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A Primer on Medicaid/CHIP Managed Care Reform

Posted on May 27, 2016 I Written By

The following is a guest blog post by Megan Renfrew, Director in the Cognosante Solutions Lab.
Megan Renfrew - Cognosante
On May 6, 2016, the Centers for Medicare and Medicaid Services (CMS) published a final regulation in the Federal Register concerning managed care in Medicaid and the Children’s Health Insurance Program (CHIP).  The first overhaul of Medicaid and CHIP managed care regulations in more than a decade, the rule “updates how Medicaid works for the nearly two-thirds of beneficiaries who get coverage through private managed care plans,” wrote CMS Acting Administrator Andy Slavitt and Vikki Wachino, CMS Deputy Administrator and Director for the Center for Medicaid and CHIP Services, in a CMS blog post.

Approximately 72 percent of Medicaid enrollees in 39 states and the District of Columbia are served through managed care plans, up 14 percent since 2013.  Combined Federal and state spending on Medicaid managed care exceeds $150 billion annually.  Those figures will grow steadily as states continue to expand Medicaid managed care coverage to include larger geographic areas, additional populations, and services previously covered through fee-for-service Medicaid, such as inpatient and Long-Term Services and Support (LTSS).

While the medical loss ratio and other financial requirements received the lion’s share of attention throughout the rule-making process, the rule’s focus on improving the beneficiary experience and increased reporting and data requirements are equally important.  Beneficiaries will benefit from quality improvement requirements, stricter provider access requirements, and stronger care management programs.  Plans and states will need to adjust contracts and IT systems to meet new data, reporting, and analytics requirements that support CMS’s goals of increased program integrity and transparency.

Beneficiary Experience & Protections

To strengthen the experience of beneficiaries, the rule requires states to address disparities and individuals who need long term care or have special health needs in their quality plans for the Medicaid managed care rule.  The final rule, which will be phased in over several years, also creates the first quality rating system for Medicaid managed care plans, aligning Medicaid with Medicare Advantage and Qualified Health Plans rules.  This will allow beneficiaries to better compare plans before enrollment.

On the care management front, the rule includes standards for care coordination, health assessments for new plan enrollees, and treatment plans for enrollees with special healthcare needs or who receive LTSS.  These rules are designed to make sure that beneficiaries receive appropriate care in the appropriate setting, and are assisted in navigating the complex healthcare system.

The rule helps ensure that beneficiaries have sufficient access to providers by strengthening provider network adequacy requirements.  States must add time and distance standards to their state network adequacy rule (31 states already have time and distance standards in place for primary care providers).  Under the final rule, however, CMS spells out the provider types subject to network adequacy requirements in greater detail.  As a result, states must now create standards for more than seven different provider types.  Plans must also report provider network data at least annually, and maintain an up-to-date provider directory for plan members.

Additional changes focus on targeted beneficiary education and outreach.  States must implement systems that support beneficiaries prior to and after enrollment, a role that will likely be played by enrollment brokers.  Under these systems, beneficiaries are educated about managed care, including benefits covered and choice of plans, and their rights and responsibilities under Medicaid.  The beneficiary support system also provides a venue for current managed care enrollees, including assistance navigating the grievance and appeals process.

Enhanced Data and Systems Needs

Under the final rule, states and plans are required to meet stronger data submission and reporting requirements to support program oversight, program integrity, and increased transparency.  To meet these requirements, states and plans must have adequate IT systems to ensure accurate and timely data delivery and reporting.  Some states and managed care plans will likely need to increase their data collection and analytics capabilities to comply with the new rule.

The most important change is that federal payment for Medicaid managed care is tied to the submission of accurate, complete, and timely encounter data to CMS in a CMS-specified format, likely TMSIS.  Historically, some states have struggled to collect complete and accurate encounter data from managed care plans, and to manage that data in legacy systems designed for fee-for-service claims.  Both states and plans will need to examine their current IT systems, data collection and submission processes, and contract language to ensure that they are well positioned to meet these requirements.

In addition to the encounter data requirements, CMS is requiring that states post information on their Medicaid managed care plans on a public website, including enrollee handbooks, provider directories, and plan contracts.  Also required is information about plan performance, including finances, operational performance, quality indicators, measures of customer satisfaction, and the results of program integrity audits.

