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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?

An Acronym Look at MACRA QPP

Posted on April 28, 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.

The proposed rule for the MACRA program has been announced. Here’s an acronym laden summary of what MACRA did (Worth noting that CHIP is the C in MACRA for those keeping track of acronyms at home).

MACRA creates a QPP.

MACRA ends SGR

MACRA creates two paths: MIPS and APMs.

MIPS and APMs timeline from 2015 through 2021.

MIPS combines PQRS, VM (or VBPM if you prefer), and Medicare EHR (MU and Certified EHR) into 1 program.

APMs include ACOs, PCMH, and bundled payments.

MU is now ACI.

If you’re not sure about some of the acronyms above, you can find their longer names here. Good thing they simplified and streamlined the various programs!

We’ll be becoming friends with the acronyms MIPS and APMs. Here’s a good summary PDF of MACRA as well. More details to come.

UPDATE: In a bit or irony, Andy Slavitt posted this acronym free video about MACRA:

Health IT Software Must Be Meaningful and Pleasurable

Posted on April 27, 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.

One of the most dynamic healthcare CIO’s is Shafiq Rab, MD, MPH, Vice President and CIO at Hackensack UMC. Healthcare Scene was lucky enough to talk with him at the DataMotion Health booth during HIMSS 2016. Dr. Rab talked with us about Hackensack UMC’s approach to healthcare IT innovation. He offered some great insights into how to approach any healthcare IT project, about Hackensack University Medical Center’s “selfie” app, and their efforts to use Direct and FHIR to empower the patient.

I love that Dr. Rab leads off the discussion with the idea that healthcare IT software that they implement must be meaningful and pleasurable. Far too many health IT software miss these important goals. They aren’t very meaningful and they’re definitely not pleasurable.

Dr. Rab’s focus on the patient is also worth highlighting. Health IT would be in a much better place if there was a great focus on the patient along with making health IT software meaningful and pleasurable. Thanks Dr. Rab and DataMotion Health for doing this interview with us.

It’s Time For A New HIE Model

Posted on April 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.

Over the decade or so I’ve been writing about HIEs, critics have predicted their death countless times – and with good reason. Though their supporters have never backed down, it’s increasingly clear that the model has many flaws, some of them quite possibly fatal.

One is the lack of a sustainable business model. Countless publicly-funded HIEs, jumpstarted by state or federal grants, have stumbled badly and closed their doors when the funding dried up. As it turns out, it’s quite difficult to get hospitals to pay for such services. Whether this is due to fears of sharing data with the competition or a simple reluctance to pay for something new, hospitals haven’t moved much on this issue.

Another reason HIEs aren’t likely to stay alive is that none can offer true interoperability, which diminishes the benefits they offer. Admittedly, some groups won’t concede this issue. For example, I was intrigued to see that DirectTrust, a collaborative embracing 145 health IT and provider organizations, is working to provide interoperability via Direct message protocols. But Direct messaging and true bilateral health information exchange are two different things. (I know, I’m a spoilsport.)

Yet another reason why HIEs have continued to struggle is due to variations in state privacy rules, which add another layer of complexity to managing HIEs. Simply complying with HIPAA can be challenging; adding state requirements to the mix can be a big headache. State laws vary as to when providers can disclose PHI, to whom it can be disclosed and for what purpose, and building an HIE that meets these requirements is a big deal.

Still, given that MACRA demands the industry achieve “widespread interoperability” by 2018, we have to have something in place that might work. One model, proposed by Dr. Donald Voltz, is to turn to a middleware solution. This approach, Voltz notes, has worked in industries like banking and retail, which have solved their data interoperability problems (at least to a greater degree than healthcare).

Voltz isn’t proposing that healthcare organizations rely on building middleware that connects directly to their proprietary EMR, but rather, that they build an independent solution. The idea isn’t incredibly popular yet — just 16% of hospital systems reported that they were considering middleware, according to Black Book – but the idea is gaining popularity, Voltz suggests. And given that hospitals face continued challenges in integrating new inputs, like mobile app and medical device data, next-generation middleware may be a good solution.

Other possible HIE alternatives include health record banks and clearinghouses. These have the advantage of being centralized, connected to yet independent of providers and relatively flexible. There are some substantial obstacles to substituting either for an HIE, such as getting consumers to consistently upload their records to the record banks. Still, it’s likely that neither would be as costly nor as resource-intensive as building EMR-specific interoperability.

That being said, none of these approaches are a pushbutton solution to data exchange problems. To foster health data sharing will take significant time and effort, and the transition to implementing any of these models won’t be easy. But if the existing HIE model is collapsing (and I contend this is the case) hospitals will need to do something. If you think the models I’ve listed don’t work, what do you suggest?

The “Feature List” Disconnect from Healthcare Problems

Posted on April 22, 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.

One of the big takeaways coming out of the Healthcare IT Marketing and PR Conference is that most health IT companies are still spouting out the features they offer and very few actually talk about the problems they solve. This is a huge mistake for a health IT company, but it’s also a big reason why most hospital executives don’t want to hear from you.

