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Avoiding Financial Losses After EMR Implementation

Posted on April 3, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

While hospitals buy EMRs to improve their operations – both clinically and financially – too often they take a hit before they work out the kinks in their installation.  In fact, healthcare institutions often end up losing up to 5 percent of their gross revenue after EMRs are implemented, according to consultant Erick McKesson.

One typical story comes from Maine Medical Center, which found that patient charges weren’t appearing after its $150 million Epic installation in 2012. These billing errors were one of the reasons the medical center posted a $13.4 million loss in the first six months after the installation, hospital executives reported.

But according to McKesson, managing consultant with Navigant, it’s possible to overcome these problems. In an article for Becker’s Hospital Review, he tells the story of a group of health systems which worked together to avoid such losses. The group worked together to identify the most valuable software features that flagged mischarges or reporting errors. They then identified the five charge program “edits” which had the largest financial impact.

Areas the cooperating health systems considered the most important included:

* Administrative codes

The health systems noted that incorrect administrative codes lead to lagging revenue. That’s particularly the case when there are different codes for the same procedure. Hospitals need to be sure that clinicians use the higher code if appropriate, which can be helped by the right technological fixes.

* Anesthesia

It’s important to monitor your charges when there are two distinct aspects of a single procedure that are charged separately, particularly with anesthesia services. If your audit system flags the absence of the added codes, it can recapture a substantial level of missing revenue.

* CT

Seeing to it that radiology charges are automatically reviewed can ensure that appropriate levels of revenue are generated. For example, in the case of CT exams, it’s important to see that charges are assessed for both the exam and if needed, the use of a contrast agent.

* Emergency Department

It’s not unusual for ED physicians to undercode high-acuity patients. But it’s important to address this issue, as undercoding can result in significant financial consequences.  Not only that, in addition to generating financial losses, undercoding can create problems with performance-based reimbursement contracts. If patients are depicted as less acute than they actually are, payors may expect better outcomes than the patients are likely to have. And that can lead to lower revenue or even significant financial penalties.

* Infusions

Auditing infusion charges can be very helpful in capturing added revenues, given that they are one of the most frequent charges in healthcare. Infusion codes are very complex, including the need to track start and stop times, difficult rules regarding what charges are appropriate during infusions and issues related to “carve out periods.” Auditing systems can help clinicians comply with requirements, including simple-to-create functions which automatically flag missing stop times.

As readers will doubtless know, getting competing health systems to engage in “coopetition” can be tough, even if it helps them improve their operations. But given the need to combat post-EMR lags in revenue, maybe more of them will risk it in the future.

ReadsforRads is Working to Democratize Radiology

Posted on December 14, 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.

At the RSNA 2016 conference, Healthcare Scene learned about a new platform for radiologists that’s looking to democratize radiology. This new platform is called ReadsforRads. In our conversation with Dr. Phillip A. Templeton, Chief Medical Officer at ReadsforRads, we learned more about ReadsforRads and their mission to democratize radiology. I love the approach they’re taking to make radiology better for both radiology departments and imaging centers. Plus, doing so will ultimate benefit the patients the most.

To learn more about ReadsforRads and the way they benefit the health system, radiologists, and patients, check out our video interview with Dr. Templeton below:

No doubt ReadsforRads has some challenges as they work to scale their platform, but I was impressed by the progress they’ve already made. Their efforts on managing radiologists credentialing was quite interesting. I mentioned the ReadsforRads platform to my radiologist neighbor and his wife instantly said “Yes! Moonlight so we can buy a house.”

While the opportunity for a radiologist to make some extra cash moonlighting is interesting, I was extremely excited about ReadsforRads ability to get the right radiologist reading the radiology image. There are a lot of situations where the radiology image needs to be read by a true expert and that person might be on vacation or small institutions might not be able to afford that type of radiologist expertise in house. ReadsforRads can cover these gaps and make sure the read is done by the most qualified person. That can really benefit all of healthcare.

Bringing EHR Data to Radiologists

Posted on December 2, 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 interesting things I saw at RSNA 2016 in Chicago this week was Philips’ Illumeo. Beside being a really slick radiology interface that they’ve been doing forever, they created a kind of “war room” like dashboard for the patient that included a bunch of data that is brought in from the EHR using FHIR.