To meet the stricter provider network adequacy requirements, plans will need to have, at a minimum, accurate data on their provider network.  As states revise their network adequacy rules to meet the CMS requirements and monitor their plans for compliance, they may benefit from using GIS-based tools that automate network adequacy analysis and allow for easy evaluation of policy options and plan performance.

To support program integrity goals, the CMS rule requires all providers in Medicaid managed care plan networks to enroll with the state Medicaid agency.  Enrollment in Medicaid was previously required only of those providers participating in the Medicaid fee-for-service program.  States may find that they need more automated provider enrollment and verification systems to handle the increased workload that this requirement will generate for state Medicaid agencies.  Luckily, provider enrollment solutions are available in the market.

To help ease the burden of implementing the systems necessary to manage the robust data collection, analysis, exchange, and reporting necessary under Medicaid managed care reform, states can leverage CMS’s previously issued final rule extending 90 percent federal matching funds for Medicaid enterprise system development.  In addition to ensuring the permanent availability of this funding, that rule extends its use to commercial-off-the-shelf and software-as-a-service solutions.  This allows states to take advantage of previously developed and tested products in the marketplace.

21st Century Medicaid

CMS and its stakeholders devoted thousands of hours to crafting sweeping reform that brings Medicaid manage care into the 21st Century, including supporting data-driven decision-making and oversight, and allowing for state innovation in delivery system and payment reform. Doing so solidifies Medicaid’s place as a key driver of health innovation and plans’ roles supporting and implementing that innovation.

About Megan Renfrew
Megan Renfrew is a Director in the Cognosante Solutions Lab.  An accomplished health policy expert who spent more than five years drafting healthcare bills for the U.S. House of Representatives, she previously served as the technical director at CMS responsible for collecting and analyzing Medicaid and CHIP eligibility and enrollment data from states. 

Appointment Scheduling Site Zocdoc Connects With Epic

Posted on May 25, 2016 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.

In a bid to capture hospital and health system business, appointment scheduling site Zocdoc announced that its customers can now connect the site to their Epic EMRs via an API. The updated Zocdoc platform targets the partners’ joint customers, which include Yale New Haven Health, NYU Langone Medical Center, Inova Health System and Hartford HealthCare. And I’ll admit it – I’m intrigued.

Typically, I don’t write stories about vendors other than the top EMR players. And on the surface, the deal may not appear very interesting. But the truth is, this partnership may turn out to offer a new model for digital health relationships. If nothing else, it’s a shrewd move.

Historically, Zocdoc has focused on connecting medical practices to patients. Physicians list their appointment schedule and biographical data on the site, as well as their specialty. Patients, who join for free, can search the site for doctors, see when their chosen physician’s next available appointment is and reserve a time of their choosing. If patients provide insurance information, they are only shown doctors who take their insurance.

As a patient, I find this to be pretty nifty. Particularly if you manage chronic conditions, it’s great be able to set timely medical appointments without making a bunch of phone calls. There are some glitches (for example, it appears that doctors often don’t get the drug list I entered), but when I report problems, the site’s customer service team does an excellent job of patching things up. So all told, it’s a very useful and consumer-friendly site.

That being said, there are probably limits to how much money Zocdoc can make this way. My guess is that onboarding doctors is somewhat costly, and that the site can’t charge enough to generate a high profit margin. After all, medical practices are not known for their lavish marketing spending.

On the other hand, working with health systems and hospitals solves both the onboarding problem and the margin problem. If a health system or hospital goes with Zocdoc, they’re likely to bring a high volume of physicians to the table, and what’s more, they are likely to train those doctors on the platform. Also, hospitals and health systems have larger marketing budgets than medical practices, and if they see Zocdoc as offering a real competitive advantage, they’ll probably pay more than physicians.

Now, it appears that Zocdoc had already attracted some health systems and hospitals to the table prior to the Epic linkage. But if it wants to be a major player in the enterprise space, connecting the service to Epic matters. Health systems and hospitals are desperate to connect disparate systems, and they’re more likely to do deals with partners that work with their mission-critical EMR.

To be fair, this approach may not stick. While connecting an EMR to Zocdoc’s systems may help health systems and hospitals build patient loyalty, appointment records don’t add anything to the patient’s clinical picture. So we’re not talking about the invention of the light bulb here.

