Internal Announcements of Farzad Mostashari’s Resignation

HHS provided this information.

From: Sebelius, Kathleen (HHS/OS)
Sent: Tuesday, August 06, 2013 10:51 AM
Subject: Important Staff Announcement

Hello Colleagues,

I am writing to share the news that Dr. Farzad Mostashari has advised me he will be stepping down as National Coordinator for Health Information Technology this fall.

Farzad has been a leader in the Office of the National Coordinator for Health Information Technology (ONC) for the last four years.  Farzad joined the office in 2009 as Principal Deputy National Coordinator and took over as the National Coordinator in 2011.  During his tenure, ONC has been at the forefront of designing and implementing a number of initiatives to promote the adoption of health IT among health care providers.  Farzad has seen through the successful design and implementation of ONC’s HITECH programs, which provide health IT training and guidance to communities and providers; linked the meaningful use of electronic health records to population health goals; and laid a strong foundation for increasing the interoperability of health records—all while ensuring the ultimate focus remains on patients and their families.  This critical work has not only brought about important improvements in the business of health care, but also has helped providers better coordinate care, which can improve patients’ health while saving money at the same time.

During this time of great accomplishment, Farzad has been an important advisor to me and many of us across the Department.  His expertise, enthusiasm and commitment to innovation and health IT will surely be  missed.  In the short term, he will continue to serve in this role while a search is underway for a replacement. Please join me in wishing Farzad all the best in his future endeavors.

Kathleen Sebelius

From: Mostashari, Farzad (HHS/ONC)
Sent: Tuesday, August 06, 2013 10:23 AM
To: OS – ONC Feds
Subject: Announcement

My Dear ONC’ers,

On a pre-dawn morning in June 2009, I paced helplessly outside my Mom’s hospital room as alarms beeped and the monitor showed the most recent run of life-threatening heart arrhythmia. I had screwed up my courage to ask to see the paper chart, but I couldn’t even read the cardiology consult’s name. After her discharge it was also very difficult to get her records; she didn’t get needed follow-up and required emergency surgery. The complications, which weren’t supposed to happen, indecently increased the hospital’s revenue.

I joined ONC a week later.  This office had a daunting task ahead of it. Working backwards from the outcomes we hoped to enable, we had to define “Meaningful Use” of electronic health records, establish a new certification program, endorse national standards, design and set up a slew of new grant programs to assist in health IT adoption, exchange, workforce, research, and privacy.  There were 32 staff members. 

You will remember the successive sprints – to recruit and establish the Regional Extension Centers and collaborate with newly appointed Health IT coordinators in every state.  The “Office of No Christmas” moniker that we earned for yuletide rulemaking. Trudging 4 miles through the blizzard–to a hotel that still had power– for Beacon application reviews.

And then came an intense focus on implementation and integrity of our grant programs. Accelerating consensus around healthcare standards through an innovative new open source community paradigm in the Direct Project and its successor Standards and Interoperability Framework. Coordinating policy with our federal partners.  Adding a new focus on consumer eHealth, and giving consumers access to their own data through the Blue Button. Creating a Health IT safety program.

We gradually assembled within ONC a microcosm of the diverse and passionate Health IT community itself.  Implementers, doctors and nurses, software developers and project managers, privacy experts, proud standards geeks, patient advocates, public health workers, researchers and data analysts. And we added strength, integrity and resilience by recruiting a core of civil servants who are dedicated to lifelong public service.

You each brought to ONC your own personal commitments and your community’s perspectives, and we unified those divisions through our shared goals: A better health system– that truly knows and cares for all of its patients- through application of information and learning. You nurtured a culture of commitment to American innovation, and an essential optimism that healthcare’s best days are ahead of us.

Regional extension centers have assisted 140,000 providers- over 40% of all primary care providers in the country and over 80% of critical access hospitals- the largest medical technical assistance project in history. Nationwide, adoption of health records has tripled in doctor’s offices and increased five-fold or more in hospitals. Over half of prescriptions are now electronic.  New functionalities essential for population health management are increasingly available and used. National standards and protocols for information exchange and interoperability are being implemented throughout the industry. Over the next 12 months we will see a great democratization of health information as individuals become empowered to download their own health information, and venture capital investment in new tools to help us manage our own health and healthcare are skyrocketing. Meanwhile, hospital readmissions are dropping, healthcare cost inflation is at historic lows, and the movement towards payment that rewards quality and value is gaining speed. 

My mom has recovered now. Her hospital is working to implement new systems to provide accountable care. Her prescriptions and health records are electronic and can be shared across the state. Like 37 million other elderly Americans, we can access her medical history with her Medicare Blue Button records on her mobile phone.

There are formidable challenges still ahead for our community, and for ONC. But none more difficult than what we have already accomplished.  In these difficult and challenging times, your work gives us hope that we can still do big things as a country. That government and the private sector working together can do what neither can do alone. We have been pioneers in a new landscape, but that landscape is one changed for ever, and for better.
It is difficult for me to announce that I am leaving. I don’t know what I will be doing after I leave public service, but be assured that I will be by your side as we continue to battle for healthcare transformation, cheering you on.

Best wishes to you all,

Farzad

Mostashari Announces Departure from ONC

It’s true “@Cascadia: New era coming as @Farzad_ONC announces he is leaving @ONC_HealthIT”

— Farzad Mostashari (@Farzad_ONC) August 6, 2013

Farzad Mostashari, MD confirmed via Twitter this morning that he will step down from ONC as National Coordinator. He did not announce his plans and his replacement has not been announced.

HIStalk reader “Bow Tie No More” provided that rumor yesterday, but ONC would not confirm.

Full text of the internal announcements is here.

Morning Headlines 8/6/13

Can plagiarism detection tools catch EHR upcoding?

A Government Health IT article explores the idea of combating copy-and-paste documentation in healthcare by adopting anti-plagiarism software popular in many academic settings.

CACI wins VLER contract

The Department of Veterans Affairs has awarded CACI International a $14 million contract to build a data exchange platform that will consolidate EHR data and benefits information across the VA, the Defense Department, and other agencies in support of the Virtual Lifetime Electronic Record program.

EMR Impact: How Patients Are Connecting To The Future Of Healthcare

A study of 1,000 insured US health consumers finds that 52 percent are interested in using a patient portal, but are not currently doing so. Patients indicating that they are using a portal reported higher than average patient satisfaction scores and stronger network loyalty.

St. Elizabeth Hospital Recognized as Leader in Electronic Medical Records

Thirty-eight bed Saint Elizabeth Hospital in Enumclaw, WA achieves HIMSS Stage 7 recognition.

Readers Write: A Meaningful View of Meaningful Use

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Readers Write: Building an Accountable Care Organization? Consider Starting in Your Own Back Yard

Building an Accountable Care Organization? Consider Starting in Your Own Back Yard
By Claudia Blackburn

Explaining my healthcare IT profession to my parents and children has never been straightforward. Yet sometimes they are the ones who can boil it down to the essence of what we do, perhaps even better than we can.  Before I became a consultant, my mom once told a family friend that I, "paid people to be healthy so that the hospital I worked for didn’t have to pay as much for health insurance." The friend responded,"Where can I sign up?" They both clearly understood the value of population health management (PHM) programs.

