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Hospital to Turn Off EHR Access for Doctors Who Haven’t Finished ICD-10 Training

Posted on July 27, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


This article is pretty shocking. I can imagine how well this would go over at most hospitals. I hope we get to hear how well this strategy works and who will win what appears like a game of chicken between the doctors and hospital. Does the hospital need the doctors more or do the doctors need the hospital more?

Here’s an excerpt from the article linked above that describes what they’re doing:

“There is a ‘go live’ date for these changes that is Oct. 1 for everyone across the country, including us, so we felt it was very important that all medical providers be trained,” Groves said. “We set a date of July 27, which is Monday — if they have not done the training by then, their access to Soarian will be cut off.”

If they don’t have access to the EHR, that’s basically saying that a doctor can’t practice at that hospital, no? It’s interesting that access to the EHR is being used as essentially revoking privileges to be a doctor at a hospital. I can hear many doctors initial reaction being that they didn’t want to access the EHR anyway. Although, it’s a lot more complex than that response would describe. Can you practice medicine at a hospital that has an EHR without having access to the EHR? I believe the answer is no unless the hospital makes some extraordinary concessions to a doctor (not likely to happen in the hospital mentioned above).

What do you think about using EHR access as a way to motivate doctors to do something? Is that a good strategy? Will we see it happen more?

Hiring Motivated People and Inspiring Them

Posted on July 8, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I found this great leadership quote on LinkedIn that was shared by Shanthi Iyer:
Leadership Quote

This is some really great advice to hospital CIOs as they approach hiring at their hospital or health system. Hiring motivated people and inspiring them is a great way to lead an organization. You’d think that inspiring people in healthcare wouldn’t be hard. However, it’s amazing how quickly people can become disillusioned with what’s happening in healthcare IT. Government regulations aren’t usually inspiring.

With that said, all of us in healthcare should be inspired by the possibility that we can save lives. I know that many doctors scoff at the idea that a technology person could have that kind of impact, but we absolutely can. No, we don’t get our hands bloody as we stitch up a patient after surgery. However, we can create systems that make the doctors better and prevent mistakes that would happen otherwise.

Of course, if we’re going to take on the opportunity to save lives we have to also take on the responsibility that if we do our job poorly we can actually damage lives. Both sides of the coin are equally important. Certainly that’s inspiration enough for everyone in healthcare. However, a great leader finds ways to casually remind staff of this vision. That’s the challenge a healthcare CIO faces. Luckily, if you hire motivated people and inspire them, you’ll be amazed by the results.

Patient Financial Clearance: Ensuring a Successful Revenue Model in Emergency Medicine

Posted on July 2, 2015 I Written By

The following is a guest blog post by Jordan Levitt serves as a Managing Partner and Founder for PayorLogic.
Jordan Levitt
In emergency medicine, most providers know this to be true: medical triage and rendering healthcare services is often the easy part. Financial clearance and obtaining payment is the challenge. This is particularly relevant in light of the Emergency Medical Treatment & Labor Act (EMTALA) that ensures public access to emergency department (ED) services regardless of one’s ability to pay.

Even with the influx of patients who now have insurance through Medicaid expansion, EDs are still up against many challenges in terms of collecting payments from urgent care encounters. Emergency patients are frequently transient and difficult to manage. And beyond the traditional self-pay patient population, a growing number of emergency patients are now insured under high deductible health plans (HDHPs). Patients themselves are increasingly responsible for a larger portion of the bill.

The burden is on emergency medicine practice administrators and their billing companies to complete the financial clearance process as early as possible—ideally immediately following medical triage and during the urgent care encounter.  The biggest hurdle is obtaining correct and accurate information to financially clear patients within the emergency setting.

Common Hurdles to Overcome
First, IT systems used during emergency transport and within the ED are commonly fragmented—even within a singular hospital system. Second, emergency encounters must focus first on medical triage and urgent care. Financial clearance is an afterthought. Patient access staff members in the ED often do not have ample time to complete financial clearance before patients are treated—and even released. Third, many organizations experience high turnover in the ED registration area, making it difficult to ensure compliance and consistency.

