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Eyes Wide Shut Meaningful Use Series

For those of you who read Hospital EMR and EHR but don’t read EMR and HIPAA (which from our latest survey is far too many of you), I wanted to highlight a series of blog posts by Mandi Bishop that I believe will be of extreme interest to those reading this site.

In this series called Eyes Wide Shut, Mandi gives some really amazing in the trenches views into how a large organization is dealing with the challenges of meaningful use and meaningful use stage 2 in particular.

Here’s a small sample from the latest entry in the series titled “Eyes Wide Shut: Meaningful Use Stage 2 Incentive Program Hardships“:

In my January update on Meaningful Use Stage 2 readiness, I painted a dismal picture of a large IDN’s journey towards attestation, and expressed concern for patient safety resulting from the rush to implement and adopt what equates to, at best, beta-release health IT. Given the resounding cries for help from the healthcare provider community, including this February 2014 letter to HHS Secretary Kathleen Sebelius, I know my experience isn’t unique. So, when rumors ran rampant at HIMSS 2014 that CMS and the ONC would make a Meaningful Use announcement, I was hopeful that relief may be in sight.

Like AHA , I was disappointed in CMS Administrator Marilyn Tavenner’s announcement. The new Stage 2 hardship exemptions will now include an explicit criteria for “difficulty implementing 2014-certified EHR technology” – a claim which will be evaluated on a case-by-case basis, and may result in a delay of the penalty phase of the Stage 2 mandate. But it does nothing to extend the incentive phase of Stage 2 – without which, many healthcare providers would not have budgeted for participation in the program, at all, including the IDN profiled in this series. So how does this help providers like mine?

In that post, Mandi also tries to not just complain about the challenges they face, but also offer some solutions. You can see her full list of ideas in the post, but I especially like the simplicity of her last line “Consider applying the hardship exemption deadline extension to the incentive program participants.”

We need more in the trenches people like Mandi sharing their stories and solutions for others to see. Otherwise, the regulators sit in their office in DC and don’t know the details of why they should adjust. If you’re someone reading this that would like to tell your story as well, I’d be happy to give you the platform. Just drop me a note on our contact us page.

March 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Large Health Systems May Miss Stage 2 Deadline

Usually, it’s the small institutions that are having fits when an IT program deadline is approaching. This time around, it’s the big boys that are struggling.

Intermountain Healthcare has announced that the organization will probably not attest to Stage 2 of the Meaningful Use program this year over concerns about patient safety, according to iHealthBeat

In an interview with HealthLeaders Media, CIO Marc Probst said that with the organization transitioning from its own EMR to EMR software from Cerner, all the software will not be running at all of the locations by the end of this year. This isn’t surprising after the relatively recent announcement that Intermountain would be switching to Cerner.

It’s not clear what it says about the success of the Meaningful Use Stage 2 program, other than that Intermountain has other priorities, but it does make you wonder what other large health systems will take a similar posture.

After all, ONC Chief Medical Officer Jacob Rieder (who also spoke with HealthLeaders) said that other large institutions are reporting similar situations. As amazing as it sounds considering the money involved, I won’t be surprised if we see more institutions following similar paths. There are a decent number of hospitals that haven’t even selected an EHR software.

According to Reider, it will be easier for small providers to meet Stage 2 requirements, given that they generally don’t have to plan as far into the future. But when it comes to large health systems, it seems that achieving this year’s Meaningful Use goal is a bridge too far.

March 4, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Hospital Chief Accused of $800,000 in Meaningful Use Fraud

Now here’s a case of the type I’ve never seen before, but expect to see more of it going forward given the temptations involved. According to the Dallas Morning News, the top administrator and CFO of a now closed chain of hospitals is facing charges that he defrauded the government of nearly $800,000 in EMR stimulus funds.

The administrator, Joe White, and the doctor who owned the hospitals, Tariq Mahmood, are accused of identity theft and stealing government healthcare funds. Meanwhile, it’s alleged that White falsely certified that Shelby Regional Medical Center in East Texas has met the requirements to receive Meaningful Use funds. Federal authorities assert that White used a computer ID and Social Security number belonging to another employee who had refused to attest at the hospital.

