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What Can We Expect with Meaningful Use Stage 3?

Posted on October 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

The incomparable John Halamka, CIO of Beth Israel Deaconess Medical Center and Co-Chair of the HIT Standards Committee, has a good post up on his blog talking about the future of standards, certification and meaningful use stage 3. Here’s one excerpt about MU stage 3 and EHR certificaiton:

Meaningful Use Stage 3 regulations are currently in draft and will be released as NPRM before the end of the year. My hope for these regulations is that they will be less prescriptive than previous stages, reducing the burden of implementation for providers and vendors.

It’s purely my opinion, but I’m optimistic that simplification will happen, given that the 2015 Certification Rule is likely to decouple Meaningful Use and certification. Certification is likely to be incremental year to year without the tidal wave of requirements we’ve seen in the past. Certification of health IT (not just EHRs) will be with us for a long time and may be leveraged by more programs than just the EHR incentive programs. Imagine that modules for patient generated data (such as wearables), health information exchange (HISPs), and analytics services (such as those used for care management by ACOs) could be certified and used in any combination to achieve outcomes.

I’m really hopeful that Halamka is right and that MU stage 3 will be dramatically simpler. However, in government work, I’m rarely confident that something will be simple. In fact, his comments about ongoing certification are sad too. Anyone who’s had to work with supposedly certified CCD documents from multiple EHR vendors that should be “standard” knows what I mean. Because of examples like this, I’m not a fan of government certification setting the standard, but Halamka might be right that they may use EHR certification to try.

What will be interesting to me is what motivation organizations will have to continue on with meaningful use stage 3. The EHR incentive money will be gone. Certainly the EHR penalties are a pretty sizable motivation for many organizations. Although, probably not as sizable as many think when you compare it against even the MU 2 burden (another reason why MU 3 needs to be simpler). Also, I still wouldn’t be surprised if we had an ICD-10 Delay-esque move by the AMA or some other healthcare organization to remove the EHR penalties. It will be a little harder since the penalties are hard revenue that has to be accounted for, but don’t put it past a good lobbyist.

The Path to Interoperability

Posted on August 28, 2014 I Written By

The following is a guest blog post by Dave Boerner, Solutions Consultant at Orion Health.

Since the inception of electronic medical records (EMR), interoperability has been a recurrent topic of discussion in our industry, as it is critical to the needs of quality care delivery. With all of the disparate technology systems that healthcare organizations use, it can be hard to assemble all of the information needed to understand a patient’s health profile and coordinate their care. It’s clear that we’re all working hard at achieving this goal, but with new systems, business models and technology developments, the perennial problem of interoperability is significantly heightened.  With the industry transition from fee-for-service to a value-oriented model, the lack of interoperability is a stumbling block for such initiatives as Patient Center Medical Home (PCMH) and Accountable Care Organization (ACO), which rely heavily on accurate, comprehensive data being readily accessible to disparate parties and systems.

In a PCMH, the team of providers that are collaborating need to share timely and accurate information in order to achieve the best care possible for their patient. Enhanced interoperability allows them access to real-time data that is consistently reliable, helping them make more informed clinical decisions. In the same vein, in an ACO, a patient’s different levels of care – from their primary care physician, to surgeon to pharmacist, all need to be bundled together to understand the cost of a treatment. A reliable method is needed to connect these networks and provide a comprehensive view of a patient’s interaction with the system. It’s clear that interoperability is essential in making value-based care a reality.

Of course, interoperability can take many forms and there are many possible paths to the desired outcome of distributed access to comprehensive and accurate patient information.  Standards efforts over the years have taken on the challenge of improving interoperability, and while achievements such as HL7, HIPAA and C-CDA have been fundamental to recent progress, standards alone fall far short of the goal.  After all, even with good intentions all around, standard-making is a fraught process, especially for vendors coming to the table with such a diversity of development cycles, foundational technologies and development priorities.  Not to mention the perverse incentives to limit interoperability and portability to retain market share.  So, despite the historic progress we have made and current initiatives such as the Office of the National Coordinator’s JASON task force, standards initiatives are likely to provide useful foundational support for interoperability, but individual organizations and larger systems will at least for the time being continue to require significant additional technology and effort dedicated to interoperability to meet their needs.

