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Hospital Takes Step Forward Using Patient-Reported Outcome Data

Posted on December 6, 2017 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.

I don’t usually summarize stories from other publications — I don’t want to bore you! — and I like to offer you a surprise or two. This time, though, I thought you might want to hear about an interesting piece appearing in Modern Healthcare. This item offers some insight into how understanding patient-generated determinants of health could improve outcomes.

The story tells the tale of the Hospital for Special Surgery, an orthopedics provider in New York City which provides elective procedures to treat joint pain and discomfort. According to the MH editor, HSS has begun collecting data on patient-reported outcomes after procedures to see not only how much pain may remain, but also how their quality of life is post-procedure.

This project began by doing a check in with the patient before the procedure, during which nurses went over important information and answered any questions the patient might have. (As readers may know, this is a fairly standard approach to pre-surgical patient communication, so this was something of a warm-up.)

However, things got more interesting a few months later. For its next step, the hospital also began surveying the patients on their state of mind and health prior to the procedure, asking 10 questions drawn from the Patient-Reported Outcomes Measurement Information System, or Promis.

The questions captured not only direct medical concerns such as pain intensity and sleep patterns, but also looked at the patient’s social support system, information few hospitals capture in a formal way at present.

All of the information gathered is being collected and entered into the patient’s electronic health record. After the procedure, the hospital has worked to see that the patients fill out the Promis survey, which it makes available using Epic’s MyChart portal.

Getting to this point wasn’t easy, as IT leaders struggled to integrate the results of the Promis survey into patient EHRs. However, once the work was done, the care team was able to view information across patients, which certainly has the potential to help them improve processes and outcomes over time.

Now, the biggest challenge for HSS is collecting data after the patients leave the hospital. Since kicking off the project in April, HSS has collected 24,000 patient responses to nursing questions, but only 15% of the responses came from patients who submitted them after their procedure. The hospital has seen some success in capturing post-surgical results when doctors push patients to fill out the survey after their care, but overall, the post-surgical response rate has remained low to date.

Regardless, once the hospital improves its methods for collecting post-surgical patient responses, it seems likely that the data will prove useful and important. I hope to see other hospitals take this approach.

When It Comes To Meaningful Use, Some Vendors May Have An Edge

Posted on December 1, 2017 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.

A new article appearing in the Journal of the American Medical Informatics Association has concluded that while EHRs certified under the meaningful use program should perform more or less equally, they don’t.

After conducting an analysis, researchers found that there were significant associations between specific vendors and level of hospital performance for all six meaningful use criteria they were using as a yardstick. Epic came out on top by this measure, demonstrating significantly higher performance on five of the six criteria.

However, it’s also worth noting that EHR vendor choice by hospitals accounted for anywhere between 7% and 34% of performance variation across the six meaningful use criteria. In other words, researchers found that at least in some cases, EHR performance was influenced as much by the fit between platform and hospital as the platform itself.

To conduct the study, researchers used recent national data on certified EHR vendors hospitals and implemented, along with hospital performance on six meaningful use criteria. They sought to find out:

  • Whether certain vendors were found more frequently among the highest performing hospitals, as measured by performance on Stage 2 meaningful use criteria;
  • Whether the relationship between vendor and hospital performance was consistent across the meaningful use criteria, or whether vendors specialized in certain areas; and
  • What proportion of variation in performance across hospitals could be explained by the vendor characteristics

To measure the performance of various vendors, the researchers chose six core stage two meaningful use criteria, including 60% of medication orders entered using CPOE;  providing 50% of patients with the ability to view/download/transmit their health information; for 50% of patients received from another setting or care provider, medication reconciliation is performed; for 50% of patient transitions to another setting or care provider, a summary of care record is provided; and for 10% of patient transitions to another setting or care provider, a summary of care record is electronically transmitted.

After completing their analysis, researchers found that three hospitals were in the top performance quartile for all meaningful use criteria, and all used Epic. Of the 17 hospitals in the top performance quartile for five criteria, 15 used Epic, one used MEDITECH and one another smaller vendor. Among the 68 hospitals in the top quartile for four criteria, 64.7% used Epic, 11.8% used Cerner and 8.8% used MEDITECH.

When it came to hospitals that were not in the top quartile for any of the criteria, there was no overwhelming connection between vendor and results. For the 355 hospitals in this category, 28.7% used MEDITECH, 25.1% used McKesson, 20.3% used Cerner, 14.4% used MEDHOST and 6.8% used Epic.