This article summarizes how one emergency medicine billing company works with its clients to provide financial clearance for emergency encounters—even for patients that present as self-pay.

How it works at ATD Resources, Inc.
As a full-service billing company that serves five emergency departments with a combined 140,000 visits per year, ATD Resources, Inc. knows the financial pressures of increasing patient payment responsibility and non-payment risk all too well. Amy Propp, CPC, CEDC, director of operations at ATD Resources, LLC, sent approximately $1 million to a collections agency each month before revamping her financial clearance process. Furthermore, nearly 50% of ATD’s 180,000 patient statements were returned due to invalid addresses.

To improve revenue capture, ATD focused on obtaining the right information the first time around as close to near-time as possible. This required partnering with a front-end financial clearance solution that integrated with each hospital’s information systems so emergency medicine patient access staff had access to real-time demographics and payment information. A three-step workflow was designed.

Step One:
Verify patients’ social security numbers, addresses, and other demographic information within the emergency department as quickly as possible: upon registration and immediately following clinical triage.

Step Two:
Generate an immediate report of all patients labeled as self-pay/no insurance and use Payor Logic’s financial clearance application to check whether these patients have any billable insurance or other payment sources. For example, in 2014, ATD identified 16% of patients as self-pay for their clients. However, after verification, 35% of these individuals were actually eligible for Medicaid.

Step Three:
For patients with no verifiable or billable coverage, ATD staff members use Federal Poverty Level status information to qualify patients for a discount or charity care—immediately communicating findings back to the emergency medicine group.

Step Four:
Finally, ATD works with Payor Logic to predict likelihood of payment. By calculating a propensity-to-pay score, ATD (on behalf of their clients) focus on patients with the highest likelihood of paying the bill. ATD can identify patients with a history of non-payment, adjust the debt, and quickly forward these accounts to collections.

Thanks to its new financial clearance process, ATD has captured more than $800,000 in revenue over 12 months for its emergency medicine clients. In addition, its returned mail volume was cut by more than 10%.

The Road Ahead
Given the increase in patient financial responsibility, emergency providers and their billing companies must find creative ways to expedite the clearance and collection process.  This critical step is becoming increasingly essential as a new era of self-pay patients are emerging amidst declining pre-acute care reimbursements within emergency services and emergency medicine.

About Jordan Levitt:
Jordan Levitt serves as a Managing Partner and Founder for PayorLogic, a healthcare technology company for self-pay accounts management, insurance verification and financial clearance within emergency services, emergency medicine, laboratory, medical imaging, durable medical, and hospitals. Jordan can be reached at: jordanl@payorlogic.com.

The Next Big Healthcare IT Brands

Posted on June 22, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In case you missed it, I wrote a post on EMR and HIPAA that talks about how patients will choose healthcare. In the article we talk about the impact of brand on healthcare decision making. Plus, I talk a bit about how many real national healthcare brands there are in the industry.

With this in mind, I was struck by this tweet from @theEHRGuy:

As the post above illustrates, I’d considered the impact of brand on healthcare decision making by patients. I hadn’t thought about the power of brand for healthcare IT companies. Over the past couple of years, we’ve definitely seen how important brand has been as many hospitals have chosen to buy from the brand as opposed to taking a best of breed approach to their IT systems. This has been an extremely important trend in healthcare IT.

In my recent post, I also talked about the move away from Best of Breed EHR systems and how that could apply to patient engagement solutions as well. I think this cycle is inevitable and I think patient engagement could be an area where a big brand establishes their name in the industry. Especially because the incumbent EHRs aren’t competing well in the patient engagement space.

I’ve also written about how I think that the Care Management System could be the next system purchase now that we’ve done HIS/PM and EHR. Could someone or a group of companies build a great brand for Care Management Systems? Could they build momentum around the need for every hospital to invest in some sort of Care Management System the way there’s been momentum for hospitals to adopt EHR?