White is also accused of demanding that data be manually inserted from paper records into the incomplete EMR, in an effort to meet Meaningful Use qualifications.

This comes as a follow-up to the catastrophic failure of Mahmood’s six-hospital chain, which came after years of increasing financial chaos, with the hospitals mounting up millions of dollars in debts to vendors and landlords. As the hospitals fell apart financially, inspectors were documenting hundreds of patient care failures, the Dallas Morning News reports.

This came amid questions as to whether White was qualified to run a medical center, given his past record as a RadioShack salesman and a maintenance man.

February 12, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Has Meaningful Use Made EHR a Commodity?

I had a really interested discussion today that had me asking the question of whether meaningful use was a commodity. The standards of meaningful use are the same and in the hospital environment we’re talking about a half dozen major EHR systems (only 2 in the top environment).

Per wikipedia, a commodity is “a class of goods for which their is demand, but which is supplied without qualitative differentiation across a market.”

There’s no doubt there’s now a demand for EHRs thanks to the EHR incentive money. The real question is whether there is a qualitative differentiation across a market. When it comes to meaningful use, there is very little differentiation. All of the top hospital EHR vendors meet meaningful use requirements.

I bet if we asked hospital CIOs what their goals were with their EHR implementation they’d almost unanimously say “meet meaningful use.” Sure, if we dug in some more we could probably find some bigger picture ideals, but the harsh operational reality is that hospital CIOs are implementing EHR to meet meaningful use.

Based on that concept, EHR certainly starts to feel like a commodity to me. We could dig into which EHR will get you to meaningful use quicker. The problem is that they are all hard and take work. I’m not seeing enough differentiation on that front and even if there is differentiation, I’m not sure how you’d measure it in any quantifiable manner.

What do you think? Is EHR now a commodity? What does it mean if it is a commodity?

January 8, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Are Vendors Buckling Under the Meaningful Use Pressure?

Today, I’m going to tell you about a legal dispute between the hospital EMR vendor NextGen Healthcare Information Systems. It’s not pretty but it’s not so spectacular that deserves a lot of publicity by itself. But the dispute does say something about the capacity of vendors to keep up with the next round of certifications and support for Meaningful Use Stage 2 and beyond.

The dispute involves two parties, the Mountainview Medical Center of White Sulfur Springs, Mt. and NextGen. According to documents filed in US District Court last week, the Medical Center had hired NextGen to install a certified EMR by June 1, 2013 for a price of $441,000. When NextGen couldn’t meet the deadline, the Medical Center gave it an extension until October 1 of this past year.

Here is where things get ugly. According to the MMC, it found out that NextGen not only failed to meet the deadline, but didn’t have a solution that complied with Meaningful Use. At that point, it seems, MMC basically threw its hands in the air and said “it’s time to fight back.” MMC now wants the $441,000 it spent to prepare for the NextGen installation.

I’m sure there’s more to this story. As you can imagine, NextGen has said that they believe the case is without merit and will defend against it. Plus, it seems that NextGen Inpatient Clinicals EHR 2.6 is 2014 Certified as a modular EHR. So, was the issue with NextGen not having enough resources to install the EHR? No doubt NextGen was certified.

My question is this: if a vendor in the size of NextGen can’t meet the meaningful use deadlines for its users, are its larger brethren at risk as well? Can we expect to see Cerner, Meditech or even Epic get so overwhelmed managing existing installations (which is what I imagine is happening with NextGen) that it will temporarily or permanently drop out of the Meaningful Use program?

Maybe your first reaction is “no way — this is just a blip on the map to successful installation and certifications for all major vendors.” But maybe not. I find myself wondering whether we’re seeing beginning of a showdown, in which, at minimum, large vendors focus on customers they’ve got already in place and lack development resources to speed the development of a certified EMR that will meet upcoming criteria.

I say, keep your vendor on a short leash. If you can’t afford to have your Meaningful Use implementation dates shift, you may need to keep close eye on even the largest and best funded vendors.