All of this being said, the researchers noted that news the hospital characteristics nor the vendor choice explained were then a small amount of the performance variation they saw. This won’t surprise anybody who’s seen firsthand how much other issues, notably human factors, can change the outcome of processes like these.

It’s also worth noting that there might be other causes for these differences. For example, if you can afford the notably expensive Epic systems, then your hospital and health system could likely afford to invest in meaningful use compliance as well. This added investment could explain hospitals meaningful use performance as much as EHR choice.

Study Suggests That Hospitals Do Better With Richer Clinical EHR Tech Support

Posted on November 29, 2017 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.

It’s hardly a mystery that providers get more use out of health IT when they get good support from the vendors who created it. According to one study, however, today’s vendors need to go further with the tech support offerings, including services extending from helpdesk through engineering interventions.

The study, conducted by research firm Black Book, involved interviewing 4,446 nurses and physicians about the quality of clinical tech support services needed to have an impact on patient care. A large majority (85%) of clinicians said that delivery of patient care services is undermined substantially by subpart user tech support, Black Book reports.

Additional interesting data came from the 1,103 respondents who reported having worked in varied facilities using different EHR systems, which gave them perspective on how tech support options impacted clinical care. Of that group, 77% of nurses and 89% of doctors said the hospitals benefited from advanced tech support, which created an excellent EHR end-user experience.

All that being said, hospital financial leaders didn’t seem confident that they could afford to pay for top-tier tech support for health IT tools. According to the survey, 155 of the 180 CFOs and financial executives who responded to the survey felt they faced too many challenges and had too few resources budgeted for 2018 to spend on additional EHR support next year.

On the other hand, the CFOs are going to get pushback from their colleagues in other departments, the survey suggests. According to the study, 49 of 82 CMOs said they were routinely discontented with a range of tech support provided to the nursing and physician employees. Meanwhile, 80% of the 1,319 IT management and CIO respondents reported that they were seeing a steep increase in clinical grievances after EHR implementation, especially among physicians.

And if they have the opportunity, they’re going to demand more from vendors on the tech support front. In fact, 70 of the 82 hospital CMOs surveyed believe that the availability of multi-level tech support from their health records vendors will be a top competitive differentiator distinguishing one inpatient EHR from the others.

So here, we have the makings of some serious financial tensions between hospitals and EHR vendors. On the one hand, CFOs are signaling that they don’t want to pay extra for additional support, even if it has the potential for improving clinical performance. CIOs and CMO’s, for their part, are willing to shortlist vendors that do a better job of supporting key end-users like physician after EHR rollouts.

Will the more aggressive vendors absorb the cost of delivering more comprehensive, clinical-friendly tech support? Or will hospital financial leaders give in to internal pressure and pay for more sophisticated support?  It’s too soon to tell who has more muscle here, but my guess is that given the still-crowded EHR market, the vendors will eventually be forced to give in and offer better tech support options as part of their base price. My guess is that hospitals still hold more of the cards.

Providing ongoing support for an EHR and other healthcare IT has become such a challenge, we’ve made it one of the themes at our new Health IT Expo conference. If finding a sustainable way to support your EHR at every tier, then join us in New Orleans to learn and share with other hospital organizations that are going through the same challenges.

Amazon May Soon Announce Major Cloud Deal With Cerner

Posted on November 27, 2017 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.

As I’ve previously noted, Amazon is making increasingly aggressive moves into the healthcare space of late. While it hasn’t been terribly public with its plans—and why should it, honestly?— there been some talk of its going into the healthcare technology space. There’s also much talk about angles from which Amazon could attack healthcare sectors, including its well-publicized interest in the pharmacy business.

Though interesting, all of this has been vaguely defined it best. However, a new deal may be in the works which could have a very concrete effect. It could change not only the future of Amazon’s healthcare industry efforts but also, potentially, have an impact on the entire health IT world.

Think I’m exaggerating? Check this out. According to a story on the CNBC site, Amazon is about to announce a “huge” deal with Cerner under which the two will work together on building a major presence in enterprise health IT for Amazon Web Services. Put that way, this sounds a bit hyperbolic, but let me lay this out a bit further.

As things stand, the online retailer’s Amazon Web Services is already generating almost $20 billion a year, boasting clients across major industries such as technology, energy and financial services. Its only stumbling point to date is that it’s had trouble cracking the healthcare market.