So what is a responsible health system to do? To achieve robust, real-time data exchange amongst its critical systems, organizations need something stronger than just standards. More and more healthcare executives are realizing that direct integration is the more successful approach to taking on their need for interoperability amongst systems. For simpler IT infrastructures, one to one integration of systems can work well. However, given the complexity of larger health systems and networks, the challenge of developing and managing an escalating number interfaces is untenable. This applies not only to instances of connecting systems within an organization, but also connecting systems and organizations throughout a state and region. For these more complex scenarios, utilizing an integration engine is the best practice. Rather than multiple point-to-point connections, which requires costly development, management and maintenance, the integration engine acts as a central hub, allowing all of the healthcare organization’s systems from clinical to claims to radiology to speak to each other in one universal language, no matter the vendor or the version of the technology.  Integration engines provide comprehensive support for an extensive range of communication protocols and message formats, and help interface analysts and hospital IT administrators reduce their workload while meeting complex technical challenges. Organizations can track and document patient interactions in real-time, and can proactively identify at-risk patients and deliver comprehensive intervention and ongoing care. This is the next level of care that organizations are working to achieve.

Interoperability allows for enhanced care coordination, which ultimately helps improve care quality and patient outcomes. At Orion Health, we understand that an open integration engine platform with an all access API is critical for success. Vendors, public health agencies and other health IT stakeholders are all out there fighting the good fight – working together to make complete interoperability among systems a reality. That said, past experience proves that it’s the users that will truly drive this change. Hospital and health system CIOs need to demand solutions that help enhance interoperability, and it will happen. Only with this sustained effort will complete coordination and collaboration across the continuum of care will become a reality.

About David Boerner
David Boerner works as a Solutions Consultant (pre-sales) for Orion Health where he provides technical consultation and specializes in the design and integration of EHR/HIE solutions involving Rhapsody Integration Engine.

Over-hyped and Under-Delivered Tech According to Hospital CIOs

Posted on March 10, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.


This is an interesting list:
#BigData
#EHR
#Cloud
#GoogleGlass
#ACO

When you think about the future of health IT, all of these except for Google Glass are guaranteed to be a major role in health IT. The use of data in healthcare is not going anywhere. EHRs will be the foundation of health IT for a long time to come. The move to cloud computing is happening everywhere in healthcare. ACOs are heading are way and I see nothing that will do anything to stop them. Google glass is the only thing on the list that might fizzle, but what Google glass represents (always on, always connected computing) won’t go anywhere.

Does health IT have a PR image issue?

What You Need to Know About Health Reform, ACOs, and Collaborative Care

Posted on March 7, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

I’ve always loved the common phrase that ACOs are like a unicorn. Everyone knows what it is, but no one’s ever seen one. I think that’s starting to change and this whitepaper called ACO & Collaborative Care – The Basics has provided the best overview I’ve seen of the healthcare reform, ACO and collaborative care world.

For example, it offers this statement that’s worth considering: “Health reform IS REAL and NOT GOING away.” Related to this is an equally powerful statement, “Value has become competitively relevant.

Chew on those statements a little bit. Let it roll around on your tongue and consider what that means for the future of healthcare. Once you get past the anger that many will feel around these changes and the lack of clarity of the changes, then you realize that it’s true. Health Reform, ACOs, and Collaborative Care are all going to shape the future of healthcare.

Plus, it’s also worth recognizing that there are no ACOs in a box that you can just plug and play into your organization and see the results. There are a lot of tools available to help you get where you need to go. Technology and data are going to be tremendous assets on this pathway, but it’s going to take more than just technology to make this a reality.