As a healthcare executive you’re inundated with marketing and sales pitches and after a while they all start to look the same. Plus, many (some might say most) of those pitches require the hospital executive to try and translate a long list of features into the problems that executive is trying to solve. It’s no wonder that most hospital executives barely look at these pitches and often aren’t aware of the opportunities for innovation that exist for the problems they’re trying to solve.

Think about how many healthcare IT companies could list the following set of features in their sales and marketing:

  • Data Analytics
  • FHIR Enabled
  • HIPAA Compliant
  • EHR Integration
  • Machine Learning
  • Mobile Optimized
  • Real Time Processing
  • etc

I could keep going on, but you get the point. I’m reminded of something Shahid Shah said at our session at HIMSS. No one in healthcare has an interoperability problem. His point isn’t that interoperability isn’t important or valuable. His point was that no one is trying to solve interoperability. They have other problems they are trying to solve and data sharing (ie. interoperability) might be the solution. However, when they think about their problems and challenges interoperability is not on that list.

Hospital systems definitely have plenty of problems they’re trying to solve. Here’s just a few examples to give you a flavor of problems hospital executives are working to solve:

  • Improving HCAPHS Scores
  • Reducing Hospital Readmissions
  • Improving Provider Efficiency
  • Ensuring Accurate Patient Identification
  • Lowering Sepsis Numbers
  • etc

This list never ends. These are problems that hospital executives are working to solve and understanding which problems are vexing a hospital executive is key to getting them interested in the solutions. I think this small change would make it so hospital executives dread the wave of marketing and sales pitches a little less. The reality is that most of these executives are looking for great solutions. It’s just often hard for them to know what problems your company can really solve.

Of course, the next challenge is showing proof of your ability to solve the problem. However, at least that gets a hospital executive one step closer to finding solutions to their problems and challenges.

HealthIT Trends from Healthcare Marketing Leaders

Posted on April 15, 2016 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin is a true believer in #HealthIT, social media and empowered patients. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He currently leads the marketing efforts for @PatientPrompt, a Stericycle product. Colin’s Twitter handle is: @Colin_Hung

Last week 180+ HealthIT Marketers gathered in Atlanta for the #HITMC conference hosted by John Lynn and Shahid Shah. This annual event brings together content creators, editors, graphics artists, strategists, analysts and managers from across the healthcare industry. It is a truly unique opportunity to learn from those that work at marketing agencies, publications, provider organizations, HealthIT companies and marketing vendors.

One of the things I love to do at #HITMC is ask fellow marketers what topics they are being asked to write about and create content for. This informal poll is a fantastic way to gain insight into what will be trending over the next few months in healthcare. Why? Because if someone in the #HITMC audience is writing about it, you can rest assured it’ll be something you will soon see in your Twitter, LinkedIn, RSS or Facebook feed.

Here is a sampling of the responses I gathered at #HITMC:

Chris Slocumb @CSlocumb – CQ Marketing

“We’re doing a lot of work on security. From the provider side we’re talking about whether the right safeguards are in place and from the vendor side we’re writing about how their tools can help with securing an organization. Analytics, HIEs and interoperability are also topics we are creating content for. Conversely we’re not seeing much in the area of patient engagement right now.”

Shereese Maynard MS @ShereesePubHlth – Envisioncare

“I find that I’m doing work in the area of Home Health right now. It’s something that providers are waking up to – the potential for care at home to help patients stay healthier at lower cost. Providers and patients alike are looking to read more on that topic. Personally I’m very interested in Direct Primary Care. I think it’s a topic that will bubble to the top soon.”

Scott CollinsAria Marketing

“Thought leadership is hot right now. It’s not exactly a specific topic, but I’m seeing a lot of companies hop onto the thought leadership bandwagon. It’s like vendors have suddenly woken up to the fact that getting ‘out there’ and demonstrating your expertise on a subject is going to lead to more business. It’s exciting. In terms of a topic, population health is something I’m seeing a lot of, but one level deeper than before. Instead of just defining it we’re going to be talking about how it will help specific communities. Oh and security is BIG.”

Beth Friedman @HealthITPR – Agency Ten22

“I’m seeing a lot of requests for content around bundled payments, revenue cycle and the new self-pay patient. The financial side of healthcare is changing.”

From the conversations at #HITMC, I would definitely say security and payment are the two hottest topics right now. Security isn’t really all that surprising given the number of recent ransomware attacks. The topic of payment and revenue cycle, however, caught me a little by surprise. I thought (hoped) interoperability or patient data access would have been a trending topic. Given the changes to reimbursement models, the movement to value-based care and the popularity of high-deductible health plans, it’s no wonder this is garnering a lot of readership/interest.

Shameless Plug: If you work in HealthIT marketing or for a HealthIT publication, I would strongly encourage you to attend #HITMC next year. Not only are the sessions educational, but by listening to the attendees you’ll get a pulse of what is trending in healthcare. Hopefully we’ll see you next year!