With the CMS news released this month about those Pioneer Accountable Care Organizations (ACOs) that have demonstrated success and shared in the savings — and of those Pioneer ACOs that are not continuing the program — there’s healthy debate about the model and the key success factors.

For those organizations considering starting an ACO, consider test-driving the concept in your own back yard with your health plan member population.

The Opportunity: An Integrated Wellness Model

Several self-insured employers – both healthcare organizations and companies from other industries – have proven that an ROI is achievable through population health and wellness programs. A few shared their program experiences showing impressive return for their wellness dollars:

• In 2011, Mercy Clinics, Inc. reported a four-to-one return on investment of wellness dollars spent. Mercy uses coaches within its practices to assist with coordination of care.
• Franciscan Missionaries of Our Lady Health System decreased health plan expenses 13 percent, with a 21 percent decrease in medical claims alone in 2011. A four-to-one return over five years projected a savings of $37.3 million.
• John Hancock’s Healthy Returns program increased savings per participant from $111 in 2009 to $261 in 2010, and preventative care increased 1 percent to 4 percent per year with an overall 2.5 to one ROI.

Just as any other employer, hospitals face increasing healthcare costs for their employee and member population. However, hospitals can use their healthcare expertise to develop practice protocols that change habits and ultimately improve the health of their self-insured member population and decrease employee benefit costs.

Strategic Elements of a Successful Population Health Management Program

Screening, prevention, and care management are all involved in population health improvement, but by far, changing the habits of individuals is the most challenging. Smart phone applications and portals, in addition to payers and providers pushing information, have not engaged members.

To engage members for best outcomes with accountability and oversight, the health management program must be a combination of people, new processes, new technology, and much better use of the collective data. There are several essential elements of an integrated PHM model:

• Claims data. Claims data define healthcare services received across the continuum of care and risk in order to target program benefits and measure improvements in utilization and cost.
• Health risk assessment (HRA). A HRA captures basic information to determine the consumer population health status and risk stratification, especially important for those with no claims.
• Electronic medical record (EMR) / biometric screening. It’s important not to allow the member to self-report on weight, cholesterol, blood pressure, and glucose. Instead, a coach or nurse should measure other biometrics charted in the EMR. Patient data from a personal health record (PHR) can be useful and selectively imported into the EMR.
• Aligned incentives. Incentives are important to move members towards participation and keep them active and accountable. Incentives such as reduced premiums, door prizes, or gift cards are helpful to encourage enrollment. Once enrolled, outcomes-based incentives can be used to keep the member working towards health goals.
• Coaching. Successful PHM programs have coaches armed with full information from claims, HRA, and EMR to motivate members to change behaviors.
• Consumer portal. The portal allows for better engagement between provider and consumer and monitoring of healthy habits, such as exercise.
• Data warehouse /analytics. Armed with holistic information about the consumer, high-risk root causes can be identified, targeted with strategic program initiatives, and measured for success or rework as part of a feedback loop to assure data-driven increased quality and decreased cost.

From the above list, clearly the “glue”for connecting the PHM program elements is a solid technology foundation. It provides a concise picture of population and individual holistic health. When combined with coaching, health systems are able to not only monitor but also influence change. Additionally, the closed-loop feedback mechanism enables measurement of the success of strategies at an enterprise level and a member level to allow for continuous improvement.

Just as my mom and her friend understood, the value of population health and wellness programs can be substantial. Keeping members accountable through incentives increases healthy behaviors and reduces the self-insured health insurance cost of the employer.

Hospitals can take a leadership position in the move toward the IHI’s Triple Aim both as an employer and a healthcare provider via PHM programs for its own self-insured member population. The individual wins, the employer wins, the hospital wins, and the community wins.

Claudia Blackburn is a consultant with Aspen Advisors of Pittsburgh, PA.

Curbside Consult with Dr. Jayne 8/5/13

Even though I’m back in town, I’m still in vacation mode, taking a few extra days to clean up some of the things I never seem to have time to tackle. I’m procrastinating on a couple of household projects, so I thought I’d catch up on email. I don’t get anywhere near the email that Mr. HIStalk gets, but I have trouble keeping up nevertheless, so tonight we’ll dip into the reader mailbag.

Dear Jayne,

I was driving to work the other day listening to the local public radio station. As usual, the “commercials” were just brief blurbs read by the station’s on-air personalities. What caught my ear was the fact that athenahealth was advertising. Do you think they get much business from that kind of exposure?

Wait Wait… Don’t Tell Me!

Dear NPR Fan,

That’s a great question. It certainly can’t get the company any less exposure than some of the EHR ads that I see in medical practice journals. You know what I’d really like to see, though? Jonathan Bush being interviewed by Car Talk hosts Tom and Ray Magliozzi. The amount of scattered random thoughts would be truly amazing.

Jayne

Dear Jayne,

I liked your recent piece on downtime. Here’s something that has helped our clients be prepared.

Lexmark Luthor

Dear Lex,

Thanks for sharing your video on the downtime-ready printers. It looks like it can work with minimal training and being able to access the downtime reports using proximity badges makes it easier for those of us who don’t want to remember one more password. I smiled when I saw the “Tray 2 Empty” indicator on the printer’s touch screen – it seems like every printer I encounter lately ends up needing paper.

Jayne

Dear Jayne,

I work in a busy ER and we have a lot of locum tenens physicians that cycle through. There is this hysterically funny blonde that recently started working with us. When I saw the zebra print clogs, it occurred to me that you might be working in my ER. Am I right?

Memphis Belle

Dear Belle,

Although I’m definitely a fan of Corky’s, I am not currently walking in Memphis. I’ll let you know if I come your way, though!

Jayne

E-mail Dr. Jayne.

Morning Headlines 8/5/13

Maine hospitals disband remote ICU program, citing costs

MaineHealth announces that it will stop offering its tele-ICU service in October after several participating hospitals drop out. The program connected nine rural hospitals across the state with a 24-hour-a-day ICU command center at Maine Medical Center in Portland.

Whistleblower suit: Hospitals defrauded Medicaid

A whistleblower lawsuit filed by the former CFO of Health Management Associates charges HMA and Tenet Healthcare with paying kickbacks to clinics that referred pregnant illegal immigrants to their hospitals where emergency care claims were then submitted for their deliveries. The report says that the scheme has been operating for more than a decade.

More doctors avoiding Medicare patients

According to CMS, the number of doctors opting out of Medicare has tripled since 2009, with 9,500 physicians opting out in 2012.

Monday Morning Update 8/5/13

From DCIntern: “Re: Stage 3 Meaningful Use. Expect ONC to recommend a delay during National Health IT Week.” Unverified.

From Fly on the Wall: “Re: [vendor name omitted]. Having glitches nationally and worldwide in its medication reconciliation programming, causing patient discharge medication lists to be in error. A safety letter was issued on August 1.” I’ve asked the company to confirm, but in fairness I’m leaving their name off until I hear back. A copy of the safety letter would be nice to have.