When I talked with Yair Briman, General Manager for Healthcare Informatics Solutions and Services at Philips, he talked about the various algorithms and machine learning that goes into the interface that a radiologist sees in Illumeo. As has become an issue in much of healthcare IT, the amount of health data that’s available for a patient is overwhelming. In Illumeo, Philips is working to only present the information that’s needed for the patient at the time that it’s needed.

For example, if I’m working on a head injury, do I want to see the old X-ray from a knee issue you had 20 years ago? Probably not, so that information can be hidden. I may be interested in the problem list from the EHR, but do I really need to know about a cold that happened 10 years ago? Probably not. Notice the probably. The radiologist can still drill down into that other medical history if they want, but this type of smart interface that understands context and hides irrelevant info is something we’re seeing across all of healthcare IT. It’s great to see Philips working on it for radiologists.

While creating a relevant, adaptive interface for radiologists is great, I was fascinated by Philips work pulling in EHR data for the radiologist to see in their native interface. Far too often we only talk about the exchange happening in the other direction. It’s great to see third party applications utilizing data from the EHR.

In my discussion with Yair Briman, he pointed out some interesting data. He commented that Philips manages 135 billion images. For those keeping track at home, that amounts to more than 25 petabytes of data. I don’t think most reading this understand how large a petabyte of data really is. Check out this article to get an idea. Long story short: that’s a lot of data.

How much data is in every EHR? Maybe one petabyte? This is just a guess, but it’s significantly smaller than imaging since most EHR data is text. Ok, so the EHR data is probably 100 terabytes of text and 900 terabytes of scanned faxes. (Sorry, I couldn’t help but take a swipe at faxes) Regardless, this pales in comparison to the size of radiology data. With this difference in mind, should we stop thinking about trying to pull the radiology data into the EHR and start spending more time on how to pull the EHR data into a PACS viewer?

What was also great about the Philips product I saw was that it had a really slick browser based HTML 5 viewer for radiology images. Certainly this is a great way to send radiology images to a referring physician, but it also pointed to the opportunity to link all of these radiology images from the EHR. The reality is that most doctors don’t need all the radiology images in the EHR. However, if they had an easy link to access the radiology images in a browser when they did need it, that would be a powerful thing. In fact, I think many of the advanced EHR implementations have or are working on this type of integration.

Of course, we shouldn’t just stop with physicians. How about linking all your radiology images from the patient portal as well? It’s nice when they hand you a DVD of your radiology images. It would be much nicer to be able to easily access them anytime and from anywhere through the patient portal. The great part is, the technology to make this happen is there. Now we just need to implement it and open the kimono to patients.

All in all, I love that Philips is bringing the EHR data to the radiologists. That context can really improve healthcare. I also love that they’re working to make the interface smarter by removing data that’s irrelevant to the specific context being worked on. I also can’t wait until they make all of this imaging data available to patients.

Creating Alliances with Large Health IT Vendors – Benefits and Challenges

Posted on June 13, 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 sat down with Nancy Hannan, Philips Relationship Director at Augusta University Health System (formerly known as Georgia Regents) to talk about their alliance with Philips Healthcare and the impact it’s had on their healthcare organization.

Along with talking about the benefits and challenges of creating a long term contract with a healthcare IT vendor, we also dive into the details of how medical device standardization has impacted their organization. Not to be left out, we also talk about how this relationship has impacted patients and doctors. If your organization is looking at how to standardize your medical equipment, this interview will give you some insight into creating a long term alliance with your vendor.

In the second part of my interview with Nancy Hannan, Philips Relationship Director at Augusta University Health System (formerly known as Georgia Regents) we discuss how they’re taking the lessons learned from the Philips alliance and applying them to their agreement with Cerner. We also talk about how cybersecurity is better having a vendor representative on site like they have with Philips.

A Complete Patient Record and You

Posted on March 9, 2016 I Written By

The following is a guest blog post by Erin Wold, Account Based Marketing Program Manager at Hitachi Data Systems. You can follow Erin on Twitter: @ErinEWold
Erin Wold
So we have discussed the first steps to getting an enterprise imaging facility but what does this and a complete patient record mean for the average patient? If I were to stop someone walking down Las Vegas Blvd (I would shoot for the more sober hours) and ask them “Who owns your medical records?” I am sure I would get the same look and response over and over. The look of confusion and the response of “my doctor’s office?”  This is exactly what enterprise data sharing is set out to change.