January 3, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Next Year, Hospitals Should Report Quality Data Electronically

While it’s not absolutely necessary, hospitals that have enough resources should prepare themselves to report clinical quality measures electronically to CMS in 2014. That, at least, is the advice two Advisory Board Co. consultants had to share in a recent blog post, Information Week reports.

Doing so will save them a great deal of time on manual chart abstraction. What’s more, it will prepare them for the electronic reporting mandate CMS is expected to issue after 2014, according to consultants Robin Raiford and Anantachai Panjamapirom.

Choosing the electronic reporting option for next year has other some advantages, too. Hospitals that do so are taking the next step in aligning the reporting of CQMs in the CMS Inpatient Quality Reporting program and Meaningful Use, they remind us.

Hospitals that choose to report electronically next year can submit patient-level data digitally on the 16 CQMs required for Meaningful Use; meanwhile, they’ll have that data count toward the IQR requirement that they report on 57 CQMs that include those 16 measures.

Not only that, they’ll only have to report electronically on the aligned measures for a single quarter, though the IQR reporting. Is the full calendar year.

As the consultants point out, hospitals can continue to report CQMs separately for each program. But it multiplies the work they must do. In that case, they’ll have to use manual chart abstraction to collect data for all the CQMs in the IQR program. And they’ll have to submit aggregated quality data by attestation to the Meaningful Use program.

The reward for submitting electronically can be great. According to CMS’s own calculations, in the 2014 final rule for the Inpatient Prospective Payment System, hospitals that report electronically will save 800 hours on average over those that engage in manual chart abstraction.

In theory, Information Week notes, this should be a “no-brainer” for hospitals, but at least during the Meaningful Use Stage 1 reporting period, many hospitals found it difficult to impossible to harvest the quality data they needed electronically.

But now, with hospitals at Meaningful Use Stage 2, data harvesting problems have largely been resolved, Raiford told the magazine. By the fiscal fourth quarter, Raiford expects to see far more hospitals reporting electronically.

December 2, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

NC Health System Uses Big Data To Improve Care

While everybody talks about the potential for so-called “big data” in healthcare, there seems to be more smoke than fire at this point. To date, health payers have been a lot more engaged with using big data than providers, according to IDC Health Insights.

That being said, there are some providers out there who have been able to get their arms around big data projects which improve careFierceHealthIT reports.

One example is the University of North Carolina Health Care (UNCHC), a health system based in Chapel Hill, N.C., where they’ve begun programs to leverage big data in improving the quality of care and reporting, according to FierceHealthIT.

As the UNCHC system has grown, it’s seen a dramatic increase in the amount of data each facility was holding — and making things even more challenging, 80 percent of the data was unstructured, according to Carlton Moore, MD, associate professor of medicine at UNCHC.

As Dr. Moore notes, it’s difficult to use unstructured data to meet accountable care objectives. For example, when patients get cancer screenings at another institution, physicians write that in the unstructured notes, but don’t check off that they’ve  had the study because it wasn’t done there.

But UNCHC has taken on the mass of data under its roof. It’s developed a unique algorithm inserted into a natural language processing plan which allows researchers to find and address abnormal results on pap smears and mammography screenings.

While this is just a beginning, UNCHC has bigger plans. It intends to take next steps in analyzing and using its mass of data such as analyzing medication compliance and determining the number of clinic visits associated with bad health outcomes.

Kudos to UNHCH on their progress. But I don’t expect to see a ton of these projects showing up in the public arena; there’s just too much involved, particularly with ICD-10 and Meaningful Use draining resources like crazy.

In the mean time, though, providers may want to embrace “skinny” healthcare data, argues my colleague John Lynn.  The concept:  instead of creating a huge enterprise data warehouse for all purposes, why not focus on smaller problems?  That might be a faster path to results, and a decent preparation for the big data future, no?

November 22, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

CMS Wants Test EMRs To Help Providers Meet Stage 2 Objectives

CMS has begun seeking EMRs that hospitals and providers can use to test whether they meet three of Meaningful Use Stage 2′s transition of care objective, according to iHealthBeat.