Still, I could see other ancillary service vendors, particularly web-based vendors, following in Zocdoc’s footsteps if they can. As health systems and hospitals work to provide value-based healthcare, they’ll be less and less tolerant of complexity, and an Epic connection may simplify things. All told, Zocdoc’s deal is driven by an idea whose time has come.

Avoiding Revenue Crunches During EMR Transitions

Posted on May 23, 2016 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.

Most healthcare leaders know, well before their EMR rollouts, that clinical productivity and billings may fall for a while as the implementation proceeds. That being said, it seems a surprising number are caught off guard by the extent to which payments can be lost or delayed due to technical issues during the transition. This is particularly alarming as more and more hospitals are looking at switching EHR.

Far too often, those responsible for revenue cycle issues live in a silo that doesn’t communicate well with hospital IT leadership, and the results can be devastating financially. For example, consider the case of Maine Medical Center, which took a major loss after it launched its Epic EMR in 2012, due in part to substantial problems with billing for services.

But according to McKesson execs, there’s a few steps health systems and hospitals can take to reduce the impact this transition has in your revenue cycle. Their recommendations include the following:

  • Involve revenue cycle managers in your EMR migration. Doing so can help integrate RCM and EMR technologies successfully.
  • Create a revenue cycle EMR team. The team should include the CFO, revenue cycle leaders from patient access and reimbursement, vendor reps and someone familiar with revenue cycle systems. Once this team is assembled, establish a meeting schedule, team roles and goals for participants. It’s particularly important to designate a project manager for the revenue cycle portion of your EMR rollout.
  • Before the implementation, research how RCM processes will be affected by the by the rollout, particularly how the new EMR will impact claims management workflow, speed of payment and staff workloads. Check out how the implementation will affect processes such as eligibility verification, registration data quality assurance, preauthorization and medical necessity management, pre-claim editing and remittance management.
  • Pay close attention to key performance indicators throughout the transition. These include service-to-payment velocity, Days Not Final Billed, charge trends and denial rates.

The article also recommends bringing on consultants to help with the transition. Being that McKesson is a health IT vendor, I’m not at all surprised that this is the case. But there’s something to the idea nonetheless. Self-serving though such a recommendation may be, it may help to bring in a consultant who has an outside view of these issues and is not blinkered by departmental loyalties.

That being said, over the longer term healthcare leaders need to think about ways to help RCM and IT execs see eye to eye. It’s all well and good to create temporary teams to smooth the transition to EMR use. But my guess is that these teams will dissolve quickly once the worst of the rollout is over. After all, while IT and revenue cycle management departments have common interests, their jobs differ significantly.

The bottom line is that to avoid needless RCM issues, the IT department and revenue cycle leaders need to be aligned in their larger goals. This can be fostered by financial rewards, common performance goals, cultural expectations and more, but regardless of how it happens, these departments need to be interested in working together. However, unless rewards and expectations change, they have little incentive to do so. It’s about time hospital and health system leaders address problem directly.

Healthcare IT Competitive Landscape Graphic

Posted on May 20, 2016 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 recently did an interview with a market research firm about healthcare IT and specifically about patient portals. They sent me their final report and in that report they shared a graphic of the competitive landscape for healthcare IT (which they said I could share):

Healthcare IT Competitive Landscape

I’m sure we could quibble over some of the categories they chose, where a company resides (ie. IBM bought Truven Analytics, so they’re now technically one company), companies left off, etc, but I thought it was an interesting overview of the kind of companies that are trying to make an impact in healthcare.

In fact, what hit me most about this graphic was the diversity of companies that have a foothold in healthcare. I’ve certainly heard and worked with all of the companies on the list. However, I’d never really sat back and thought about the breadth of companies that are trying to do something in healthcare.

Of course, when you think about the trillions of dollars being spent on healthcare, it’s not that big of a surprise that these large companies would want a piece of that large pie. In fact, there are a number of other very large companies that are definitely missing from this graphic (no doubt the graphic wasn’t intended to be comprehensive).

I’d love to hear what other categories of companies you think should be represented on the list. Any other category of companies you see working in healthcare?

Are Current Population Health Tools Becoming Outdated?

Posted on May 18, 2016 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.