A complete patient record for the patient means that a patient can go from their primary care physician to sub specialist without having to call ahead and have their records faxed over. It means that in the case of an emergency room visit they don’t have to worry about leaving with paperwork and getting it back to their primary care physician. It means their records follow them to whatever doctor they (or their insurance) choose.

For example, a couple weeks ago I won myself a trip to the emergency room after cutting a chunk out of my hand while slicing vegetables on a mandolin. (OUCH!) Not knowing my experience in healthcare IT, the resident, who came in first, was checking off all the boxes and asked “do you have a primary care physician?” In my pain ridden and snarky voice I responded “Why does it matter? Your computer can’t talk to hers anyway.” He got a chuckle and said I had a good point and then asked if I was in healthcare. But we have all been there. We have seen one physician only to turn around and have to tell the story all over again with the follow-up care physician because the records just aren’t there.

Not to mention I had pictures of the wound on my phone I had taken right after the incident. My follow-up physician asked that I send her these photos so she could take a look (because she didn’t have access to photos snapped in the ER). I asked her if she could put them into my patient record being my PCP? Her response, “no I don’t have a way to get them uploaded.” Similar to what Alex Towbin, MD, Director of Radiology Informatics at Cincinnati Children’s Hospital, said in his session at HIMSS16, he has multiple pics on his phone and there is nothing wrong security wise with that, but that’s not where the belong.

A complete patient record should include all medical data related to you. This includes images or all kinds whether an X-ray or photo snapped on an iPhone, textual reports (path, lab etc), and even larger data files including genome sequencing data, and digital breast tomosynthesis. I don’t think you would find one physician who would argue that any of your data is unimportant and can be left out.  In the wise words of John Halamaka, MD, CIO of Beth Israel Deaconess Medical Center the next time you ask why your patient record can’t be all in one and they (physicians or IT) respond because there is too much data to store, you should ask them “well how does Google do it then?”

De-silo Health IT

Posted on March 8, 2016 I Written By

The following is a guest blog post by Erin Wold, Account Based Marketing Program Manager at Hitachi Data Systems. You can follow Erin on Twitter: @ErinEWold
Erin Wold
So we have started on the path of enterprise imaging with redefining the EMR, but we can’t stop there. Although, I noticed more familiar faces at HIMSS16, there weren’t enough imaging professionals. We need to de-silo the IT departments within healthcare systems and align them with the strategy that IT is just technology whether it’s radiology, cardiology, mammography etc. The overall IT department should be focused on interoperability and coming together to create a cohesive EMR including enterprise imaging.

Imaging is no longer limited to radiology, yet we still have specific radiology IT staff. This creates more siloes. I have seen it time and time again where the specialty IT departments are at odds with the hospital IT because they want to claim ownership of the data. I can’t blame them though because if something goes wrong with that data they are held responsible. So I don’t blame them, but like redefining the EMR to include all types of data we have to align the IT departments to reflect the whole EMR.

There should no longer be specific departmental IT rather there should be one large IT team with breakout teams that are dedicated to specific departmental (cardiology, radiology, pathology, billing, etc.) software and applications like the PACS or picture archiving system. They should be under the EMR and be tuned into it to create a cohesive team that can complete the patient within the EMR. No more “this is my data and you can’t touch it.” It is now this data belongs to the patient and it needs to be readily available to the patient and all the point of care physicians.

We as vendors and providers need to think of the patient record as the point of documentation rather than each individual department and physician creates their report and then sends it to the referring physician. The patient’s team of physicians and departments where studies and test are completed should be considered team data.

Next time you head into your doctor or head to the ER ask the question: “What is your hospitals standard for sharing?” If they respond with “Well we’ll send you home with a CD or we’ll provide you with a paper print out of a PDF.” RUN and run far away from that place. While a CD may sound like a good idea I am pretty sure you don’t have a DICOM viewer in your basement to view these images. Most likely your point of care physician doesn’t have the same viewer as the images were taken on and what if the CD gets scratched in transfer or even worse lost. If you get my drift, a CD is not the answer. Those images belong in the EMR and so does the radiology software and application support staff.