Either way, if you haven’t dug into what’s happening around changing reimbursement, ACOs, and health reform, I suggest you start by downloading this whitepaper for a basic overview of where it’s going.

Interview with Dana Sellers: Encore Pay for Perfomance (P4P) Managed Services

Posted on February 20, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

The following is an interview with Dana Sellers, CEO of Encore Health Resources about their new Pay for Performance Managed Services offering which they’ll be sharing at HIMSS 2014.
Dana Sellers
Tell us your vision for how your new P4P Managed Services will work.
Our vision is to help our clients manage performance and data components against payer contracts to maximize quality, obtain incentives, and avoid penalties. Our offering uses a combination of Encore subject-matter experts (SMEs), software tools, and methodologies that we’ve already tested and proven in large healthcare systems. P4P Managed Services lifts the burden of meeting these value-based demands off our clients’ shoulders and into Encore’s hands. As part of this innovative offering, we also share risks and rewards via multi-year partnerships. We work with clients to ensure that they have the trusted data they need to support performance improvement and obtain incentives.

Our service begins with the P4P Value-driven Roadmap, which identifies the dollars and associated measures at stake in clients’ at-risk, value-based contracts — including projections for the next few years. As input for the roadmap, we perform a data assessment of a client’s EHR and other source systems to determine if they are capturing the right data for the targeted measures. The roadmap defines the multi-year data and process program required to obtain the desired incentives.

Next, we establish this required program along with data governance, technology, and data tools. We also build the value components of the program, including EHR remediation, workflow redesign, change management, data profiling, ETL, and dashboards required to monitor performance.

Once the program foundation is established, the value-management cycle begins. Encore monitors each client’s performance, providing insight through performance analysis and suggesting needed performance improvements to meet all targeted incentives and enhance the quality of care. Also, as new contracts emerge, we work with clients to incorporate new eMeasures into the program.

By creating trusted, transparent data, Encore helps health systems transform and meet new payment-model requirements by using eMeasures to adhere to evidence-based standards. The result is better patient care and an improved bottom line. We provide the consulting expertise, unique methodologies, and our own, in-house developed software tools to help our clients succeed — as we’ve proven by our results in helping other large clients accelerate their achievements through eMeasures.

Why did you choose to offer a service like this?
We know EHR data! Our methodologies and software tools are built around EHR data and eMeasures.

Encore was founded to provide consulting services with a focus on analytics fueled by clinical data. In the broad spectrum of consulting services that we provide – from HIT and clinical advisory to implementation, go-live services, and analytics — our focus is trained on identifying and gathering the data that our clients need to improve healthcare and operational performance. Therefore, our P4P Managed Services offering is a natural extension of our mission. At-risk contracts require the ability to track eMeasures, which has been an Encore strength – and differentiator — since our founding five years ago.

Our vision for P4P Managed Services is also supported by our clients – especially CIOs and CFOs. They have told us that they need assistance with all aspects of data capture, analytics, and performance improvement. When we lift that burden from our clients’ shoulders, it frees them to focus on other critical issues, such as cost reduction, while we leverage our unique expertise and proven experience to manage the value side of the equation.

Which P4P programs do you see Encore supporting?
We support measures — quality measures that go back to incentives. These include Medicare, Medicaid, commercial P4P/Fee-for-Value type contracts, IQR, PQRS, ACO, ACAs, ACCs, NQF/CQMs, PCMH, PCQUS, clinically integrated networks, and the like.

Our methodology and tools tie the eMeasures directly to workflow, so we know how to change each client’s workflow to get better results. Our knowledge bases include over 350 eMeasures.

How much of this offering is technical and how much of it is services.
This is an important question. Encore is first and foremost a services company – a services company that is strongly differentiated by unmatched, in-house-developed software solutions that are uniquely designed to support the services we provide. So our new offering is precisely that: services supported by innovative technology and processes on a flexible, as-needed basis.