These days, virtually all hospitals and health systems are looking at ways to manage population health. Most of their approaches assume that it’s a matter of identifying the right big data tools and crunching the numbers, using the data already in-house. Doing this may be costly and time-consuming, but it can be done using existing databases, integration engines and the appropriate business analytics tools, or so the conventional wisdom holds.

However, at least one health IT leader disagrees. Adrian Zai, MD, clinical director of population informatics at Massachusetts General Hospital, argues that current tools designed to enable population health management can’t do the job effectively. “All of the health IT tools companies call population health today will be irrelevant because the data they look at can only see what goes through hospital, which is far too narrow in scope.”

Zai points out that most healthcare organizations attempt to leverage claims data in doing population health management analyses. But that approach is far from ideal, he told Healthcare IT News. Claims data, he points out, is typically one to two months old, which significantly limits the value healthcare providers can generate from the data. Also, most hospitals’ claims data only covers about 20% to 30% of the area’s population, he notes.

Instead, organizations need to study real-time data drawn from a significantly broader population if they hope to achieve population health management goals, Zai argues. For example, it’s important to look at the Medicaid population, whose members may get most of their care through community health centers. It’s also important to collect data from other consumer touch points. (Zai doesn’t specify which touch points he means, but mobile health and remote patient monitoring data come to mind immediately.)

I think Zai make some excellent points here. In particular, while achieving true real-time analysis is probably well the future for most healthcare organizations, the fresher data you can use the better. Certainly, analyzing archival data has a purpose, but to have a major impact on outcomes, it’s important to foster behavior change in the present.

However, I’d argue that few providers are ready to roll ahead with this approach. After all, to achieve his goals means establishing some new definitions as to what data should be included in population health analysis. And that’s not as simple as it sounds. (For a recent look at how providers look at population health, check out this survey from last summer.)

First, providers need to take a fresh look at how they define the term “population,” and develop a definition that takes in a more comprehensive view of patient data. Certainly, claims data analysis is start, but that by definition is limited to insured patients seen at the hospital. Zai recommends that population health management efforts embrace all patients seen at the hospital, insured or not. In other words, he’s recommending hospitals address the community in which they are physically located, not just the community of patients for whom they have provided care.

Just as importantly, hospitals and health systems need to consider how to collect, incorporate and analyze the exponentially-growing field of digital health data. While some middleware solutions offer to serve as a gateway for such data, it seems likely that providers will still need to do a lot of hands-on work to make use of these data sources.

Finally, providers need to continually improve the algorithms they use to pinpoint problems in a given population, as well as the ways in which they create actionable subsets of the population. For example, it may be appropriate to target patients by disease state today, but other ways of improving outcomes might arise, and providers’ IT solutions need to be flexible enough to evolve with the times.

Over time, the industry will evolve best practices for population health management, and definedthe IT tools best suited to accomplish reasons. And while some existing tools may work, I’d be surprised if most survive the transition.

EMR Replacement Frenzy Has Major Downsides

Posted on May 16, 2016 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.

Now that they’ve gotten an EMR in shape to collect Meaningful Use payouts, hospitals are examining what those incentive bucks have gotten them. And apparently, many aren’t happy with what they see. In fact, it looks like a substantial number of hospitals are ripping and replacing existing EMRs with yet another massive system.

But if they thought that the latest forklift upgrade would be the charm, many were wrong. A new study by Black Book Research suggests that in the frenzy to replace their current EMR, many hospitals aren’t getting what they thought they were getting. In fact, things seem to be going horribly wrong.

Black Book recently surveyed 1,204 hospital executives and 2,133 user-level IT staffers that had been through at least one large EMR system switch to see if they were happy with the outcome. The results suggest that many of these system switches have been quite a disappointment.

According to researchers, hospitals doing new EMR implementations have encountered a host of troubles, including higher-than-expected costs, layoffs, declining inpatient revenues and frustrated clinicians. In fact, hospitals went in to these upgrades knowing that they would not be back to their pre-EMR implementation patient volumes for at least another five years, but in some cases it seems that they haven’t even been keeping up with that pace.

Fourteen percent of all hospitals that replaced their original EMR since 2011 were losing inpatient revenue at a pace that would not support the total cost of the replacement EMR, Black Book found. And 87% of financially threatened hospitals now regret the executive decision to change systems.

Some metrics differed significantly depending on whether the respondent was an executive or a staff member.