I needed updated copies of Microsoft Office and wasn’t too thrilled at the price or the limit of installing it on only one PC (it was three PCs in previous versions), so I was happy to have stumbled onto Office 365. The Premium version (Word, Excel, PowerPoint, Outlook, OneNote, Access, and Publisher, all in 2013 version) runs $99.99 year for up to five PCs or Macs and also five mobile devices. I don’t like renting software instead of owning but was about to bite the bullet when I strayed onto Office 365 University. Students, faculty, and staff of approved education institutions (like my hospital) can get a four-year, two-PC subscription that includes 20GB of SkyDrive storage for $79.99, which I did –$20 per year is just fine with me. Installation was slick, fast, and in the background. The new software versions work great, but I haven’t been able to figure out how to use the cloud features, especially with Outlook. It would be a really slick package if Microsoft offered an easy guide on how to use all the file-sharing features it touts. I admit that I didn’t spend much time trying to figure it out, but so far I’m using it just like the old CD version.

Three-fourths of poll respondents don’t see HIMSS as a major player in the debate about healthcare quality and cost. New poll to your right: do you follow the “Most Wired Hospital” type awards? The poll accepts comments once you’ve voted if you would care to elaborate.

Stock picking TV celebrity Jim Cramer, whose lips were perpetually planted on Glen Tullman’s posterior until Cramer finally advised dumping Allscripts shares way too late, is now enamored with Jonathan Bush and athenahealth. Cramer is entertaining, but watching him can be expensive if you take his stock advice. Bush says hospitals are in a decline and struggling ones are being bought up by sharp for-profit operators whose efficiency allows them to make a profit. Cramer says athenahealth “is solving a lot of the healthcare problems in this country.”

Financially struggling MaineHealth will shut down its nine-hospital tele-ICU program that loses $500K annually. One hospital says it pays $150K each year to participate, but, “While the service is fantastic for our patients, it’s not reimbursable … The consequence of this will be that some patients that may have stayed in the local community may have to travel further for care that we won’t be able to offer. MaineHealth signed a splashy deal with VISICU (now Philips) in 2005, with the health system’s president saying then, “The savings in lives and ultimately in dollars make it an important investment. It’s the kind of service that is possible only because we have forward-thinking clinical and administrative leadership.”

The previously insignificant number of physician practices that don’t accept Medicare is growing, according to a Wall Street Journal report that says 9,500 doctors opted out in 2012.

In England, a study of Internet searches for takeout food that originated from a hospital IP address finds that those searches quadrupled in one year.

An Iowa nursing home fires two employees for taking inappropriate photos of a resident and posting them on an unnamed social media site.

A former Health Management Associates hospital CFO files a whistleblower lawsuit claiming that the for-profit HMA and Tenet hospital chains paid kickbacks to two Georgia clinics in return for sending pregnant illegal aliens to their hospitals so they could bill Medicaid for emergency services. The clinics, which advertised, “We care about your health, not your immigration status,” were paid kickbacks disguised as translation service fees, according to the lawsuit. Illegals aren’t eligible for Medicaid, but emergency services, including childbirth, are covered.

Vince covers the HIS-tory of Siemens, Part 3 this week.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Time Capsule: Here’s President Obama’s Mandatory EMR Feature List: Firing GM’s CEO Makes it Clear That Federal Money Has Strings Attached

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in April 2009.

Here’s President Obama’s Mandatory EMR Feature List: Firing GM’s CEO Makes it Clear That Federal Money Has Strings Attached
By Mr. HIStalk

Was anyone but me surprised when President Obama decided it was time for GM’s CEO to quit and that Chrysler had no choice but to merge with Fiat? Man, I guess you really give up day-to-day control when a big lender (like Uncle Sam or the mafia) puts up the cash to keep you in business. Even Nixon wasn’t so bold as to say that what’s good for the country damned better be good for GM or else.

Say, wait a minute … healthcare is getting a lot of government money. Surely the feds wouldn’t start telling us how to run our shop, right?

I wouldn’t count on it. We might be selling our souls here.

This particular government, faced with a dismal economy and an ambition to make major changes in American society, doesn’t seem to be shy about crossing that previously sacred line between government and private industry. It’s surprising that a Democratic government would be as hard-nosed as private equity firms in putting their people in key positions of responsibility, demanding equity in return for financial support, and mandating changes in product development and sales despite the market’s sometimes differing interest (car makers made a ton of profit on gas-guzzling SUVs that consumers apparently wanted, at least until gas got temporarily expensive and financing became unavailable).

Everybody’s clinking their glasses and high-fiving over the gravy train headed healthcare IT’s way. Fear the person from the government who’s here to help: there may be a hidden price.

It’s clear that CCHIT (or something like it) will enjoy unprecedented power to set mandatory product requirements. “Effective use” will do the same for providers, spelling out exactly how they must use their technology. As Uncle Sam becomes an even more dominant buyer of healthcare services, the ratchet may be turned on reducing costs and following somebody’s medical cookbook. Viewer discretion is not advised.

It was flattering when Obama and company got interested in our little world of healthcare IT. Now it’s scary.

There’s not much question that government is now driving the HIT industry. The question is: to what? Will it be just like today, only bigger? Or is the real agenda to use government clout to finally whip private industry around a little, making businesses behave in some unspecified way that runs contrary to the free market?

I’m as shell-shocked about the economy as everybody else, so I get tired of reading headlines of mind-boggling historical significance that still sound like just more bad news. Somehow, Obama’s giving GM and Chrysler marching orders got my attention, even after watching the financial industry basically disappear overnight. The CEO of every company right now, right or wrong, is the former junior senator from Illinois who has never held a real job (I don’t count being a professor or lawyer) or run a business.

All I will say is this: be careful out there. It’s becoming clearer that government gifts, like private equity investments, come with strings attached. I’m really confused at this point whether I should feel proud or disgusted.

Morning Headlines 8/2/13

Cerner to redevelop Bannister Mall site as office park with as many as 15,000 workers

Cerner has purchased a 236-acre former mall outside Kansas City that it will use to house its growing workforce.

EDCO Awarded Patent for Medical Record Scanning Technology and Process

Frontenac, MO-based EDCO Health Information Solutions has been granted a patent for a scanning solution capable of identifying a document type by analyzing its content, rather than requiring a bar code.

Hospitals Face Challenges Using Electronic Health Records to Generate Clinical Quality Measures

The American Hospital Association reports that hospitals are struggling to adopt automated clinical quality reporting following a study that tracks the implementation of electronic clinical quality measures across four hospitals.

Quality Systems Seen Luring Bids Amid Pressure: Real M&A

According to Bloomberg, NextGen parent company Quality Systems, Inc. could attract buyout bids from Siemens and McKesson.

News 8/2/13

Top News

Cerner announces plans to acquire a 237-acre abandoned mall near its Innovation campus in Kansas City. A new campus on the property will eventually house up to 15,000 new Cerner employees as the company grows over the years.

Reader Comments

From Jobu: “Re: access control. Have there been recent discussions about deploying fingerprint or iris scanner recognition systems vs. multiple passwords?” I’m sure there’s a case study out there somewhere from Caragidm or Imprivata or another user access systems vendor. Feel free to point the way if you’ve seen something.