What does the cost structure look like for this service?
As described earlier, the P4P Managed Services cost structure is based upon a roadmap we define with each client to quantify the value-based, at-risk dollars and the client’s capabilities to manage the quality-performance components of their at-risk contracts. Contract details, therefore, will vary with each client’s situation. The bottom line is that Encore is willing to manage our P4P Managed Services contracts while working with clients to define a risk-sharing arrangement that incents everyone to achieve.

Why would an organization choose to outsource the P4P to Encore as opposed to doing it in-house?
The process of managing performance against eMeasures across a health system is complex, and many clients have not put together a disciplined approach to performance improvement. Further, many of our clients are telling us that they simply do not have the full complement of expertise, resources, technology, and program-management disciplines available to move fast enough against a dizzying array of government and commercial at-risk contracts. But we do, and we – especially our skilled eMeasures experts — have a track record that proves it.

Also, an increasing number of health systems are recognizing that they’ll have to enter a world of eMeasures that is growing every year. With P4P Managed Services, we bring the expertise, skills, tools, and methodology that can take this eMeasure world and our clients under our wing. Our new service provides clients the breathing room to focus on multiple fronts simultaneously – and not leave any dollars on the table as a result.

A third reason for choosing our new offering is because it’s a cost-conscious solution. We eliminate the need for clients to hire more architects, eMeasures specialists, analysts, and report builders.

Finally, P4P Managed Services can preserve endangered species. That is, we supplement our clients’ existing IT department with some of the hardest resources to find: clinicians and operational SMEs with an understanding of data; eMeasures experts; and, technical SMEs with an understanding of the clinical and the operational worlds.

How much accountability is Encore taking on with these P4P Managed Services? Where do you draw the line?
Our new offering is a full life-cycle solution that we approach as a partnership. We nail down the amount of accountability – the risk that we’re able to share – on a case-by-case basis through the roadmap. Depending upon what we learn, we then determine the degree of accountability that both we and our clients can share to incent the highest levels of achievement.

Is there some risk on Encore’s part that the client will fall short on what they need to accomplish for Encore to provide the P4P services? Encore can’t go in and do the documentation for the doctor.
This is precisely what our new service is in place to define. As with every engagement, we use a thorough, careful assessment process to ascertain the nature of the challenges involved. With P4P Managed Services, that means understanding:
• The incentives involved
• The risk involved if our clients can’t achieve optimal revenue reimbursement – say with Medicare and Medicaid contracts
• The risk involved for Encore if those contractual incentives are not earned
Bottom line: we both win, or we both lose. With P4P managed services, we are convinced that we can define on a case-by-case basis the mix of Encore services, solutions, and client resources that Encore will manage to produce a win or multiple wins for both sides.

This feels similar to revenue cycle management (RCM) applied to P4P programs. Can you apply some of the RCM learnings to this type of offering?
Yes, similarities do exist between RCM and the management of quality performance components of at-risk contracts. The way we see it, RCM has been responsible for collecting patient data and getting claims ready for a long time. It remains fairly unchanged and encompasses the management of people, processes, and technology across health systems to improve revenue collection. By tying eMeasures to clinical rather than latent claims data, performance issues can be corrected within a few days. That is because the use of EHR data literally “moves the needle” in real time. Beyond claims data, we use EHR clinical data to affect change that meets the required quality measures thresholds.

At present, there is an increased focus on traditional cost monitoring, which informs RCM. This typically happens at the service line and department level; not at the episode-of-care level. Although direct, indirect, fixed, and ad-hoc costs are certainly important and are included, value-based cost control and reduction efforts must focus on the clinical processes, just like the quality performance components. Both will require tracking the costs and quality across the entire continuum of care, constantly analyzing performance and applying adjustments. And the revenue cycle is a significant piece of this. So the discipline and techniques needed for RCM can certainly inform a health system’s approach to fee-for-value focused management.