For example, 62% of non-managerial IT staffers reported that there was a significantly negative impact on healthcare delivery directly attributable to an EMR replacement initiative. And 90% of nurses said that the EMR process changes diminished their ability to deliver hands-on care at the same effectiveness level. In a striking contrast, only 5% of hospital leaders felt the impacted care negatively.

Other concerns resonated more with executives and staff-level respondents. Take job security. While 63% of executive-level respondents noted that they, or their peers, felt that their employment was in jeopardy to the EMR replacement process, only 19% of respondents said EMR switches resulted in intermittent or permanent staff layoffs.

Meanwhile, there seemed to be broad agreement regarding interoperability problems. Sixty-six percent of system users told Black Book that interoperability and patient data exchange functions got worse after EMR replacements.

What’s more, hospital leaders often haven’t succeeded in buying the loyalty of clinicians by going with a fashionable vendor. According to Black Book, 78% of nonphysician executives surveyed admitted that they were disappointed by the level of clinician buy-in after the replacement EMR was launched. In fact, 88% of hospitals with replacement EMRs weren’t aware of gaining any competitive advantage in attracting doctors with their new system.

Now, we all know that once a tactic such as EMR replacement reaches a tipping point, it gains momentum of its own. So even if they read this story, my guess is that hospital executives planning an EMR switch will assume their rollout will beat the odds. But if it doesn’t, they can’t say they weren’t warned!

Will Hospital EMR Prices Ever Fall?

Posted on May 9, 2016 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.

In most industries, prices fall as supply rises. Basic economics, right? Well, if that’s true, will the price of EMRs fall as the industry matures?  A recent discussion on LinkedIn demonstrates – as you might expect – that there’s a lot of room for debate on the topic.

Davíð Þórisson, an emergency physician at Landspitali University Hospital in Iceland, kicked things off with this question:

Now that the major workflow has been designed in all major EHR systems available it would seem the biggest part of the hospital needs are addressed. Competition should increase as more vendors catch on… prices surely must go down from here?

Nelson Wong, a senior consultant with Fuji Xerox, responded that price increases are all but inevitable when EMR vendors compete with proprietary technology:

The only way out is a vendor neutral EHR providers to integrate all systems with international standard like HL7.

Zac Whitewood-Moores, a clinical data standards specialist who’s helping to implement SNOMED CT in systems across the NHS in England, noted that EMR vendors currently have little incentive to switch to a cheaper, less-customized EMR model:

Vendors appear reluctant to share work from previous deployments and part of this has to be that the commercial model is built on consultancy, not just licensing of the IT product itself.

But Whitewood-Moores also holds out hope that true data interoperability could do the trick:

When there is more use of SNOMED CT and common interoperability models forced by purchasing goverments/health providers…this may bring down costs if customers are not locked in by their data and the costs of migrating large amounts of it.

And Ryan Pena, social media manager at MentorMate and MobCon, argued that innovation might yet reduce health data management costs:

I think the key with EHRs is to ensure the industry continues to innovate on how information is captured. Perhaps secure automation will drive down this cost as we learn ways to transfer health data from medical grade wearables?

On the other hand, other people who commented felt that even some kind of open source reference EMR wouldn’t do the trick. John Shepard, president and co-founder of HIT software vendor Shepard Health, points out that there’s actually surprisingly little pressure on vendors to lower prices, in part because the market is still evolving:

The cost of EHRs has already gone down but also up. For example, you can buy an EHR out of the box at Costco or utilize one of the open source EHRs for free. However, to get a supported enterprise-level EHR (Epic, McKesson, etc.) then the price is very high and I don’t think it will come down anytime soon…[After all,] the cost of the EHR is not preventing sales because there is minimal change in demand based on increase in cost.

Meanwhile Pim Volkert, terminologies coordinator for Nicitz, the National IT Institute for Healthcare in the Netherlands, shared an interesting view of the future. He seems to suggest that paying more for EMRs may actually be justified as they grow more sophisticated:

EHRs will move more and more into the clinical domains. [They] will become a medical device just like an MRI or DaVinci robot. Development, testing of software and liability insurance fees will increase costs.

Obviously, there’s no way to predict exactly where EMR prices will go, but I’m more on the side of the posters suggesting that enterprise EMRs have nowhere to go but up. I hope I’m wrong!

