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Survey: Confusion Slowing Meaningful Use Compliance

While Meaningful Use is likely to spur improvements in health IT, confusion over regulations — and the need to pursue other pressing HIT projects — are slowing down MU compliance, according to a new study.

The survey was conducted by Stoltenberg Consulting, which spoke with health IT managers, clinicians, HIT vendors and government agencies that attended this year’s HIMSS event.

Researchers asked which areas in which HIT will achieve the biggest improvements over the next 12 months. The biggest group (35 percent) named Meaningful Use, while 19 percent said health information exchange, clinical integration and mobile health were due for the most growth.

When asked what might hold them back from meeting Meaningful Use requirements, 29 percent said confusion and/or ambiguity in the regulations were a challenge. Others named competing health IT projects (23 percent) and a lack of key resources such as funding, IT skills, talent and time (17 percent).

The survey also asked respondents what issues were likely to dominate HIT discussions this year. Respondents favored health information exchange (62 percent), followed closely by mobile health (58 percent) and clinical analytics (54 percent).

As part of the survey, Stoltenberg also asked survey respondents which problems HIT executives would most likely attempt to solve with the help of a specialized IT consulting firm. The responses included ICD-10 (25 percent), Meaningful Use (25 percent), clinical and business intelligence (23 percent), cloud computing (21 percent) and CPOE/clinical systems implementation (20 percent).

Is Epic Stifling Health IT Innovation?

In many ways and definitely based on the buzz, Epic is at the top of the hospital EMR market. According to one estimate, about 40 percent of the U.S. population has its medical information stored in an Epic EMR, a stunning number given the level of competition in the hospital EMR space.

The question is, what impact is that having on the EMR marketplace? According to one piece posted this week by Medical Economics, Epic may be stifling health IT innovation due to its nearly-unassailable market lead.

As readers probably know, Epic has established an empire built around antiquated technology (MUMPS), which essentially forces any company that hopes to interoperate to bear its MUMPS core in mind. We’re talking the blunted edge here.

Perhaps more importantly, now that Epic has such a dominant market share, if it chooses to keep a closed system in place, customers will only get what innovations are driven internally by Epic. If hospitals want innovations emerging outside the Epic bubble, they’ll have to consider the staggering costs — in some cases in the hundreds of millions of dollars — of switching outright to another vendor. If that doesn’t stifle innovation I don’t know what does.

This situation hasn’t been lost on healthcare industry leaders, some of whom have begun to balk at Epic’s rise, Medical Economics reports.

As the piece notes, Epic has attracted outspoken critics that question whether Epic’s’ market dominance is bad for the health IT world as a whole. One of those critics is Paul Levy, former CEO of Beth Israel Deaconess Medical Center, who has taken shots at the EMR giant from his “Not Running A Hospital” blog.

Levy, who Medical Economics cites as one of Epic’s toughest opponents, has been known to compare customers’ relationship with Epic to Stockholm Syndrome, a condition occurring when hostages begin to sympathize and identify with their captors.

All that being said, at the moment, there’s little critics can do to change Epic’s business practices or development plans. Perhaps the Federal Trade Commission will step in at some point if it appears to staff there that Epic’s market control is anti-competitive. In the mean time, though, Epic seems to have a lock on the hospital marketplace — and a disproportionate role in shaping the future of EMRs generally.

EMRs Have Certifications Yanked

A California EMR developer has become the first to have its certification for Meaningful Use taken away by the ONC.

EHRMagic-Ambulatory and EHRMagic-Inpatient, both of which were developed by Santa Fe Springs, Calif.-based EMRMagic, failed to meet certification requirements, reports EMR Thoughts.

The de-certification process began when ONC and ONC-authorized certification body InfoGard Laboratories were notified that the EHRMagic products didn’t meet Meaningful Use certification requirements.

InfoGard Laboratories analyzed the information sent along with the notification and contacted the vendor. It then began the process of ONC-ACB required surveillance activities, according to HIN. At that point, InfoGard decided to test the two products for compliance with certain requirements. EHRMagic’s products were then retested, and failed to meet criteria for Meaningful Use certification.

Fortunately for the company’s customers, no providers had yet attempted Meaningful Use attestation using these products. One can only imagine the frustration they would have faced if they attempted to attest in good faith and found out that the EMR product they were using wasn’t capable of supporting MU certification.

I’m left wondering whether providers would have grounds for a lawsuit against the offending vendor if they attempted certification with a product that didn’t support Meaningful Use, particularly if the vendor had any idea that this might be the case.

Realistically, it seems likely at some point in the future, some provider will be left high and dry by a certified product that shouldn’t have gotten the go-ahead. My guess is that things will get nasty pretty quickly!