Back to the tweet embedded above, I think it’s pretty interesting to think about the next big healthcare IT brands. Which brands do you think are going to be the next big ones? Every hospital CIO should be spending some time thinking about and watching these trends.

Best of Breed in Patient Engagement?

Posted on June 17, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As I’ve been thinking more about the future of healthcare IT, I wrote that I think the next major healthcare IT product could be a Care Management System. Maybe it will go by a different name, but the functionality that’s described by a care management system is already going into place. Regulations are headed that direction and every organization will need to have a care management system.

At the core of a care management system will be functionality that engages the patient. I use that term in the broadest sense possible and not the fully corrupted meaningful use version of patient engagement. I’m talking about truly engaging the patient in their care in a bi-directional way that includes communication, support, education, social influence, and more.

As I consider the broad possibilities around patient engagement, there are hundreds of companies (possibly thousands) working in this space. Some are working with diabetic patients while others are focused on cardiac issues. Others are using text messages while some startups are leveraging full smart phone applications. A few tie in with the EHR vendors and many don’t. A hospital system is going to need a patient engagement solution that cuts across all of these slices.

With that in mind, it begs the question, “Are we going to implement and manage a cobbled together “best of breed” solution for patient engagement?

If EHR history tells us anything, most hospitals will adopt some point patient engagement solutions and then over time they’ll realize that the best of breed approach to patient engagement has gotten unwieldy and they’ll start looking for an all in one patient engagement solution. In some ways, this has to be the path forward. There’s no all in one patient engagement solution today. So, hospital systems have to choose to either sit on the sideline and wait for the all in one system to arrive (like many did with EHR software) or they have to go best of breed to start while the all in one patient engagement solutions come together.

I’m not sure this path is such a bad thing. It’s good for a health system to understand patient engagement in a smaller way before expanding across the entire system. We’re starting to see more of this happen in hospitals. However, be sure to keep your eye on the long game being one unified patient engagement system.

We’re Entering the 15th Year of Our EHR Implementation

Posted on June 12, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was recently talking to someone about a major progressive hospital system that’s been using technology and EHR for a long time. This person then told me that it felt like this hospital system was in its 15th year of its EHR implementation.

I’m sure that most hospital organizations can relate to this statement. Each hospital system will replace the number of years with a different number, but I think every hospital probably believes that their EHR implementation is never complete. Certainly you might have a go live event with the initial installation of the software, but that’s far from a fully implemented EHR system.

This concept reminds me of two things we’ve talked about before. The first is a controversial post I did called The Tyranny of “Time” – EHR Efficiency Has a Lifecycle. I put up a chart which I think illustrates an important lesson about the lifecycle of an EHR implementation and many disagreed with the chart. I still stand behind the principle that time has a way of eroding even the best EHR implementation. So, you better have a long term plan to deal with the Tyranny of Time.

The second is a comment from a hospital CIO who made a comment on one of my posts many years ago. In the post I’d commented about how we’d implemented a new practice EHR in about 2 weeks time frame. The doctor was opening his practice in 2 weeks and so we literally crunched in the entire EHR implementation and purchasing process into those 2 weeks so they didn’t have to start on paper charts. The Hospital CIO’s comment on that article was “You lost me at 2 weeks EHR implementation.” Of course, this was an EHR implementation at a solo practice.

Although, even in the case of a small ambulatory practice, the EHR implementation is never done. At hospitals there’s always more that can be done to improve how you use your EHR. I don’t think it’s a bad thing to think that you’re in your XX year of your EHR implementation. As long as you still create milestones so that staff feel the sense of accomplishment in the process.

Behold The Arrival of The Chief Mobile Healthcare Officer

Posted on June 9, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Managing fleets of mobile devices is an increasingly important part of a healthcare IT executive’s job. Not only must IT execs figure out how to provide basic OS and application support – and whether to permit staffers and clinicians to do the job with their own devices – they need to decide when and if they’re ready to begin integrating these devices into their overall lines of service. And to date, there’s still no standard model using mobile devices to further hospital or medical practice goals, so a lot of creativity and guesswork is involved.