From Bluebonnet: “Re: Oregon Health & Science University patient information stored on Google Drive or Gmail. Does this not point to an organization not meeting the needs of its users to promote patient care? Given that this organization has been pretty progressive, is it not troublesome?” That question rarely gets asked: what system deficiencies created the need to store information on consumer-grade services in the first place? OHSU plastic surgery residents were keeping a spreadsheet of their service’s patients on Google Docs, which contained minimal patient information. A similar practice was discovered in the urology and kidney transplant areas. Questions: (a) was the only problem that the hospital didn’t have a business associate agreement with Google? (b) does the hospital’s system not provide a snapshot of which patients each service is covering? (c) if not, then does the hospital not provide network storage for saving copies of files, or was the problem related to mobile devices? Give the residents credit for trying to do the right thing in making sure handoffs were done and using technology to do it. It’s a tough sell to argue that ubiquitous cloud storage is fine for almost everything except PHI.

From HIS Junkie: “Re: Siemens. Looks like the CFO will take over. Is the SMS ride about to end? Less R&D for Malvern? John Glaser in trouble? We all know they been losing their client base to Epic and others for the last three years. Will they come to the same conclusion as GE – healthcare IT can’t be a winner?” Siemens issues a surprise profit warning and uncharacteristically quickly fires its CEO, replacing him with the CFO (you just can’t beat the excitement of an engineering company run by a bean counter.) The new guy says the company tried to grown too fast and needs to get back to execution (not referring to that of his predecessor). The deposed CEO, who steered the company around its global bribery scandals, will get $20 million in severance and a $20 million pension for his six years in the job.

A reader asked whether outside healthcare IT experts could help veterans and what the 90-day agenda would look like. Proud veteran, healthcare IT guy, and HIStalk/HIStalk Connect contributor Lt. Dan provided this response:

I’d scrap iEHR and spend what’s left of the money creating a patient portal that would make the soldier the acting custodian of their own electronic medical record. After every clinic visit, ED visit, or hospitalization, the entire chart from that visit is pushed to the patient portal. It has lab results, physician notes, PT/ OT, all of it, an exact carbon copy of everything entered in the chart for every visit. The portal IS the medical record, and it houses all details of any injuries or illnesses treated.

The portal follows them through their military career and grows as they need services. If they’re transferring from Ft. Bragg, NC to Ft. Stewart, GA they process out of medical at Bragg where the Bragg doctor signs off on the chart and the portal is updated to show that the soldier is transferring to a new duty station, and that Ft. Stewart is now the primary care location.

When the soldier is ready to be discharged, they have their entire military record on the portal from all bases, including medical and dental. When they get back to the civilian world and meet their new civilian PCP, they can at worst print out the medical record for them, and at best leverage some type of HL7 interface to push a medical summary (CCD) to the provider with extractable allergies, prescriptions, problems, and medical history.

If the vet needs to submit a disability claim with the VA, they grant access to their portal so VA reps can review the records immediately, rather than waiting up to 90 days for DoD to find, print, and mail them a copy.

Vets already have a portal. It’s called My HealtheVet. It looks exactly like your typical portal. A dumbed-down, patient-centric version of a medical record. It’s fine, it’s just missing much of the information clinicians will want to see if they’re taking you on as a new patient after military service, or information that a VA rep would want to see if they’re processing a disability claim.

To help vets within 90 days, I’d get the entire medical record from the first day the soldier enters the military, feeding into that patient portal so that soldiers would have custodianship of their own medical record. Then I’d enhance that portal so that vets can easily authorize access to any or all of the content within it and could transmit a CCD from it.

I’d get a team of sergeants, corporals, and privates to execute the plan. It would be done in 89 days and there would be enough money left over in the budget to spend the last day drinking beer and barbecuing.

HIStalk Announcements and Requests

What you may have missed this week on HIStalk Practice: the number of physicians opting out of Medicare has tripled since 2009, according to CMS. CareCloud adds more than 150 new medical groups in the second quarter, with more than half also selecting CareCloud’s integrated EHR/PM. Dr. Gregg shares a story of a blogosphere encounter with another physician who took his office fully live on EMR in one day. Dr. Gregg offers additional insight on the doctor’s EMR platform in a subsequent post. Click over to HIStalk Practice and catch up on the latest ambulatory HIT news, sign up for e-mail updates, and check out the offerings of our sponsors. Thanks for reading.

Acquisitions, Funding, Business, and Stock

Ascension Health Ventures invests in Quantros, a portfolio company of Francisco Partners.

The Advisory Board Company reports Q1 results: revenue up 18 percent, adjusted EPS $0.31 vs. $0.31. The company also announces its purchase of referral technology vendor Medical Referral Source for $11.5 million.

MedAssets reports Q2 results: revenue up 4.7 percent, adjusted EPS $0.30 vs. $0.28.

McKesson re-elects all its board members at the company’s annual meeting despite dissent from activist shareholders who wanted the company to cut CEO John Hammergren’s pay and split his chairman and CEO roles.

A Bloomberg article says, without any facts to back it up, that Quality Systems has become a Siemens and McKesson takeover target because its share price has dropped and proxy fights have pushed the company to reevaluate its strategy.

Sales

Hallmark Health System (MA) selects athenahealth’s athenaClarity to proactively manage its patient population and engage in new reimbursement contracts.

The Hospital for Sick Children in Toronto selects MetaVision’s MVperfusion solution.

People

HIT Application Solutions names Betty Jo Bomentre, MD (Vitalize Consulting Solutions) CMIO.

Healthwise SVP Karen Baker joins the board of Center for Plain Language, a nonprofit that advocates for clear communication in government and business documents.

Health Care DataWorks names Kathleen Kimmel (MedeAnalytics) chief clinical officer.

Announcements and Implementations

Cerner opens an on-site health center for 2,800 employees and covered dependents of the California-based ViaSat, a communication products company. Providers will use Cerner’s EHR and patients will have access to the Cerner Patient Portal.

Brightree changes the name of its CareAnyware EMR software to Brightree Home Health and Hospice.

NorthCrest Medical Center (TN) implements Allscripts Sunrise Clinical Manager.

PinnacleHealth (PA) goes live on Soarian Financials.

University of Arkansas for Medical Sciences had the first of three Epic go-lives Thursday, bringing up ambulatory scheduling and registration, kiosks, referring physician portal, retail pharmacy, MyChart, and professional billing in all of its clinics. A third of the clinics also went live on EMR.

The Discovery Channel aired an episode of “Today in America” highlighting PeriGen’s PeriCALM and PeriBirth on Thursday. It’s pretty good, although host and former NFL quarterback Terry Bradshaw struggles painfully to pronounce the big words as he adopts the “Serious Terry” persona instead of his usual goofy on-screen presence.

The US Patient & Trademark Office awards EDCO Group a patent for its Solarity medical record scanning and indexing process that identifies a scanned document type by its recognizable content rather than by a printed bar code.

PatientOrderSets.com announces the integration of its order set tools with Cerner Millennium.