Only Incentives Will Make EHR Interoperability Happen

Today we had a really interesting #HITsm chat about interoperability, data hoarding, and sharing healthcare data. Tomorrow we’ll have a post on EMR and EHR that summarizes some of the key tweets from the chat. Although, there was one theme that really struck home to me during the chat.

The biggest barrier to EHR interoperability and data sharing is incentives.

During the chat multiple people including myself made the observation that the reason EHR vendors don’t share data is that there’s no incentive to share data. I can’t say I’ve ever seen a hospital choose to not go with an EHR because it couldn’t interoperate with another EHR vendor. The incentive isn’t there for the hospital and therefore the EHR vendor.

Think about the EHR interoeprability announcement of CommonWell. While the CEO’s of the five EHR vendors can sit there and say that they’re doing it because it’s the right thing to do for healthcare, these public company CEOs also have a legal responsibility to do what’s best for the shareholders of their company.

The reality is that CommonWell would have never happened if there wasn’t an incentive for these companies to put CommonWell together. Rather than beat around the bush, these EHR companies came together to stick it to Epic and to give them a strategic advantage over other companies that can’t or won’t share data. You can certainly make an argument for why doing this is good for healthcare as well, but if there was no outside business incentive to CommonWell then the healthcare benefit wouldn’t have been enough.

As one person tweeted during the Twitter chat, If there were money paid for sharing data, all the fear and issues would suddenly disappear and solutions provided.

When thinking about incentivizing EHR interoperability, Farzad Mostashari’s words at The Breakaway Group event at TEDMED come ringing into my ears, “Incentives and money aren’t always the same.” Cash or otherwise, EHR interoperability needs some incentive.

Growing Number Of Children’s Hospitals Use EMRs

The number of children’s hospitals with EMRs in place — and compliant with Meaningful Use — has increased substantially over the last few years, though minor teaching and nonteaching institutions are not as far along, according to a new study appearing in the journal Pediatrics.

The study, which compares data on EMR adoption from 2008 with data on 2011, collected data from 126 children’s hospitals. Researchers calculated EMR adoption rates by using existing definitions of the key functionalities which make up an EMR. The study also looked at Meaningful Use compliance, which it evaluated by by checking whether a given hospital could meet 12 core Meaningful Use criteria.

The study found that between 2008 and 2011, the number of childrens’ hospitals with an EMR grew from 21 percent to 59 percent. But even using 2011 data, only 29 percent of children’s hospitals had demonstrated that they could meet the 12 core criteria used as a Meaningful Use proxy.

All told, EMR adoption rates and Meaningful Use compliance rates were much higher for childrens’ hospitals than for adult hospitals as a whole. However, the results were similar for adult and childrens’ teaching hospitals.

These results square well with an early 2012 report by HIMSS Analytics which looked at Meaningful Use Stage 1 compliance among hospitals. HIMSS found that teaching hospitals were one of the hospital types most likely to have embraced Meaningful Use.

The question, for me, is when childrens’ hospitals are going to step up further in their Meaningful Use efforts. I don’t know about you, but to me 29 percent compliance isn’t terribly impressive.

Study: Most Health Organizations Are Implementing HIEs

A study by revenue cycle management vendor Emdeon has concluded that most hospitals and medical practices are getting involved with HIEs, and that a majority of providers were implementing automated medication reconciliation, e-prescribing and EMRs.

To conduct the study, researchers spoke with 147 people from hospitals, large practices and small practices about their HIT practices, according to Becker’s Hospital Review.

Eighty-eight percent of hospitals surveyed had fully implemented or were in the process of implementing health information exchange, Emdeon found. Large practices were even more involved, with 94 percent of those surveyed having fully implemented or begun the process of implementing HIEs. Even smaller practices were largely on board, despite their resource constraints, with 72 percent having fully or partially implemented HIE connectivity.

As for the other health IT initiatives studied, here’s a quick overview of what Emdeon found (stats courtesy of Becker’s):

Hospitals

* 77 percent have implemented or are on the way to implementing automated medication reconciliation
* 85 percent have partially or completely implemented EMRs
* 61 percent have partially or completely rolled out e-prescribing

Large Medical Practices

* 57 percent are implementing or have completed rollout of automated medication reconciliation
* 74 percent have partly or completely implemented EMRs
* 82 percent have partly or fully implemented e-prescribing

Small Medical Practices

* 55 percent have partly or fully implemented automated medication reconciliation
* 62 percent have partly or completely rolled out EMRs
* 62 percent have partly or fully rolled out e-prescribing

Senators Question Meaningful Use EHR Investment

Six Republican Senators have released a report arguing that there’s no evidence the $32 billion spent on Meaningful Use is delivering the benefits it was designed to offer.

The report, entitled “Reboot: Re-Examining The Strategies Needed to Successfully Adopt Health IT,” was released by Senators Thune, Alexander, Roberts, Burr, Coburn and Enzi. In the report, these Senators dig into the implementation of Meaningful Use and critiquing how the money’s being spent.