Mayo Clinic’s Shift To Epic Eats Up Most of IT Budget

Posted on May 6, 2016 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.

Mayo Clinic has announced that it will spend about $1 billion to complete its migration from Cerner and GE to Epic. While Mayo hasn’t disclosed they’re spending on software, industry watchers are estimating the agreement will cost hundreds of millions of dollars, with the rest of the $1 billion seemingly going to integration and development costs.

The Clinic said in 2014 that it would invest $1.5 billion in IT infrastructure over multiple years, according to the Minneapolis/St. Paul Business Journal. Then last year, it announced that it would replace Cerner and GE systems with an Epic EMR. Now, its execs say that it will spend more than $1 billion on the transition over five years.

Given what other health system spend on Epic installations, the $1 billion estimate sounds sadly realistic. Facing up to these costs is certainly smarter than lowballing its budget. Nobody wants to be in the position New York City-based Health and Hospitals Corp. has gotten into. The municipal system’s original $302 million budget expanded to $764 million just a couple of years into its Epic install, and overall expenses could hit $1.4 billion.

On the other hand, the shift to Epic is eating up two thirds of the Mayo’s $1.5 billion IT allowance for the next few years. And that’s a pretty considerable risk. After all, the Clinic must have spent a great deal on its Cerner and GE contracts. While the prior investments weren’t entirely sunk costs, as existing systems must have collected a fair amount of data and had some impact on patient care, neither product could have come cheaply.

Given that the Epic deal seems poised to suck the IT budget dry, I find myself wondering what Mayo is giving up:

  • Many health systems have put off investing in up-to-date revenue cycle management solutions, largely to focus on Meaningful Use compliance and ICD-10 preparation. Will Mayo be forced to limp along with a substandard solution?
  • Big data analytics and population health tech will be critical to surviving in ACOs and value-based payment schemes. Will the Epic deal block Mayo from investing?
  • Digital health innovation will become a central focus for health systems in the near future. Will Mayo’s focus on the EMR transition rob it of the resources to compete in this realm?

To be fair, Mayo’s Epic investment obviously wasn’t made in a vacuum. With the EMR vendor capturing a huge share of the hospital EMR market, its IT leaders and C-suite execs clearly had many colleagues with whom they could discuss the system’s performance and potential benefits.

But I’m still left wondering whether any single software solution, provided by a single vendor, offers such benefits that it’s worth starving other important projects to adopt it. I guess that’s not just the argument against Epic, but against the massive investment required to buy any enterprise EMR. But given the extreme commitment required to adopt Epic, this becomes a life-and-death decision for the Mayo, which already saw a drop in earnings last year.

Ultimately, there’s no getting past that enterprise EMR buys may be necessary. But if your Epic investment pretty much ties up your cash, let’s hope something better doesn’t come along anytime soon. That will be one serious case of buyer’s regret.

3 EHR Gaps That Hinder Systematic Chronic Disease Management

Posted on May 2, 2016 I Written By

3 EHR Gaps That Hinder Systematic Chronic Disease Management

The following is a guest blog post by Andrei Khomushka.

An EHR typically contains multiple highlights of patients’ health, including observations, lab results, diagnoses and treatment plans. However, this data might be insufficient for systematic chronic care management, and there are 3 key reasons for that.

1. Interrupted care setting

Most EHRs are built around the idea that patients control their conditions to the extent that they can arrange timely appointments with their doctors should disturbing symptoms arise. However, the no-shows rate is still high (up to 55%, according to Family Medicine, 2013), and chronic patients often tend to overlook and mistreat symptoms. Leading to occasional appointments in acute situations. This breaks patient data and thus care delivery. So, EHRs can’t show the real picture of a disease progression.

Only continuous care and health tracking can help prevent, or at least detect early complications and exacerbations. As EHRs simply don’t have the tracking functionality, providers need additional solutions bound to their EHRs. For example, mobile patient apps connect individuals and caregivers, allowing the former to sync medical devices and continuously share their health data with doctors, thus ensuring remote monitoring of health status. Then, this information is automatically analyzed and aligned with the EHR so it’s always up-to-date.

2. Lack of patient engagement

As individuals can’t access EHRs directly, they don’t provide any patient engagement elements. Patients can only interact with the EHR data (to some extent) by visiting the patient portal. Here is your chance to engage them. With the standard functionality, such as appointment scheduling, e-billing, lab results checking, portals allow setting goals, sharing achievements across social media, exploring interactive learning materials and more.