If you think about it, when you log into an online banking account like Chase you don’t have to log into your mortgage, credit card, savings account, checking account and investment specialists to get all the additional information. You have ONE VIEW of all these accounts as soon as you log in. I don’t know about you, but I consider all my banking information: social security number, credit score, retirement savings as vital as my healthcare information and should be kept as secure. Therefore I see no reason that HIT shouldn’t be aligned more like banking and offer a complete patient record. HIMSS gives us an ideal platform to align all of these departments.

Redefining the EMR

Posted on March 7, 2016 I Written By

The following is a guest blog post by Erin Wold, Account Based Marketing Program Manager at Hitachi Data Systems. You can follow Erin on Twitter: @ErinEWold
Erin Wold
Walking through the HIMSS 2016 exhibit hall, booth after booth I see interoperability this and interoperability that. So I decided to stop and ask the vendors, “When you say interoperability, what do you mean?” Answer after answer I heard, “We integrate with the EMR and other vendors to provide data into the patient record.” When asked to clarify what types of data, the majority mentioned all types of textual data. Never once did anyone respond with images of any sort. I actually got the response of “Why would enterprise imaging be at HIMSS?” when I asked “What about enterprise imaging?”

Here ladies and gentlemen lies our problem. When going to HIMSS vendors and attendees alike aren’t thinking of enterprise imaging for the most part. When you search for sessions, very few pop up when searching for imaging. This year’s HIMSS has seen a few more familiar faces from the imaging scene which is extremely exciting for the future of healthcare and patient engagement.

I was able to sit in on multiple imaging sessions and was lucky enough to go to one that was actually about enterprise imaging but neither were titled or tagged that way in the program. All great sessions with very informative information on why enterprise imaging is a must. It is not only easier for the point of care physician to access the patient record but it will increase patient care and reduce time between study and treatment.

As we move into the era where telemedicine is becoming a reality and anyone can receive care at their corner Walgreens, enterprise imaging is crucial to patient care. How do we get there?  How do we get the EHR gurus to work with the imaging gurus. After sitting through a session led by Alex Towbin, MD, Director of Radiology Informatics at Cincinnati Children’s Hospital; I see how it needs to start.

It started right then and there after he said we must redefine EMR.  We as vendors and providers have defined the EMR as a repository for textual data. We have done ourselves a disservice and we now have to reverse it. The EMR should be a central location where the patients care team can enter ALL data that has been collected on that patient. In essence it should be more like your teenage cousin’s Facebook page where they put everything than your Myspace page from 10 years ago where nothing has been uploaded because you can’t remember the password to gain access.

I was shocked when John Hamlaka, MD, CIO of Beth Israel Deaconess Medical Center, presented that only 50% of pediatric scans are read by the correct sub-specialist. This is in part due to the referring physician, the radiologist and the sub specialist lacking a way to share these scans and therefore the sub-specialist never knew it existed. Enterprise Imaging makes way for this to happen. Other risks that arise because of a lack of enterprise imaging: double exposure to radiation, misdiagnoses, crucial lapse in time between scan and start of treatment, and an incomplete patient record.

A step in the right direction was taken this year at HIMSS by aligning with SIIM or the Society for Imaging Informatics in Medicine and hosting dual sessions as well as a meet-up at the HIMSS Spot. Eighteen months ago they created a coalition of innovative members from both organizations. Moving forward it will take leaders from medical societies: HIMSS, SIIM, RSNA, ACR,  etc. Redefining  is only the beginning. While it seems like a long, hard road ahead we have to start somewhere.

Can Silo-ed Leadership Work Together Effectively?

Posted on November 30, 2015 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.

All week I’ve been chewing on David Chou’s recent article about running health care IT as a business. David makes a pretty solid case for why hospital CIOs should become essentially the CEO of the hospital IT business. There’s a lot of value in a leader taking that type of responsibility and forward thinking approach to their organization. However, it can also lead to some interesting challenges.

This concept has been extended as I’ve attended the RSNA (radiology) conference in Chicago. Many of the same messages are being shared with radiologists about leading their organization and about being proactively involved with the patient. You could say that radiologists are being encouraged to run their departments as if they’re CEO of the radiology department.

While this seems like sound advice it should also come with a partial caution. If you’re not careful this can lead to a lot of conflict between various fiefdoms. Everyone feels like they’re the “CEO” and so that ownership and leadership can make it hard for them to work with others. It takes a really powerful leader to bring together department heads who see themselves as CEOs.