Government and Politics

VA Undersecretary of Health Robert Petzel, MD says that while one million veterans currently use some type of VA telehealth offering, he hopes to boost the number to more than four million.

Above is Farzad Mostashari, MD responding to questions at the Senate Finance Committee hearing on healthcare IT this week, courtesy of Brian Ahier.

ONC releases its user guide to EHR contract terms.

Innovation and Research

Researchers find that providers who use EHR clinical decision support predictive tools at the point of care are less likely to order antibiotics for respiratory tract infections.

Technology

The American Hospital Association says even EHR-experienced hospitals are struggling to implement electronic clinical quality measures, recommending: (a) slow the transition by reducing and then improving the measures; (b) make EHRs and eCQM tools more flexible; (c) improve EHR and eCQM standards to meet Meaningful Use expectations; (d) test eCQMs to make sure they are reliable and valid before rolling them out nationally; and (e) provide more tools and guidance for the transition.

Other

A Capterra infographic lists the 20 most popular ambulatory EHRs based on number of customers, number of users, and social media presence. The accuracy of the information is suspect given that Epic is listed as having one to 50 employees rather than its actual 6,500. Potential buyers should note that “most popular” is not the same thing as “most likely to succeed” in a given practice, where the vendor’s prolific Tweeting and Facebook likes may provide little consolation.

Consumer advocates in Florida oppose a proposal that would boost allowed charges for providing copies of medical records to $1.00 per page rather than $1.00 per page for the first 25 pages and then $0.25 per page afterward. Lobbyists for release of information provider HealthPort technologies filed the request, surely seeing dollar signs at the prospect of nearly quadrupling revenue given the size of the average chart.

Dialysis patients of Boston Medical Center (MA) were exposed to hepatitis B earlier this year because nurses weren’t allowed to use the hospital’s EMR, the state health department has concluded. Contracted dialysis nurses from DaVita weren’t given access to the EMR that would have flagged an infected dialysis patient, leading them to improperly sterilize equipment and expose 13 patients to the disease. The state said the hospital should give EMR access to non-employed nurses who are delivering patient care.

Healthcare employers cut 6,843  jobs in July, the highest monthly total since November 2009. Hospital finances have been hurt by sequestration, Medicare payment cuts, and lower utilization as patients move to high-deductible insurance policies.

The CEO of WakeMed Health & Hospitals (NC) warns employees of possible cost-cutting and layoffs as the health system’s accumulated losses hit $15 million before the September fiscal year end. The hospital is spending $100 million implementing Epic and expects a $23 million reduction in payments next year.

The bond ratings agency for Johns Hopkins Health System gives it kudos for its system integration, including installing Epic system-wide.

In England, the BBC finds that Royal Berkshire Hospital has paid $25 million to 200 consultants over five years to help it bring up Cerner Millennium. The article says the total cost is $42 million so far, it’s still not working right, the annual cost is $10 million, and IT is now one of the biggest departments in the hospital.

Sponsor Updates

• Joseph Eberle of CTG Health Solutions presents a case study on using data analytics to improve outcomes for chronic kidney disease patients at this week’s National Forum on Data & Analytics.
• Impact Advisors’ Senior Advisor Janice Wurz co-authors an article with Henry Ford Health CTO John Hendricks on planning and designing strategic technologies for clinical BI.
• Allscripts adds integration with Spaulding webECG, allowing the app to be launched from within Allscripts Enterprise EHR to support physician orders and provide access to ECG reports.
• 3M Health Information Systems introduces Patient-focused Episodes software, which considers the costs and outcomes of longitudinal care.
• Quest Diagnostics works with Greater Houston Healthconnect to make lab results available to providers.
• Ingenious Med offers a white paper, “Transition from ICD-9 to ICD-10: Managing the Process.”
• Andre L’Heureux and and Kevin Entricken of Wolters Kluwer participate in a roundtable on the genome approach to investing.
• INHS recognizes 18 of its customers that were named Most Wired.
• API Healthcare reports that it expanded its market reach to include behavioral health and rehabilitation centers in the second quarter.
• Truven Health Analytics will add animated videos from Health Nuts Media to its Micromedex Patient Connect Suite.
• Holon’s Scott McCall discusses the importance of good communication skills for HIE implementation team.
• INHS client St. Elizabeth Hospital (WA) earns HIMSS Analytics’ Stage 7 recognition for EHR adoption.
• Health Catalyst SVP Dale Sanders lists five indispensable information systems needed for ACO success.
• RazorInsights will showcase its ONE Enterprise HIS solution during the Illinois Rural Health Association Educational Conference Aug. 22-23.
• Five Medicity clients are serving as HIO ambassadors to a Chinese delegation gathering best practices for organizing, administering, and sustaining an HIO.

EPtalk by Dr. Jayne

The American Academy of Family Physicians has a new Web page covering the Medicaid-Medicare parity payments specified in the Affordable Care Act. Included is a checklist with the steps providers must follow to obtain the payments.

Clinical Decision Support update time: The US Preventive Services Taskforce publishes a draft recommendation for annual screening of high risk smokers by CT scan. Although it’s still a draft and insurers are not paying yet, it’s a good excuse to review the steps needed to configure new screening guidelines in your EHR.

I was intrigued by a blurb about Cisco’s “Video-enabled virtual patient observation” offering. Essentially it’s remote monitoring of patients who would normally require a “sitter” to ensure they don’t fall out of bed, remove IVs and other tubes, or otherwise cause self-harm. I wanted to find out more about it, but couldn’t without filling out a 17-field questionnaire including budget and timeline information. Based on my recent experiences from the patient perspective, I’d lobby that no technology can replace the presence of a family member at the bedside. For those who can’t have someone there 24×7 or for hospitals that have a shortage, it might be an interesting option.

Researchers at Temple University in Philadelphia are conducting a two-year study looking at virtual speech therapy. Patients will be pushed to spontaneously generate speech rather than practicing scripted conversations.

There have been several additions to the HealthIT.gov site recently, including a document on key terms used in EHR contracts. Based on some of the questions I receive from our affiliated providers, it should be required reading for anyone thinking about purchasing an EHR or going live on a hospital’s platform as part of an alignment strategy or Accountable Care Organization. It’s not a bad read on legal terms in general, especially for providers in the habit of signing documents without reading them.

Bianca Biller alerted me to the proposed cuts to the 2014 Medicare physician fee schedule. Highlights include the (now usual) 24.4 percent cut due to the SGR formula, implementation of value-based modifiers, changes to the Physician Quality Reporting System, and limitations on nearly 200 services where the physician fee schedule non-facility payment is more than the total payment for the same service in a facility setting.

It’s been a rough couple of weeks in the trenches, so I’m going to recharge my magic wand with a long weekend somewhere sunny. If I were a fairy godmother, this is what I would feel like about now. Here’s to sunscreen and fruity drinks.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 8/1/13

CareCloud Surpasses Record Revenue Growth, Secures Funding for Expansion

CareCloud reports that it has achieved sustained growth for 14 consecutive quarters and beaten its all-time quarterly revenue record with its latest Q2 results. The company also announced that it has closed a $20 million Series B financing round.

