t documented.

If we use a phone number for patient matching, even if the patient’s no longer using that phone number for communicating with the clinic, we can at least continue to have them use that same phone number for patient matching.

It becomes a proxy for a standard ID, but that patient’s going to carry that card with them year after year. Those elements aren’t going to change. They can voluntarily take that card to registration at a hospital, lab, radiology facility, outpatient clinic, or the ER. The data for that patient are going to get populated in registry systems at every healthcare organization that that patient touches. That’s going to allow us to do patient matching at a much, much higher percentage.