But over time, it seems likely that health systems and medical practices will go from tacking mobile services onto their infrastructure to leading their infrastructure with mobile services. Mobile devices won’t just be a bonus – an extra way for clinicians to access EMR data or consumers to check lab results on a portal – but the true edge of the network. Mobile applications will be as much a front door to key applications as laptop and desktop computers are today.

This will require a new breed of healthcare IT executive to emerge: the mobile healthcare IT leader. It’s not that today’s IT leaders aren’t capable of supervising large mobile device deployments and integration projects that will emerge as mHealth matures. But it does seem likely that even the smartest institutional HIT leader won’t be able to keep up with the pace of change underway in the mHealth market today.

After all, new approaches to deploying mHealth are emerging almost daily, from advances in wearables to apps offering increasingly sophisticated ways of tracking patient health to new approaches to care coordination among patients, caregivers and friends. And given how fast the frontier of mHealth is evolving, it’s likely that healthcare organizations will want to develop their own hybrid approaches that suit their unique needs.

This new “chief mobile healthcare officer” position should begin to appear even as you read this article. Just as chief medical information officers began to be appointed as healthcare began to turn on digital information, CMHOs will be put in place to make sense of, and plan a coherent future for, the daily use of mobile technology in delivering care. The CMHO probably won’t be a telephony expert per se  (though health systems may scoop up leaders from the health divisions of say, Qualcomm or Samsung) but they’ll bring a broad understanding of the uses of and potential for mobile healthcare. And the work they do could transform the entire institution they serve.

Susannah Fox Named As First Woman CTO of HHS

Posted on May 29, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In case you’ve been busy like me, this week Susannah Fox was named as the new CTO of HHS. She’s the first woman to be appointed to this position and is following in the footsteps of Todd Park (who later became the US CTO) and Bryan Sivak.

The HHS CTO position was started in 2009 and so it’s a relatively new position, but I think it’s exciting that HHS would choose Susannah Fox for this position. Fox has worked as the associate director of the Pew Research Center and as the entrepreneur in residence at the Robert Wood Johnson Foundation.

Those of us on social media know @SusannahFox very well since she was very active on Twitter and often joined in on various healthcare IT discussions that were happening online. Plus, Susannah Fox was a regular speaker at healthcare IT events.

What I love most about the prospect of Susannah Fox being involved at HHS is that she’s a total health data geek. I say that with the utmost respect and admiration. In fact, I don’t throw compliments like that out easily. She’s a true data geek that’s been diving into healthcare data for a long time. I think that’s going to be a very valuable quality in her new role at HHS.

Maybe I’m wrong, but I think that one of HHS’ major roles should be around using data to improve healthcare in the US. I think that’s the potential opportunity for them and one that they haven’t done a great job leveraging to date. I’m hopeful that Susannah Fox will be able to help in that regard.

Think about all the powerful women at the head of HHS: Sylvia Burwell, Karen DeSalvo, and now Susannah Fox (and I’m sure there are many more that I don’t know as well). I think that’s a great thing. I look forward to the future they’re paving. They don’t have an easy job ahead, but I do think they have tremendous opportunity.

The Hospital With No EMR

Posted on May 20, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

This weekend, feeling a bit too ill to wait to see my PCP, I took myself to a community hospital in my neighborhood. For various reasons, I went to a hospital I don’t usually visit, one about 10 miles away from my home.

When I entered the emergency department lobby, nothing seemed amiss.

In fact, the light-filled, pleasantly-constructed waiting room was comfortable and modern, the staff seemed bright and knowledegeable, and the triage nurse saw me promptly.

But I got something of a surprise when I checked in with the triage nurse during my initial assessment. Noting that she had not taken my medication history, I told the nurse that I assumed someone would be entering it into their EMR later.

“We don’t have an EMR,” said the kind and sympathetic triage nurse apologetically. “Everything is still on paper. We might have an EMR in a year or so, but we’re not even sure about that.”