EHR Contracts: Key Contract Terms for Users to Understand

ONC publishes a guide that explains EHR contract terms for healthcare providers shopping for a new EHR.

Go-live gone wrong

Recent high-profile implementation failures are profiled in an article that points a finger at Meaningful Use for forcing a culture of big bang implementations.

Mount Sinai Lands $3.7M for Genomic Medicine Project in Kidney Disease

Researchers at the Icahn School of Medicine at Mount Sinai receive a $3.7 million grant from the National Human Genome Research Institute to find out if incorporating genome data and genome-related alerts into EHRs can improve treatment of kidney disease in patients who are of African ancestry.

Hospital Board — Two Profitable Months

Twenty-five-bed Fulton County Hospital (AR) closes its fiscal year on two profitable months, projecting a 2013-2014 net loss of $53,000 compared to the previous year’s loss of $380,000. Fulton’s accounts receivable days jumped to 66 after a Healthland EHR implementation, which caused short-term financial hardships.

Readers Write: Think Beyond the Text: Understanding HIPAA and Its Revisions

Think Beyond the Text: Understanding HIPAA and Its Revisions
By Terry Edwards

Every day, an increasing number of physicians and other health care providers are exchanging clinical information through a wide range of modes, including smart phones, pagers, CPOE, e-mails, texts and messaging features in an EMR. It’s no surprise that hospital and health system leaders are increasingly focused on securing protected health information in electronic form (ePHI)—a trend that has certainly invoked some confusion across the industry.

As PHI data breaches increase in frequency, hospital executives must strategize ways to eliminate security threats and remain HIPAA compliant. Especially since HIPAA violations can be extremely expensive, leaving these already-strapped organizations in an even more stressful financial situation.

In order to prioritize tangibles such as patient safety, physician satisfaction and overall efficiency across processes and hospitals, health care leadership must consider ways to tackle this confusion and maximize the benefits enabled by modern technology and electronic communications.

PHI can take a variety of paths in today’s complex healthcare environment and expose a health system to risk. But time and time again I see health systems looking to implement stop-gap measures and point solutions that address part—and not all—of the problem.

While texts are commonly sent between two individuals via their mobile phones, the communication “universe” into which a text enters is actually much bigger. It also includes creating ePHI and sending messages—in text and voice modalities—from mobile carrier web sites, paging applications, call centers, answering services and hospital switchboards.

For example, a 400+ bed hospital generates more than 50,000 communication transactions to physicians each and every month. Many of these communications contain ePHI. And if they were transmitted through unsecure networks and stored in unencrypted formats, they would represent a meaningful potential security risk to both the hospital and its medical staff.

In order to identify all potential areas of vulnerability, health care leaders need to consider all mechanisms by which ePHI is transmitted and the security of those mechanisms and processes. No mode of communication can be viewed in isolation. By failing to address all transmitted ePHI, organizations become vulnerable to security breaches with adverse legal and financial consequences, as well as loss of patient trust and reputation in marketplace.

In addition, contrary to what many health leaders have been led to believe, HIPAA provisions do not call out any specific modes of communication. Text messaging is permissible under HIPAA. The law simply stipulates that a covered entity (CE) must perform a formal risk assessment; develop and implement and effective risk management strategy based upon sound policies and procedures; and monitor its risk on an ongoing basis. These regulations apply to providers communicating PHI in any electronic form.

As a result, there is no such thing as a “HIPAA-compliant app.”

HIPAA provisions emphasize the risk management process rather than the technologies used to manage risk. For hospitals and health systems, the pathway to safeguarding electronic communication of PHI lies in the creation of an overall risk management strategy.

Ideally, leaders of the CE will form an information security committee to develop and execute the strategy, which includes representatives from IT, operations, the medical staff, and nursing, as well as legal counsel. Leaders should also consider including an external security firm in the group. Once the committee is formed, the organization should take these four essential steps for protecting the security of ePHI:

1. Organize and execute a formal risk analysis. A formal risk analysis should break down types of technology used for electronic communication as well as the transmission routes for all ePHI. To ensure HIPAA compliance, ePHI transmitted across all channels must be “minimally necessary,” which means it includes only the PHI needed for that clinical communication. This layer of complexity, which is common in clinical communication processes, underscores the need for a comprehensive security assessment and strategy appropriate for the organization, coupled with the resources necessary to implement that strategy.
2. Establish an appropriate risk management strategy. The committee should develop a risk management strategy that’s specific to the needs and vulnerabilities of the organization and is designed to manage the risk of an information breach to a reasonable level. HIPAA does not specifically define “reasonable,” but in general, the risk management strategy should include policies and procedures that ensure the security of message data during transmission, routing, and storage. The strategy should also include specific administrative, physical, and technical safeguards for ePHI.
3. Roll out these policies and procedures and train staff. Implementing new policies and procedures is the biggest challenge for organizational leaders, especially as a substantial proportion of reported security breaches are due in part to insufficient training of staff. As a result, appropriate individuals should be assigned specific implementation tasks for which they are held accountable, while leaders and committee members must carefully monitor the success of implementation. All staff with access to PHI must be educated about the specific policies and procedures, which will help ensure they are upheld across the organization.
4. Monitor risk on an ongoing basis. To ensure continued compliance with security standards, organizations must conduct ongoing monitoring of their information security risk. Leaders should receive regular trend reports from the information security committee based on their ongoing assessment of ePHI security at the organization. Those reports should support the ongoing assessment of security needs as technology and health care delivery change, and act as a catalyst for changes that may need to be made to the policies and procedures over time.

In today’s increasingly complex healthcare environment, analyzing and implementing a broader policy around security across all forms of electronic communications—rather than focusing on a single mode of communication in isolation—is critical to any health system’s ability to avoid and mitigate the adverse consequences of a breach. By clarifying the confusion around electronic communications now, hospitals and health systems will be better prepared to minimize risk and maximize best-practice communication process in the future.

Terry Edwards is president and CEO of PerfectServe of Knoxville, TN.

Readers Write: Seven Strategies for Optimizing the EHR

Seven Strategies for Optimizing the EHR
By Marcy Stoots MS, RN-BC

Healthcare organizations are making a mistake if they subscribe to the notion that once an EHR is successfully implemented, it no longer requires attention. Even the most carefully designed EHR will not work as intended in all situations, causing users to create workarounds that are counterproductive and inefficient. It’s important to develop and implement an ongoing strategy for fine-tuning the EHR so that users can input and access the data they need with fewer clicks and better outcomes, which will improve clinician satisfaction.

Besides moving toward usability and adoption, optimization will help with plans to achieve Meaningful Use Stage 2, which raises the bar significantly. Under the Stage 2 final rule, for example, hospitals must report on 16 of 29 clinical quality measures (CQMs) and Eligible Professionals must report on nine of 64 CQMs. Optimizing the EHR to properly capture this data and generate compliance reporting is crucial.

Finally, optimization is a key step to realizing the financial ROI of the EHR, in which a substantial investment has been made. In today’s landscape of cost containment and healthcare reform, an organization can ill afford to sacrifice financial ROI or be bogged down by inefficiencies.