Under Meaningful Use Stage 2, providers must either successfully meet the transition of care requirement in one of two ways, either by successfully performing one electronic exchange of a summary of care document with a recipient using a different technology, or, successfully conduct at least one exchange test with a CM-designed test EMR during the EMR reporting period.

Vendors have been given instructions on how to get involved. CMS has set up a new website explaining how developers’ products can become designated test EMRs, which lists the minimum set of technical capabilities for participation.

If they meet CMS’s standards, all designated test EMRs will register with a software system hosted by the National Institute of Standards and Technology, which will randomly match providers with a designated EMR that’s different from their own to allow them to meet the transition-of-care objective.

While this sounds like a reasonable way to get one aspect of Meaningful Use handled, it’s worth remembering that many medical groups are concerned about the entire Stage 2 package. A few months ago, the head of the Medical Group Management Association wrote a letter to HHS Secretary Kathleen Sebelius arguing that her members faced serious issues in stepping up to Stage 2.

The MGMA leader, president and CEO Susan Turney, noted that many vendors are proving slow to produce Stage 2-certified products, leaving practices in the lurch. In fact, when the letter was written (August), there were only 75 products and 21 complete EMRs certified for Stage 2 criteria, a tiny fraction of the more than 2,200 products and nearly 1,400 complete EMRs certified under 2011 criteria for ambulatory eligible professionals.

I don’t know about you, but to me this is a no-brainer: isn’t this certification gap where CMS should be focusing its Meaningful Use compliance efforts?

November 21, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Almost 80% Hospital Participation in EHR Incentives – Infographic

I know I’m a sucker for an infographic. I think it’s the data geek in me since most infographics have some interesting data. This health IT infographic comes from HealthIT.gov and talks about the EHR incentive program. I think the data in it is a bit old, but the number that really stood out to me was the 80% hospital participation rate in the EHR incentive program. I knew that most hospitals didn’t have a choice when it came to participating (the money was too much to ignore), but it’s interesting to see that play out in the numbers.

Health IT Adoption Infographic

November 11, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

25% Of Hospitals Stalled On EMR Progress

As most readers know, HIMSS has developed a proprietary scale which it uses to track how far along hospitals are in their EMR adoption process.

As I discussed previously, the predictable has happened when it comes to progress. Hospitals with extensive resources, notably academic medical centers and large suburban chains, have climbed the eight-step ladder of the scale, known as the HIMSS Analytics EMR Adoption Model (EMRAM), while smaller and rural facilities have moved more slowly.

Now, there’s evidence suggesting that making progress on EMRAM is harder than it seemed previously. New research from HIMSS comparing quarterly EMRAM progression of 4,811 hospitals during the last five years (Q2 2008 and Q2 2013) has concluded that a surprising number of hospitals are basically stuck in place.

The new report has found that 73.7 percent of  U.S. hospitals have advanced by at least one stage over the past five years, and that half of those who advanced climbed the scale by two or three stages. Another 20 percent of those advancing moved up four or more stages during the five-year period studied.

Right now, the largest number of hospitals (at 34.5 percent at Q2 2013) fall into EMRAM stage 3, which includes nursing/clinical documentation, CDSS (error checking) and PACS available. Stage 4 through 6 account for 43.3 percent all together, the most populated level being stage 5, closed loop medication administration, with 18.7 percent.

That being said, 25 percent of hospitals had made no progress whatsoever over the last five years. What’s more, four percent of hospitals have remained at EMRAM stage 0 (completely paper-based). As I see it, these are fairly surprising results given the Meaningful Use pressures hospitals face.

Meanwhile, only 2.1 percent of hospitals had what HIMSS Analytics regards as a “complete EMR” — one which includes CCD transactions to share data, data warehousing and data continuity with the ED — in place as of the second quarter of this year.

So, how’s your facility doing?  Is it able to progress toward higher EMR goals? Or is it mired down with the 25 percent?

October 22, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.