However, systematic chronic care is more effective when a technology is proactive and connected to a patient’s daily life (patient portals can’t beat mobile patient apps here). This way, when multiple personal encouragements, guidelines and notifications are already in your pocket, it’s easier to control a chronic condition.

3. Patient-generated data missing

Most EHRs can’t collect and store patient-generated information such as physical activity, nutrition, daily subjective and objective. To benefit from daily updates of patients’ health statuses, we suggest implementing a separate solution integrated with the EHR. This will automatically process and analyze data to identify condition changes that require a physician’s attention. Then, the solution will notify both the patient and the health specialist about the disturbing patterns and suggest scheduling an appointment or test.

Afterword: Reducing the gaps

Overcoming these limitations is essential for a systematic care of chronic patients in the comfort of their homes. However, a thorough rebuild of an EHR is not realistic. Instead of investing substantial time and budget in making the EHR something it is not supposed to be, we recommend creating a holistic solution based on a chronic disease management system (CDMS), which will be connected to the mobile patient application and the EHR. You can find more about CDMS and its benefits in our recent chronic disease management entry.

Telemedicine A Growing Priority For Hospitals

Posted on April 29, 2016 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.

Telemedicine programs are not new to hospitals. In fact, tele-stroke and tele-ICU programs have gained significant ground over the past several years, and other subspecialties, such as tele-psychiatry, seem likely to grow in popularity.

In coming years, telemedicine will go from being a one-off strategy to an integral part of hospital care delivery, if a new survey is any indication. Government and private insurers are gradually agreeing to pay for telemedicine services, knocking down the biggest obstacle to rolling out such programs. And while integrating telemedicine services with EMRs poses major challenges, hospital leaders seem determined to address them.

Virtually all of the hospitals responding to the survey, which was conducted by telemedicine vendor ReachHealth, told researchers that they were busy planning and preparing for telemedicine programs. Twenty-two percent of survey respondents, which also included some medical practices, said that rolling out telemedicine programs was one of their top priorities, and another 44% said that it was a high priority. Health systems averaged 5.51 telemedicine service lines, up almost 20% from last year.

I was interested to note that 96% of respondents were planning to roll out telemedicine because they felt it would improve patient outcomes. I’m not aware that there’s any substantial body of evidence demonstrating that telemedicine can have this effect, but clearly this is a widespread belief.

Also, it was a bit surprising to read that “improving financial returns” was a very low priority for providers when developing telemedicine programs. On the other hand, as researchers point out, hospitals and practices to see improved patient satisfaction as a driver of ROI. Apparently, execs responding to this survey are convinced that telemedicine to have a substantial effect on satisfaction and outcomes, though to date, only 55% said telemedicine was improving outcomes and 44% felt it was boosting patient satisfaction.

Researchers also found that providers that dedicate more resources to telemedicine are seeing more success than those that don’t. Specifically, hospitals and clinics that have a 100% dedicated telemedicine program manager in place were doing better with their initiatives.

In fact, two thirds of respondents with a dedicated program manager in place ranked their efforts to be “highly successful,” while only 46% of programs without a dedicated program manager met that description. (The programs were most successful when a VP or director was put in charge of telemedicine efforts, but only slightly more than when a CEO or coordinator was in charge.)

That being said, it seems that the highest barriers to telemedicine success are technical. The respondents complained that the lack of common EMR in hub and spoke hospitals, and the lack of integration between telemedicine and their current EMR, were still standing in their way. Many were also concerned about the lack of native telemedicine capabilities in their EMR.

Despite all of the obstacles to creating a flourishing telemedicine program, hospitals and clinics have continued to make progress. In fact, 36% have had a tele-stroke program in place for more than three years, 23% tele-radiology for three years plus, and 22 percent have had neurology and psychiatry telemedicine programs for three years or more. ReachHealth researchers note that service lines requiring access to specialists are growing more rapidly than other service lines, but contend that this is likely to shift given pending shortages of primary care physicians.

Admittedly, any survey published by telemedicine vendor is likely to be biased. Still, I thought these statistics were worth discussing. Do they track with what you’re seeing out there? And do you think EMR vendors will do more to support telemedicine anytime soon?