Below are seven strategies for optimizing the EHR to increase efficiency, improve the ROI, drive adoption, and improve usability, with the ultimate goal of providing better outcomes.

1. Create a Governance Structure

Just as an organization needed a governance structure during planning and implementation of the EHR, it will need one for ongoing optimization. This will provide an avenue for making decisions and keeping the optimization plan moving forward. Problems will continue to arise and solid governance will ensure that they are dealt with effectively. A process should be in place to manage variances when clinicians do not want to adhere to a standardized documentation or workflows. When these crop up, the governance group will need to decide upon appropriate action.

2. Create a Solid Informatics Structure

Many healthcare organizations struggle with the size and organization of the informatics team. From an optimization standpoint, it’s important to get this right. There is no standard answer here; every organization is different. Detailed descriptions of job roles and responsibilities should be created and appropriate resources budgeted.

3. Assign Responsibility

An individual at the leadership level should be designated as the responsible party for optimization. This function should be incorporated into that person’s job description. This is typically an informatics director, but could also be a CMIO or IT director, depending on the organizational structure. Assigning this responsibility will help ensure that optimization is an ongoing process, since it requires continual evaluation and modification. Ideally, for larger health systems, there should also be an optimization team in place that could include clinical leadership, operational leadership, informatics analysts, and super users. For smaller health systems, the team would be much smaller, but informaticists should have optimization as a core job function.

4. Measure

The pain points of clinicians should be determined by interviewing stakeholders, examining service desk tickets, listening to input from IT and informatics staff, analyzing reports and metrics, and observing end-to-end workflows. The most important issues should be focused on with data collected at baseline and after 30, 60 and 90 days. Measuring is an ongoing process. It should be used to monitor progress and gauge success.

5. Create Scorecards

Scorecards are a powerful tool for demonstrating what has been achieved. They display the collected data and communicate improvements to the team and stakeholders. Managing workarounds starts with accountability; Scorecards lets users know where they stand and create a healthily competitive environment that encourages success. They can be used to compare units within a hospital or hospitals within a health system.

6. Provide a Quick Win

Clinicians can be easily frustrated by glitches in the EHR, so areas should be pinpointed that will quickly increase their satisfaction. These are issues that are important to them, yet easy to address, the low-hanging fruit that delivers the highest impact. Success breeds enthusiasm, setting the stage for better adoption.

7. Continue Refining

Optimization is never complete. It is an ongoing endeavor without an endpoint.

Workarounds are a reality. The organization should have an optimization plan to monitor and manage them, as well as establishing ownership of that plan. With proper planning and a roadmap in place, addressing problems and overcoming challenges will go smoothly. The end result will be satisfied users and healthier patients (and lower costs).

Marcy Stoots MS, RN-BC is a principal with CIC Advisory of Clearwater, FL.

An HIT Moment with … Devin Gross

An HIT Moment with ... is a quick interview with someone we find interesting. Devin Gross is CEO of Emmi Solutions of Chicago, IL.

What are the problems and opportunities involved with patients forgetting or not understanding what their doctor tells them?

Research shows that by the time patients get to the car, they forget about 80 percent of what their doctors have told them. Frankly, the time you’re in front of the doctor is the worst time to learn, whether it’s in an ambulatory or inpatient environment. We need to empower people to learn at a time when it’s most convenient for them on the terms that they want, whether that’s on a desktop computer, laptop, tablet, or smartphone.

If they don’t remember what their providers have told them, they won’t understand, they can’t become an engaged patient, and their circle of care may feel even more in the dark. That means they won’t follow pre-op or post-op instructions and they won’t know what to expect.

When you can engage patients and their circle of care when and where they are ready to learn and on the devices they already own, they are more compliant and prepared before they come in and are more compliant after the procedure. Their expectations are effectively set, so they’re more satisfied with their experience.

How many patients are really willing and able to participate in their own care and outcomes?

Look at any other industry – banking, airline travel, retail – and you’ll see a growing consumer base that wants more control. Healthcare is no different.

We track and document everything, so this is a very easy question for us to answer. What we know is if we ask someone to participate in one of our programs, somewhere between 40 and 50 percent of people are going to engage. That may be higher depending on geography or conditions. For example, an acute episodic patient might be more likely to engage than a chronic condition patient.

When they activate, our data, which is based on over five million of these encounters, shows that roughly 80 to 90 percent of those patients are going to complete the encounters. We continue to work with our clients around better messaging, around incentives, and around other levels of activation to increase that number. Patients are hungry for this information across all demographics and our data and our platforms support that.

How do your offerings improve patient satisfaction with hospitals?

This goes back to what we discussed before about convenience and empowerment. When you look at what patients want, they want to be communicated with, they want to be engaged on their terms, and they want to understand what is going to happen during their experience. Emmi does that. We extend the conversation. We extend the relationship for both the hospital and the clinician to better communicate, empower, and engage patients. When you do that, patients are going to be more satisfied.

We’ve conducted a number of studies over time that demonstrate when patients are engaged with Emmi, they’re going to be more satisfied.

Will it become common for physicians to prescribe learning material and patient engagement activities?

Yes, it’s already becoming common. We’ve been at this for 11 years, and back then, few physicians and hospitals understood the value of engagement. Today, we’re in hundreds of hospitals around the country and our pipeline is stronger than ever before. Hospitals are looking for this kind of integrated program. It’s not enough to just put a video on the web site and hope they come. It’s important for this to be a prescriptive experience where they can measure the impact and what’s happening out there. Prescribing engagement activities is happening today, and it’s going to happen more and more quickly.

Patient engagement isn’t a fad. It’s here to stay. As new models of care — both around reimbursement and delivery — continue to evolve, the ability to engage and empower people in their care is going to be critical. The ability to engage and empower with a vendor that has been doing it for a long time and has a proven, documented track record is going to be critical. The more we measure, the more we prove, and the more readily we’re seeing provider adoption.

How do your programs integrate with EHRs?

Our solutions are integrated into the leading HIS and EHR systems. Providers, mid-levels, and admin staff alike can order and track Emmi programs for patients right inside their EHR. Many of our integrated clients employ best practices like alerts, order sets, and bulk ordering to streamline Emmi into the standard clinical workflow. In addition, Emmi programs are integrated directly into the patient portal.

As the healthcare market begins the transition from volume to value, Emmi is increasingly being integrated into tools that manage large populations of patients, including registries, population health platforms, and data analytics vendors. Our technology platform and the way that we facilitate integration and analysis are well positioned to take advantage of these trends.

Morning Headlines 7/31/13

Community Health Agrees to Buy H.M.A. for $3.6 Billion

Community Health Systems agrees to buy Health Management Associates for about $3.6 billion. Including the assumption of debt, the merger is valued at about $7.6 billion.

Catholic Health Initiatives Optimizes Nursing Care Delivery in Collaboration With Cerner Clairvia

Catholic Health Initiatives has increased patient satisfaction scores, saved $1.5 million from reduced overtime, and and saved another $3 million from reduced length of stay after completing a three-year project that included analyzing nurse processes and implementing Cerner Clairvia to measure and streamline them.