A great example of the consequences of this silo-ed leadership is illustrated by what we call shadow IT. For those not familiar with shadow IT, it’s IT purchases and implementations that happen outside of IT. It essentially operates in “the shadows” as opposed to out in the open. This is often purchased with department budget and is usually some sort of hosted application and so departments are able to implement their IT project without the involvement of the main IT organization.

A department head that felt like CEO of their department would have little to no issue with a shadow IT purchase. They rationalize that they can’t wait for IT because if they wait for IT it will never get done. In fact, going around IT seems like the right option since it gets them access to a tool or technology that they need to provide better patient care. That’s what you should want your leaders to do no? Provide the best patient care possible.

Unfortunately, shadow IT has lots of challenges. For example, did they think about the long term cost of supporting the shadow IT system? Did they ensure that the shadow IT system met all the HIPAA security requirements? Did they vet the vendor to ensure that they would be a good long term choice? etc etc etc.

It’s a real challenge for these internal “CEOs” to balance the needs of their department against the needs of the organization as a whole. Many times they’ll get it wrong and it will be lock the gears of an engine or clock that aren’t aligned quite right. It can grind things to a halt. However, with the right leader in place, all of the gears can be leaders within their own departments while still working together nicely with all the other leaders around you.

Isn’t that the real challenge of leadership? Get everyone on board with the same vision, but leave them enough flexibility that they can surprise you with their results.

3D Printing Saves Wife’s Sight

Posted on January 14, 2015 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.

This is a great article which illustrates the importance of being an active patient advocate in your care, but also illustrates some of the future of technology in healthcare. Here’s a brief excerpt from the article.

Balzer downloaded a free software program called InVesalius, developed by a research center in Brazil to convert MRI and CT scan data to 3D images. He used it to create a 3D volume rendering from Scott’s DICOM images, which allowed him to look at the tumor from any angle. Then he uploaded the files to Sketchfab and shared them with neurosurgeons around the country in the hope of finding one who was willing to try a new type of procedure. Perhaps unsurprisingly, he found the doctor he was looking for at UPMC, where Scott had her thyroid removed. A neurosurgeon there agreed to consider a minimally invasive operation in which he would access the tumor through Scott’s left eyelid and remove it using a micro drill. Balzer had adapted the volume renderings for 3D printing and produced a few full-size models of the front section of Scott’s skull on his MakerBot. To help the surgeon vet his micro drilling idea and plan the procedure, Balzer packed up one of the models and shipped it off to Pittsburgh.

Pretty amazing use of 3D printing technology and it’s great to see that he could pretty easily convert the MRI and CT scan data into a 3D image that could be printed on a 3D printer. No wonder the 3D printing area was next to the digital health section at CES.

Which Health IT Is Poised For Hospital Growth?

Posted on January 21, 2014 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.

Wondering which hospital applications are likely to be popular in the near future?  According to HIMSS Analytics, contenders include patient portals, clinical data warehousing/mining, and radiology barcoding software are poised for faster uptake in hospitals.

To gather this information, HIMSS Analytics did an analysis of the current market penetration and projected five-year sales trajectory each application considered in its Electronic Medical Record Adoption Model (EMRAM) report.  Researchers found that first-time purchases of these advanced EMR applications should grow dramatically in hospitals across the U.S.

According to Healthcare Informatics, there are good reasons why each of these three technology should be on the upswing in hospitals.  For example, the patient portal market is growing because it’s tied to Meaningful Use Stage 2 requirements.  Expected growth in sales of clinical data warehousing/mining technology is tied to the need to leverage data held in EMRs, and it’s that that sales increases in and radiology barcoding are probably associated with patient safety initiatives.

Meanwhile, the report also noted that several basic applications which have already saturated the hospital market will be responsible for a high-volume IT replacement sales, including laboratory barcoding, pharmacy management systems and information systems for radiology and laboratorydepartments.

The report from HIMSS seemingly doesn’t take mobile applications and systems into account — I’d argue because they are not yet seen as enterprise-level tools — but I think hospitals will be spending more on mobile technology than anticipate over the next few years, as tablets and smartphones become a permanent part of their infrastructure.  Just how fast that will happen remains to be seen, but it will happen.