Making the Case for a Unique Patient Identifier – #MyHealthID

Posted on April 13, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

Healthcare is a high priority for the US Government and as HIM professionals, we know the importance of keeping our fingers on the pulse of issues facing our nation. We must stay current with proposed regulatory changes and those that address the needs of the US healthcare system as they relate to HIM, privacy and security, and Health IT. One issue our nation has struggled with is secure universal identification for citizens. Social security numbers were not originally meant to be secure identifiers yet they have controversially been used as unique identifiers by Centers for Medicare and Medicaid Services (CMS) for many years.

In our line of work, we see all of the potential negative implications and the important role that patient identification plays in patient safety, HIPAA compliance, and health record accuracy. When patients are not appropriately identified throughout the continuum of care, many issues arise that can lead to misdiagnosing, incomplete information, unnecessary testing, and fraud to name a few. Duplicates and overlays are far too common due to issues matching patient names and dates of birth versus using a universal secure identifier. Sharing information through health information exchange is nearly impossible when patients are registered in multiple systems with different spellings or misidentification.

The HITECH act of 2009 laid the ground work for the Department of Health and Human Services (HHS) to standardize unique health identifiers among other tasks but we have yet to see any real progress on this subject due to federal budget barriers. In response to this, AHIMA sees this as a critical need and has started a petition to the White House to:

“Remove the federal budget ban that prohibits the U.S. Department of Health and Human Services (HHS) from participating in efforts to find a patient identification solution. We support a voluntary patient safety identifier. Accurate patient identification is critical in providing safe care, but the sharing of electronic health information is being compromised because of patient identification issues. Let’s start the conversation and find a solution.”

The campaign is called MyHealthID and looks to have 100,000 signatures on the petition to garner the attention of the US Government. HIM professionals recently took to Washington, DC to visit with Congressmen and Senators from each state to advocate for MyHealthID. The message that “there’s only one you,” hopes to resonate with politicians and make the case that a unique patient identifier is necessary and important to healthcare.

I encourage all healthcare professionals to sign this petition and assist the advocacy efforts toward a unique patient identifier. MyHealthID will not only help with HIM and Health IT initiatives; it will be in the best interest of healthcare consumers nationwide.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

Looking Into the Future of Hospital EHR

Posted on April 11, 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’ve been thinking a lot lately about where the world of hospital EHR software is going to head. At the top of the market we have Cerner and Epic taking most of the share. As we go down the market we see a lot of other large players, but we still only have 20 or so EHR vendors playing in the hospital EHR world.

In the last year we’ve seen aggressive moves by athenahealth and eCW to enter the hospital EHR space as well after previously only providing ambulatory EHR software. I’ve heard predictions that entrants like these are going to charge significantly less for their EHR software and that’s going to really shake up the market. You can imagine how the discussions in most hospitals will go if there’s an EHR alternative that’s 1/10th the price of their current EHR.

What’s interesting is that I haven’t seen any major moves by the large competitors to really accelerate the services, features, and functions they provide a hospital in order to justify the large premium. If I were Epic or Cerner, I’d be thinking about something really special that we could create that would be cost prohibitive for these new entrants to create. No doubt the Innovator’s Dilemma is at play here. Hard to fight against so much proven history around business dynamics.

Something that’s shocking to me is that these new entrants into the hospital EHR space aren’t really leveraging new technology either. They’re not building new features or functionality that doesn’t exist today (for the most part). They’re using things like cloud and mobile that are now relatively old technologies, but haven’t been applied to healthcare.

Said another way, will doctors love this new breed of hospital EHR any more than the current breed? I believe the answer to that question is no. Doctors will hate this new breed of EHR just as much. With this insight, I could imagine some other companies coming along and creating true innovation with new technologies that today we can’t even imagine. Although, it won’t likely be just technology innovation, but in healthcare it will likely include business model innovation as well.

EHR Ratings – GomerBlog Style

Posted on April 8, 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 first saw this tweet without the image and wondered what the GomerBlog had done for April Fool’s day. I also wondered how I’d missed it on that day. Turns out that the above image and the corresponding blog post on the GomberBlog was definitely not on April Fool’s day, but on March 26th. Although, some might say that the GomerBlog celebrates April Fool’s all year round. For those not familiar with it, they’re basically the Onion of healthcare.

I had to laugh at the ratings they posted. The should have added another column to the chart “Vendor’s Take” and had them all say “Fantastic!” as well.

Dean Sittig is right in his tweet though that this chart isn’t far from the truth. Things that are close to the truth make for the best humor. However, if you’re a doctor or nurse using an EHR, it’s likely getting less and less funny.

Also, for those searching for EHR ratings, good luck. There are so many reasons that EHR ratings are a challenge to do. I’d be careful trusting any rating system out there.

Accessing Near Real Time Patient Data In & Out of the Hospital with Alan Portela

Posted on April 4, 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.

Healthcare Scene recently sad down with Alan Portela, CEO of AirStrip to talk about the shifting world of real time access to healthcare data in and out of the hospital. We cover a lot of ground including AirStrip’s experience being on stage at the announcement of the Apple Watch, the challenge of EHR data interoperability, and the amazing work that AirStrip is doing to make near real time health data available on devices across healthcare. Enjoy the recorded video interview with Alan Portela below:

In the “after party” discussion, we continue the discussion and are joined by Jimmie Legan, MD and Charles Webster, MD.