Apparently, at the re:Invent conference in Las Vegas next week, AWS’s CEO will announce that Amazon is teaming up with Cerner to convince senior healthcare leaders to use AWS for key initiatives like population health management.

Sources who spoke to CNBC that the partnership will initially focus on Cerner’s HealtheIntent population health product, presumably as a door into convincing hospitals shift more of the cloud-based business to AWS.

Now why, you ask, is this deal bigger than the average bear?  is it one of those vaporware partnerships that fly a flag and promise a lot but don’t really go anywhere?

Yes, I admit that’s always possible, but in this case, I don’t think it’s going to turn out that way. The fit simply seems to work too well for this to be one of those much-ballyhooed deals that fade away quietly. (In fact, I could visualize a Cerner/Amazon merger in the future, as crazy as that might sound. It’s certainly less risky than the Whole Foods deal.)

For one thing, both Amazon and Cerner have significant benefits they can realize. For example, as the story notes, Amazon hasn’t gotten far in the healthcare market, and given its talent for doing the impossible, it must be really stuck at this point. Cerner, meanwhile, will never pull together the kind of cloud options AWS can offer, and I doubt Epic could either, which gives Cerner a boost in the always next-and-neck competition with its top rival.

If this agreement goes through, the ripples could be felt throughout the healthcare industry, if for no other reason than the impact it will have on the enterprise EHR market. This one should be fun to watch. I’m pulling out the popcorn.

Surescripts Deal Connects EMR Vendors And PBMs To Improve Price Transparency

Posted on November 22, 2017 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.

I’m no expert on the pharmacy business, but from where I sit as a consumer it’s always looked to me as though pharmaceutical pricing is something of a shell game. It makes predicting what your airline ticket will cost seem like child’s play.

Yes, in theory, the airlines engage in demand-oriented pricing, while pharma pricing is based on negotiated prices spread among multiple contracted parties, but in either case end-users such as myself have very little visibility into where these numbers are coming from.  And in my opinion, at least, that’s not good for anyone involved. You can say “blah blah blah skin in the game” all you want, but co-pays are a poor proxy for making informed decisions as a patient as to what benefits you’ll accrue and problems you face when buying a drug.

Apparently, Surescripts hopes to change the rules to some degree. It just announced that it has come together with two other interest groups within the pharmacy supply chain to offer patient-specific benefit and price information to providers at the point of care.

Its partners in the venture include a group of EMR companies, including Cerner, Epic, Practice Fusion and Aprima Medical Software, which it says represent 53% of the U.S. physician base. It’s also working with two pharmacy benefit managers (CVS Health and Express Scripts) which embrace almost two-thirds of US patients.

The new Surescripts effort actually has two parts, a Real-Time Prescription Benefit tool and an expanded version of its Prior Authorization solution.  Used together, and integrated with an EHR, these tools will clarify whether the patient’s health insurance will cover the drug suggested by the provider and offer therapeutic alternatives that might come at a lower price.

If you ask me, this is clever but fails to put pressure on the right parties. You don’t have to be a pharmaceutical industry expert to know that middlemen like PBMs and pharmacies use a number of less-than-visible stratagems jack up drug prices. Patients are forced to just cope with whatever deal these parties strike among themselves.

If you really want to build a network which helps consumers keep prices down, go for some real disclosure. Create a network which gathers and shares price information every time the drug changes hands, up to and including when the patient pays for that drug. This could have a massive effect on drug pricing overall.

Hey, look at what Amazon did just by making costs of shipping low and relatively transparent to end-users. They sucked a lot of the transaction costs out of the process of shipping products, then gave consumers tools allowing them to watch that benefit in action.

Give consumers even one-tenth of that visibility into their pharmacy supply chain, and prices would fall like a hot rock. Gee, I wonder why nobody’s ever tried that. Could it be that pharmaceutical manufacturers don’t want us to know the real costs of making and shipping their product?

Epic Mounts Clumsy Public Defense On False Claims Lawsuit

Posted on November 6, 2017 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.

A former employee of a health system using Epic filed a False Claims Act whistleblower suit claiming that the vendor’s platform overbills for anesthesia services by default. The suit claims that Epic’s billing software double-bills both Medicare and Medicaid for anesthesia, as well as commercial payers.

At this point, let me be clear that I’m not accusing anyone of anything, but in theory, this could be a very big deal. One could certainly imagine a scenario in which multiple Epic customers colluded to permit this level of overbilling, which could generate staggering levels of overpayment. If so, one could imagine hospitals and health systems paying out judgments that add up to billions of dollars. To date, though, nobody’s made such a suggestion. In fact, Epic has said essentially the opposite and pointed to the need to understand how medical billing works, but we’ll get to that.