The Senators’ concerns are as follows:

* Interoperability: They argue that HITECH is not doing enough to promote interoperability. The Senators say that incentive payments are being doled out without clear evidence that providers can connect with one another.

* Cost savings: Health IT has been promoted as a tool for taking costs out of the health system, and, the Senators concede, is projected by the CBO to save Medicare and Medicaid $12.5 billion through 2019. However, they note that some reports state that health IT may have accelerated ordering of unnecessary care as well as increased billing per procedure.

* Oversight: The Senators cite reports from the HHS Inspector General and the GAO which seem to suggest that the Administration hasn’t done enough to prevent fraud and waste in the Meaningful Use program.

* Security: The report argues that Meaningful Use standards don’t do enough to secure private patient data; they cite reports from the HHS OIG claiming that Medicare and ONCHIT are “lax” in this area.

* Sustainability: When the Meaningful Use money runs out, will providers still be able to keep their health IT equipment running? In the report, the Senators suggest that the ongoing cost of maintaining EMRs and other health IT may be too much to bear, especially for small practices, when the money runs out.

As with most reports of this kind, I’d argue that there’s some truth mixed in with some partisan posturing. For example, I can see where Senatorial observers might be frustrated with the pace of interoperability efforts. On the other hand, I think the sustainability argument may be a straw horse; my gut tells me that once a practice or hospital has spent years implementing an EMR, they’re not going to drop it like a hot potato when the incentives stop coming.

What do you think of the Senators’ critique?

The Big Takeaways from The Breakaway Group Healthcare Forum at TEDMED

I had the tremendous opportunity to spend the day hearing and interacting with a group of healthcare leaders across the entire spectrum of healthcare. I was invited to the Healthcare Forum as a guest of The Breakaway Group. They’d told me that the group would have a large number of influential people in healthcare and they were right. Along with recognizable names like Dr. Farzad Mostashari, Glen Tullman and Lee Shapiro were a number of hospital CEOs, CIOs, and CMIOs. There were doctors, insurance executives, and many other executives which made for a very well rounded and interesting discussion.

I won’t go through an entire recap of the event and all the things that were shared during the various presentations. If that interests you, go and read through my @ehrandhit tweets and check out the #simplehealth hashtag and you’ll get a good overview of everything that was presented from those of us live tweeting the event.

I do want to highlight a couple key takeaways and then suggest a list of major themes we’ll be confronting in healthcare.

Farzad Mostashari, MD was the event keynote with a great view on the future of healthcare. Farzad’s intro was perfect when Charles Fred, Founder & CEO of The Breakaway Group, said, “The wedding of healthcare and technology is over and Farzad has joined us for the marriage.”

Farzad’s message covered a lot of ground including a message of optimism for healthcare, the need to affect all parts of healthcare both small and large, and using the “most underutilized resource in healthcare…the patient.” He also talked about the need for some accountability in healthcare. Farzad suggested that there’s no “scale” in healthcare that we can step on and know how well we are doing. We need the data to be able to tell us how we are doing so we can improve. Without the data we almost always overestimate how good we are and underestimate the things we’re doing poorly.

One of the most powerful concepts Farzad discussed was around being careful not to change healthcare from a social contract into a financial contract. He said, “Incentives and money aren’t always the same.” This point was illustrated brilliantly by one of the attendees who said, “An ACO should be the way we live and breathe healthcare every day and not just a reimbursement program.” I think we often need a reminder to not let the business of healthcare overwhelm the care provided.

Finally, for those of us who love EMR and EHR, Farzad offered this incredible perspective on where we are at when it comes to EHR progress, “We are at about 50% EHR adoption and about 5% workflow adjustment.” It’s the first time I’ve seen him acknowledge the idea that EHR adoption isn’t enough. In fact, the initial implementation of an EHR is just the very first step in a process of really optimizing the EHR for your workflow and for improved patient care. It does make me wonder what things ONC might do in the future to try and address the 95% of EHR workflow adjustments that remain.

I’m sure I’ll be pulling nuggets of information out of Dr. Jennifer Brull, Bill Rieger, Dr. CT Lin, Ashwin Ram, and Heather Haugen’s talks in future posts. They all offered some unique insights into quality of care, EHR leadership, patient engagement, patient portals, and EHR implementation.

Here’s the list of themes from the day as identified by those who attended:

Using Data
Transparency
Need for Leadership to Change
Adoption vs. Implementation (EHR)
Patient and Family Involvement in Care (through social media often)
Change Happens at a Different Pace for Different People

And then we identified the following important future healthcare topics:

Interoperability
Social and Mobile
Patient Engagement
How Do We Ask the Best Questions
Make the Right Thing to Do, Easy
Big Data, Small Actions (for doctors and patients)
Changing Reimbursement

The Healthcare Forum at TEDMED was a well organized event that provided a lot of food for thought. My only complaint from the experience was that pretty much everyone in the room could have been a speaker at the event. Thinking about that makes me wish there had been more time to hear from those in the audience. Although, it isn’t a bad thing to leave us thirsting for more.