Give the public access to the Medicare database

Senators Chuck Grassley and Ron Wyden call for the release of Medicare’s claims database, arguing that research potential and transparency trumps both the privacy concerns of the patients receiving care and the business concerns of providers uncomfortable with their reimbursement rates being made public.

Fitch Rates Catholic Health Services of Long Island, NY’s 2013 Revs ‘BBB+’; Outlook to Negative

Catholic Health Services of Long Island, NY has its bond rating downgraded and outlook revised to "negative" due in part to a $144 million Epic implementation that led to a $18 million operating loss for the interim period.

News 7/31/13

Top News

Community Health Systems will buy for-profit hospital competitor Health Management Associates for about $3.6 billion in cash and stock. With the assumption of debt, the merger is valued at $7.6 billion and includes 206 hospitals in 29 states. It will be interesting to see if HMA shareholders approve the deal since it only pays $10.50 per share compared to Monday’s closing stock price of $13.92.

Acquisitions, Funding, Business, and Stock

Specialty medical billing vendor Zotec Partners will acquire Atlanta-based ED billing firm Medical Management Professionals for $200 million from CBIZ. The combined companies will have 1,750 employees and $215 million in annual revenue.

Mediware CEO Kelly Mann says the company, which has acquired five home health software companies, will acquire one or two software vendors each year, focusing on home health and long-term care.

Sales

Excela Health (PA) contracts with SCI Solutions for its Schedule Maximizer, Order Facilitator, and Results Facilitator solutions.

The Arkansas Office of HIT selects Get Real Health as the patient portal development vendor for providers participating in the statewide HIE.

People

CareTech Solutions CEO Jim Giordano is named chairman of the St. John Providence Health System (MI) board of trustees.

John Lutz (Navigant Consulting) joins Huron Consulting Group as managing director of the company’s healthcare practice.

Justin Graham, MD (NorthBay Healthcare) is named chief innovation officer, healthcare of Hearst Business Media.

Dann Lemerand (The HCI Group) joins eVariant as vice president, solution engineering.

Clinical Architecture appoints Andrew Frangleton (UBM Medica) managing director of the company’s UK office.

Announcements and Implementations

Qsource and the Tennessee Office of eHealth Initiatives introduce Direct Technology for secure exchange of patient data.

Catholic Health Initiatives reports savings of nearly $1.5 million from reduced overtime and $3 million for reduced length of stay since its 2010 implementation of the Cerner Clairvia workforce and operations suite in 14 of its hospitals.

TECSYS announces the OR Inventory Manager perioperative supply change management system.

Napa State Hospital (CA) and two other psychiatric facilities give employees Ekahau RFID-powered name badges to signal for help and transmit their location in an emergency.

Baltimore-based Parallax Enterprises will begin beta testing its CHaRM OR safety checklist system starting in the fall.

Government and Politics

Through the end of June, 305,778 EPs and 4,024 hospitals collected more than $15.5 billion in EHR MU incentives.

In a Politico opinion piece, Senators Chuck Grassley (R-IA) and Ron Wyden (D-OR) argue for the passage of legislation that would make Medicare claims data available through a free, searchable online database. The senators contend, “The publication of Medicare data will become healthcare’s new financial baseline; the measure of what America’s largest and most powerful buyer of healthcare gets for nearly $600 billion a year.” I understand that privacy issues remain a chief concern, but I have yet to hear a argument compelling enough to convince me that keeping this data largely sealed is preferable to open access and transparency for researchers and consumers.

A Time article recaps a Washington Post investigative article from earlier this month that describes the AMA group that tells the government how much Medicare should pay doctors. According to former CMS Administrator Tom Scully, “The idea that $100 billion in federal spending is based on fixed prices that go through an industry trade association in a process that is not open to the public is pretty wild.” The AMA criticized the article saying its recommendations are just optional guidelines, but left out the fact that the government accepts 90 percent of those recommendations without question.

Innovation and Research

A team from the Houston VA Medical Center creates EHR-based triggers to make sure that clinicians follow up on abnormal lab results that can indicate cancer (PSA, occult blood, iron-deficiency anemia, and bloody stools.) Positive predictive value ranged from 58 to 70 percent.

A heart surgeon in India who founded a chain of 21 medical centers offers coronary bypass surgery for $1,583 and hopes to drop the price to $800 within 10 years. The same procedure at Cleveland Clinic costs $106,000.

Other

MMRGlobal announces Australian singer Guy Sebastian as the spokesperson for its “Don’t Worry Be Happy” advertising campaign for its personal health record.

The ratings agency for Catholic Health Services of Long Island downgrades its bonds, with a key ratings driver being, “Additional expense pressures in fiscal 2013 related to the implementation of an electronic medical record (EMR) has resulted in an operating loss of $18 million for the interim period.” The system filed a $144 million certificate of need in 2010 to implement Epic, which it estimated would add $40 million to its bottom line beyond HITECH payments, including a projection that its length of stay would drop 0.5 days for an annual savings of $28 million.

A jury awards a woman $1.44 million after a female Walgreens pharmacist shared her prescription records with the pharmacist’s husband, who was also the patient’s former boyfriend. Walgreens says the jury was wrong in finding it responsible for the actions of an employee who intentionally violated company policy and says it will appeal.

Weird News Andy calls this article “Potty Mouth.” A China-based research team grows teeth from stem cells extracted from urine. WNA says of this article about a venipuncture robot, “He vants to drink your blaad.”

Sponsor Updates

• CommVault announces enhancements to its Edge software that give users the ability to securely share, search, and restore files across their mobile, desktop, and laptop devices.
• NextGen reseller TSI Healthcare will integrate PatientPay with NextGen PM.
• HealthTronics will integrate SampleMD’s eCoupon and eVoucher solutions from OPTIMIZERx Corp. within its UroChartEHR and meridianEMR platforms.
• McKesson adds real-time analytics and mobile access to its Strategic Supply Sourcing supply chain solution.
• ONC head Farzad Mostashari, MD and MGMA Healthcare Consulting Group’s Rosemarie Nelson will deliver keynote addresses at this week’s Aprima 2013 Annual User Conference in Dallas.
• Greenway Medical will provide its PrimeSUITE customers access to PatientCo’s patient financial engagement  platform.
• Greythorn Senior Account Executive Paul Tran writes about the importance of “soft skills” within a technology environment.
• LiquidEHR partners with DrFirst to offer users integrated e-prescribing functionality.
• Allscripts profiles Manitoba e-Health and its implementation of dbMotion’s eChart solution.
• Infor Healthcare highlights the success of its supply chain management solutions at several organizations, including MLK Community Hospitals (CA), Huntington Hospital (CA), Prime Healthcare (CA), WellStar Health System (GA), University Health System (TX), and Greenville Health System (SC).
• Talksoft Corporation integrates its portfolio of messaging services within the Healthpac Computer Systems billing platform.
• Craneware introduces an update to its Supplies ChargeLink solution that includes an automated search function to identify HCPCS codes.
• Ingenious Med releases a white paper that offers tips for transitioning to ICD-10.
• A local publication features the use by Colquitt Regional Medical Center (GA) of Versus RTLS to improve patient care.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.