In the suit, which was filed in 2015 but unsealed this month, Geraldine Petrowski contended that Epic’s software was billing for both the base units of anesthesia for procedures and the time the procedure took.

Petrowski, a former employee with the compliance team at Raleigh, N.C.-based WakeMed Health & Hospitals, alleges that setting the billing to these defaults has resulted in “hundreds of millions of dollars in fraudulent bills” submitted to Medicare, Medicaid and other payers. (WakeMed is an Epic customer.)

According to an article appearing in Modern Healthcare, Petrowski developed these concerns when she worked with Epic as the provider’s liaison for its software implementation between 2012 and 2014. In the complaint, she says that she raised these concerns with Epic, but got a dismissive response. Eventually, after Petrowski kept up the pressure for a while, Epic fixed the billing issue — but only for WakeMed.

Apparently, the U.S. Department of Justice reviewed Petrowski’s case and decided not to intervene, a fact which Epic has not-surprisingly mentioned every chance it gets. Perhaps more tellingly, the vendor has suggested that Petrowski filed the suit largely because she’s clueless. “The plaintiff’s assertions represent a fundamental misunderstanding of how claims software works,” Epic spokesperson Meghan Roh told the magazine.

Now, I don’t want to go off on a rant here, but if the best public defense Epic can mount in this case is to offer some mixture of “everybody’s doing it” and “you’re a big dummy,” you’ve got to wonder what it’s got to hide.

Not only that, trying to brush off the suit as the product of ignorance or inexperience makes no sense given what’s involved. While False Claims whistleblowers can collect a very large payoff, getting there can take many years of grueling work, and their odds of prevailing aren’t great even if they make it through the torturous litigation process.

No, I’m more inclined to think that Epic has tipped its hand already. I’d argue that fixing only the WakeMed billing system shows what the legal folks call mens rea – a guilty mind — or at least a willingness to ignore potential wrongdoing. Not only that, if the system was operating as expected, why would Epic have gotten involved in the first place? Its consulting services don’t come cheap, and I’m guessing that Petrowski didn’t have the authority to pay for them.

It doesn’t look good, people…it just doesn’t look good.

Sure, the hospitals and health systems using Epic’s billing solution are ultimately responsible for the results. Maybe Epic is completely blameless in the matter this case. Regardless, if Epic’s hands are clean, it could do a better job of acting like it.

AHA Asks Congress To Reduce Health IT Regulations for Medicare Providers

Posted on September 22, 2017 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.

The American Hospital Association has sent a letter to Congress asking members to reduce regulatory burdens for Medicare providers, including mandates affecting a wide range of health IT services.

The letter, which is addressed to the House Ways and Means Health subcommittee, notes that in 2016, CMS and other HHS agencies released 49 rules impacting hospitals and health systems, which make up nearly 24,000 pages of text.

“In addition to the sheer volume, the scope of changes required by the new regulations is beginning to outstrip the field’s ability to absorb them,” says the letter, which was signed by Thomas Nickels, executive vice president of government relations and public policy for the AHA. The letter came with a list of specific changes AHA is proposing.

Proposals of potential interest to health IT leaders include the following. The AHA is asking Congress to:

  • Expand Medicare coverage of telehealth to patients outside of rural areas and expand the types of technology that can be used. It also suggests that CMS should automatically reimburse for Medicare-covered services when delivered via telehealth unless there’s an individual exception.
  • Remove HIPAA barriers to sharing patient medical information with providers that don’t have a direct relationship with that patient, in the interests of improving care coordination and outcomes in a clinically-integrated setting.
  • Cancel Stage 3 of the Meaningful Use program, institute a 90-day reporting period for future program years and eliminate the all-or-nothing approach to compliance.
  • Suspend eCQM reporting requirements, given how difficult it is at present to pull outside data into certified EHRs for quality reporting.
  • Remove requirements that hospitals attest that they have bought technology which supports health data interoperability, as well as that they responded quickly and in good faith to requests for exchange with others. At present, hospitals could face penalties for technical issues outside their control.
  • Refocus the ONC to address a narrower scope of issues, largely EMR standards and certification, including testing products to assure health data interoperability.