Read more coverage from TEDMED from Xerox on the Real Business at Xerox blog and follow@XeroxHealthcare.

Big Data Could Generate $450 Billion For Healthcare System

Here’s some information that should give all of us something to chew on this week, courtesy of the always-interesting Jane Sarasohn-Kahn at the HealthPopuli blog. In a recent piece, Sarasohn-Kahn pulls data from McKinsey & Company suggesting that if big data is properly harnessed, it can produce nearly — wait for it — $450 billion in value for the healthcare system.

As always, however, there’s a catch. This value explosion can’t happen, McKinsey says, unless big data is leveraged across five dimensions of care. These dimensions, which McKinsey calls “new value pathways,” offer opportunities for better efficiencies and economies of scale for the health system, HealthPopuli notes.

The five dimensions include:

* Right living, in which big data is used to help patients take an active role in staying healthy, by such mechanisms as daily health reminders and getting patients to seek care early when problems do arise.

* Right care, in which big data tools, particularly coordination of data across providers and settings, make sure that patients get the right care at the right time.

* Right provider, in which data analytics matches patients with the ideal provider for their situation, sometimes to lower-cost providers that can provide appropriate care.

* Right value, which uses big data analysis to reward providers who produce the best outcomes.

* Right innovation, a pathway in which big data is mined to promote continuous improvement and productivity in healthcare processes as well as R&D.

Sounds great, doesn’t it? Well, maybe not so much given what has to change. To travel down these pathways, McKinsey notes, it will take re-aligning several key forces in the healthcare system, including privacy and data security, a shift to value-based reimbursement, partnerships across industry segments currently found in deep silos (such as payors and providers), and data analysis capabilities current lacking in the health IT workforce. Sigh. And I was feeling hopeful there for a bit.

As Sarasohn-Kahn notes, one way McKinsey sees to meet some of these goals more quickly would be to promote transparency as a cultural norm. But honestly, the silos we see today exist for important institutional and competitive reasons. If we want key partners in the big data effort to cooperate, it’ll probably take a governmental club to that head. Hey, ONC, are you ready to get rough with those who don’t want to play in the same data sandbox?

Patient EMR Access May Be The Biggest Cultural Shift

As most readers probably know, U.S. doctors are skittish about giving patients full access to their medical records. That fact was underscored by a recent Accenture study, which concluded that 65 percent of doctors think patients should only have limited access, and 4 percent feel patients should have no access.

While I have no proof of this, my gut feeling is that these results aren’t just a snapshot in time, but rather a sign of a stubborn problem that’s not likely to melt away quickly. Though much of the high-level thinking about EMRs counts on building collaborative patient relationships over shared records, that thinking may be flawed.

Why are doctors hanging back from full and free disclosure of electronic health data?

* Self-consciousness: Doctors may say things in records that they’d be a bit embarrassed to reveal. To some extent, this is a problem whether the doc is using paper or an EMR, but EMRs are trickier for doctors to use, adding to the awkwardness factor if a patient questions their work or feels offended by the commentary.

* Poor collaboration skills: If patients get to see their records, they’re likely to become all e-patient-ish and want to have more control of their care. Old-school doctors aren’t trained to think this way, nor are they likely to want such a relationship temperamentally.

* Low digital comfort generally: Even among younger physicians, there are those that are naturally wired and those that only use computing devices when they must. I’d argue that when you toss in the generation of doctors who trained 100 percent on paper, you’re looking at a large population of physicians who may never quite be on board with touchy-feely data sharing.

Bottom line, data sharing with patients requires a cultural shift which a surprising number of healthcare pros seem ill-equipped to embrace. I believe it is this cultural shift — from patient as object of notes to patient as co-creator — which will ultimately pose the biggest obstacles to getting value from EMR investments.

Yes, it’d be nice to think that as doctors get more used to living with EMRs, a large number will loosen up, but I doubt that’s the case. Let’s hope the cynic in me is wrong this time.

Is Epic Stifling Health IT Innovation?

EMRs Have Certifications Yanked

Only Incentives Will Make EHR Interoperability Happen

Growing Number Of Children’s Hospitals Use EMRs

Study: Most Health Organizations Are Implementing HIEs

Senators Question Meaningful Use EHR Investment

The Big Takeaways from The Breakaway Group Healthcare Forum at TEDMED

Big Data Could Generate $450 Billion For Healthcare System

Patient EMR Access May Be The Biggest Cultural Shift

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