As it later turned out, she was mistaken. The hospital did indeed have an EMR in place, one by MEDITECH, but had put all new upgrades on hold, leaving the clinical staff to do almost all documentation on paper.  Regardless, the staff didn’t have access to the higher capabilities of an EMR, and that’s the message that the triage nurse had gotten. (And no one ever did take my list of medications.)

Now, it’s not necessarily the case that this hospital had no grasp of its data. In fact, to my surprise, the front desk was able to tell me that I had been seen there in 2002, something of which I had no memory.

But it’s hard to imagine that the very long wait I endured, which took place in the attractive lobby of a quiet, prosperous suburban hospital, was not due in part to the hospital’s lack of automation. It should be noted that within the next several months to a year, the chain to which the hospital belonged expects to bring the hospital I visited onto its Epic platform. But again, the staff was stumbling around in the dark, comparatively speaking, the day I visited the ED.

Now, hospitals survived on paper documentation for many years, and there’s no reason to think this one won’t survive for a year or so using paper charts. What’s more, it may very well be that the real problem this hospital faced had to do with patient mix and staffing concerns. I did note that many of the patients coming in seemed to be seeking weekend primary care, for which the hospital may not have been as prepared as it should have been.

That being said, an EMR is not just a clinical tool. Put coldly, it’s an instrument of industrial automation which can keep patients moving through the assessment and discharge process more quickly and effectively.

I’m not saying the facility needs to have a fully-launched marquee EMR just to impress patients like myself. In fact, postponing expanding the Epic EMR for a while may be a great financial decision, and from an IT standpoint, better to roll the Epic system out at a sustainable pace than throw it at an unprepared workforce.

But watching nurses and doctors record details on endless sheets of paper, and struggle to track down paper charts for acutely ill patients, was a harsh reminder of what the industry has left behind.

What If Doctors Owned Part of Hospital EMRs?

Posted on May 19, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

After this many years of widespread use, you’d think that physicians would have accepted that EMRs are an inevitable part of practicing medicine — and at least sometimes, a useful tool that helps doctors manage their panel of patients more effectively.  But it seems some hospital administrators have concluded that a significant percentage of doctors loathe EMRs.

I draw this conclusion not from casual conversation with physicians, but from a hospital recruiting advertisement quoted in The New York Times.  The advertisement, which was attempting to attract doctors to a facility in Phoenix, closed its glowing description of state-of-the-art equipment and an attractive location with a single provocative line, all in bold: “No E.M.R.s.”

While EMRs are getting long in the tooth these days, they haven’t won over many doctors. As physician Robert Wachter notes in his NYT piece on the subject, a 2013 RAND survey found physicians most unhappy with EMRs, citing “poor usability, time-consuming data entry, needless alerts and poor work flows.”

I think it’s pretty obvious why EMRs continue to stay user-hostile. While doctors are the end users of  EMRs, hospital IT leaders and other CXOs make the final buying decisions. And he (or she) who writes the check makes the rules.

In theory, it’s strongly in hospital management’s interests to force EMR vendors to clean up their usability act.  After all, not only do hospital leaders want their EMRs used effectively, they want the data to be robust enough to be usable for value-based care delivery. But the truth is that hospital leaders are nowhere near demanding enough of EMR vendors. And because they’re the ones writing the checks, doctors get stuck with the ugly results.

But what if there was a way to involve both doctors and hospitals financially, as partners, in buying EMRs?  Not being the world’s greatest finance wizard, I don’t know how a hospital and a group of physicians could structure a deal that would allow them to jointly own the hospital’s EMR system. And I’m aware, though I don’t know how they would be addressed, that there could be significant legal issues to be resolved if the hospital was a not-for-profit entity.

But at least in theory, if doctors were paying for a percentage of the EMR, they’d have a lot more say as to what level of usability they’d demand, what features were most important to them, and what price they’d be willing to pay for the system. In other words, if doctors had skin in the game, it would put a great deal of pressure on vendors to make EMRs doctors actually liked.

Now, I realize that doctors might have no interest in buying into a technology which has let them down again and again. But there’s a chance that more visionary and tech-friendly physicians might grab the chance to have a substantial say in the EMR-buying process. The idea is worth a look.