I am actually somewhat surprised to say that these proposals seem to be largely reasonable. Typically, when they’re developed by trade groups, they tend to be a bit too stacked in favor of that group’s subgroup of concerns. (By the way, I’m not taking a position on the rest of the regulatory ideas the AHA put forth.)

For example, expanding Medicare telehealth coverage seems prudent. Given their age, level of chronic illness and attendant mobility issues, telehealth could potentially do great things for Medicare beneficiaries.

Though it should be done carefully, tweaking HIPAA rules to address the realities of clinical integration could be a good thing. Certainly, no one is suggesting that we ought to throw the rulebook out the window, it probably makes sense to square it with today’s clinical realities.

Also, the idea of torquing down MU 3 makes some sense to me as well, given the uncertainties around the entirety of MU. I don’t know if limiting future reporting to 90-day intervals is wise, but I wouldn’t take it off of the table.

In other words, despite spending much of my career ripping apart trade groups’ legislative proposals, I find myself in the unusual position of supporting the majority of the ones I list above. I hope Congress gives these suggestions some serious consideration.

Is Allscripts An Also-Ran In The Hospital EMR Business?

Posted on August 18, 2017 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.

It all began with a question, as many classic tales do. Someone writing for the HIStalk.com website  – I think it was ever-anonymous, eponymous  leader Mr. HISTalk – asked readers to answer the question “Who will benefit most from the proposed acquisition of McKesson EIS by Allscripts?”

The survey results were themselves worth a read:

* Approximately 29% voted for “McKesson customers”
* About 27% voted for “Allscripts customers”
* 8.4% voted for “McKesson shareholders”
* Roughly 23% voted for “Allscripts shareholders”
* About 13% voted for “Allscripts competitors”

Two things about these responses interested me. One is that almost a third of respondents seem to think McKesson will make the bigger score after being acquired by Allscripts. The other is that a not-inconsiderable 13% of the site’s well-informed readers think the deal will help Allscripts’ competitors. If these readers are right, perhaps Allscripts should rethink the deal.

I was even more engaged by the analysis that followed, which the writer took a close look at the dynamics of the hospital EMR market and commented on how Allscripts fit in. The results weren’t surprising, but again, if I were running Allscripts I’d take the following discussion seriously.

After working with data supplied by Blain Newton, EVP of HIMSS Analytics, the writer drew some firm conclusions. Here are some of the observations he shared:

  • While McKesson has twice as many hospitals as Allscripts, most of these hospitals have less than 150 beds, which means that the acquisition may offer less benefit, he suggests.
  • In addition to having only 3% of hospitals overall, Allscripts controls only 6% of the 250+ bed hospital market, which probably doesn’t position it for success. In contrast, he notes, Epic controls 20% of this market and Meditech 19%.
  • His sense is that while hospitals typically want a full suite of products when they work with Epic, Cerner or Meditech, Allscripts customers may be more prone to buying just a few key systems.
  • Ultimately, he argues, Cerner, Epic and Meditech have a commanding lead in this market, for reasons which include that the three are well ahead when it comes to the overall number of hospital served.
  • Given his premise, he believes that Epic is at the top of the pyramid, as it has almost double the number of hospitals with 500+ beds that Cerner does.

To cap off his analysis, Mr. HISTalk concludes that market forces make it unlikely that a dark horse will squeeze out one of the top hospital EMR vendors: “Everybody else is eating their dust and likely to lose business due to hospital consolidation and a shift toward the most successful vendors as much as all of us who – for our own reasons – wish that weren’t the case.”

It would take a separate analysis to predict whether the top three hospital EMR vendors are likely to win out over each other, but Epic seems to hold the most cards. Last year, I wrote a piece suggesting that Cerner was edging up on Epic, but I’m not sure whether or not my logic still holds. Epic may indeed be King of the (HIT) Universe for the foreseeable future.

Is It Time To Put FHIR-Based Development Front And Center?

Posted on August 9, 2017 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.

I like to look at questions other people in the #HIT world wonder about, and see whether I have a different way of looking at the subject, or something to contribute to the discussion. This time I was provoked by one asked by Chad Johnson (@OchoTex), editor of HealthStandards.com and senior marketing manager with Corepoint Health.

In a recent HealthStandards.com article, Chad asks: “What do CIOs need to know about the future of data exchange?” I thought it was an interesting question; after all, everyone in HIT, including CIOs, would like to know the answer!

In his discussion, Chad argues that #FHIR could create significant change in healthcare infrastructure. He notes that if vendors like Cerner or Epic publish a capabilities-based API, providers’ technical, clinical and workflow teams will be able to develop custom solutions that connect to those systems.

As he rightfully points out, today IT departments have to invest a lot of time doing rework. Without an interface like FHIR in place, IT staffers need to develop workflows for one application at a time, rather than creating them once and moving on. That’s just nuts. It’s hard to argue that if FHIR APIs offer uniform data access, everyone wins.

Far be it from me to argue with a good man like @OchoTex. He makes a good point about FHIR, one which can’t be emphasized enough – that FHIR has the potential to make vendor-specific workflow rewrites a thing of the past. Without a doubt, healthcare CIOs need to keep that in mind.

As for me, I have a couple of responses to bring to the table, and some additional questions of my own.

Since I’m an HIT trend analyst rather than actual tech pro, I can’t say whether FHIR APIs can or can’t do what Chat is describing, though I have little doubt that Chad is right about their potential uses.

Still, I’d contend out that since none other than FHIR project director Grahame Grieve has cautioned us about its current limitations, we probably want to temper our enthusiasm a bit. (I know I’ve made this point a few times here, perhaps ad nauseum, but I still think it bears repeating.)

So, given that FHIR hasn’t reached its full potential, it may be that health IT leaders should invest added time on solving other important interoperability problems.

One example that leaps to mind immediately is solving patient matching problems. This is a big deal: After all, If you can’t match patient records accurately across providers, it’s likely to lead to wrong-patient related medical errors.

In fact, according to a study released by AHIMA last year, 72 percent of HIM professional who responded work on mitigating possible patient record duplicates every week. I have no reason to think things have gotten better. We must find an approach that will scale if we want interoperable data to be worth using.

And patient data matching is just one item on a long list of health data interoperability concerns. I’m sure you’re aware of other pressing problems which could undercut the value of sharing patient records. The question is, are we going to address those problems before we began full-scale health data exchange? Or does it make more sense to pave the road to data exchange and address bumps in the road later?

We Can’t Afford To Be Vague About Population Health Challenges

Posted on June 19, 2017 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.

Today, I looked over a recent press release from Black Book Research touting its conclusions on the role of EMR vendors in the population health technology market. Buried in the release were some observations by Alan Hutchison, vice president of Connect & Population Health at Epic.

As part of the text, the release observes that “the shift from quantity-based healthcare to quality-based patient-centric care is clearly the impetus” for population health technology demand. This sets up some thoughts from Hutchison.

The Epic exec’s quote rambles a bit, but in summary, he argues that existing systems are geared to tracking units of care under fee-for-service reimbursement schemes, which makes them dinosaurs.

And what’s the solution to this problem? Why, health systems need to invest in new (Epic) technology geared to tracking patients across their path of care. “Single-solution systems and systems built through acquisition [are] less able to effectively understand the total cost of care and where the greatest opportunities are to reduce variation, improve outcomes and lower costs,” Hutchison says.

Yes, I know that press releases generally summarize things in broad terms, but these words are particularly self-serving and empty, mashing together hot air and jargon into an unappetizing patty. Not only that, I see a little bit too much of stating as fact things which are clearly up for grabs.

Let’s break some of these issues down, shall we?

  • First, I call shenanigans on the notion that the shift to “value-based care” means that providers will deliver quality care over quantity. If nothing else, the shifts in our system can’t be described so easily. Yeah, I know, don’t expect much from a press release, but words matter.
  • Second, though I’m not surprised Hutchison made the argument, I challenge the notion that you must invest in entirely new systems to manage population health.
  • Also, nobody is mentioning that while buying a new system to manage pop health data may be cleaner in some respects, it could make it more difficult to integrate existing data. Having to do that undercuts the value of the new system, and may even overshadow those benefits.

I don’t know about you, but I’m pretty tired of reading low-calorie vendor quotes about the misty future of population health technology, particularly when a vendor rep claims to have The Answer.  And I’m done with seeing clichéd generalizations about value-based care pass for insight.

Actually, I get a lot more out of analyses that break down what we *don’t* know about the future of population health management.

I want to know what hasn’t worked in transitioning to value-based reimbursement. I hope to see stories describing how health systems identified their care management weaknesses. And I definitely want to find out what worries senior executives about supporting necessary changes to their care delivery models.

It’s time to admit that we don’t yet know how this population health management thing is going to work and abandon the use of terminally vague generalizations. After all, once we do, we can focus on the answering our toughest questions — and that’s when we’ll begin to make real progress.