Do you see this as the start of offering even more Managed Services offerings?
Yes. We are now working on another offering – it’s in the packaging stages – around Meta-Data Management. Stay tuned for more details later this year.

Two Pillars: Cost Containment or Revenue Generation

Posted on January 27, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

Far too often we try to make simple things really complex. Healthcare is replete with examples of really simple things that are made much harder than they need to be. For a hospital executive, I recently heard a really simple way to look at the revenue situation of a hospital.

It’s all about Cost Containment or Revenue Generation.

Turns out, these principles apply to any business. Those are the only two ways you can improve the cash flow of a hospital organization. Feels pretty simple, but no doubt there’s a lot of nuance to each category.

As I noted in my post Expense Growth vs Revenue Growth in hospitals, we’re entering a new era in healthcare where a hospitals revenue is decreasing. There are enormous pressures right now to lower the costs of healthcare and that directly relates to decreased revenue for a hospital.

In theory, new ACO models should present some new revenue opportunities to hospitals. Will they completely offset their revenue loss? I don’t think so, but they could provide some relief to the decreased revenue parade. Are you ready for an ACO model of reimbursement?

The EHR is likely to be the foundation of any ACO participation. However, even more than the EHR, the analytics platforms built on top of those EHR are going to really drive a hospital’s success in an ACO. This is why I think so much investment is happening in analytics programs. Watch for even more of it to happen in 2014.

Using our simple explanation, an investment in analytics can make a hospital’s ACO work possible and become a nice revenue generator. Plus, if done right, the analytics can also provide a hospital with cost containment. On face, analytics sounds like a great investment. The problem is that most analytics investments like to talk the talk of cost containment and revenue generation, but in actual implementation they fall well short.

Thanks to government stimulus money, the EHR didn’t have to go through the analysis of EHR as a cost containment or revenue generation mechanism. However, I bet over the next couple years, we’re going to see a lot of questions about how EHR can help in either of these two categories and where it’s hurting these two categories as well.

Where do you think EHR can help with cost containment or revenue generation? Where is EHR having a bad impact on these two areas?

The Big Takeaways from The Breakaway Group Healthcare Forum at TEDMED

Posted on April 17, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

I had the tremendous opportunity to spend the day hearing and interacting with a group of healthcare leaders across the entire spectrum of healthcare. I was invited to the Healthcare Forum as a guest of The Breakaway Group. They’d told me that the group would have a large number of influential people in healthcare and they were right. Along with recognizable names like Dr. Farzad Mostashari, Glen Tullman and Lee Shapiro were a number of hospital CEOs, CIOs, and CMIOs. There were doctors, insurance executives, and many other executives which made for a very well rounded and interesting discussion.

I won’t go through an entire recap of the event and all the things that were shared during the various presentations. If that interests you, go and read through my @ehrandhit tweets and check out the #simplehealth hashtag and you’ll get a good overview of everything that was presented from those of us live tweeting the event.

I do want to highlight a couple key takeaways and then suggest a list of major themes we’ll be confronting in healthcare.

Farzad Mostashari, MD was the event keynote with a great view on the future of healthcare. Farzad’s intro was perfect when Charles Fred, Founder & CEO of The Breakaway Group, said, “The wedding of healthcare and technology is over and Farzad has joined us for the marriage.”

Farzad’s message covered a lot of ground including a message of optimism for healthcare, the need to affect all parts of healthcare both small and large, and using the “most underutilized resource in healthcare…the patient.” He also talked about the need for some accountability in healthcare. Farzad suggested that there’s no “scale” in healthcare that we can step on and know how well we are doing. We need the data to be able to tell us how we are doing so we can improve. Without the data we almost always overestimate how good we are and underestimate the things we’re doing poorly.

One of the most powerful concepts Farzad discussed was around being careful not to change healthcare from a social contract into a financial contract. He said, “Incentives and money aren’t always the same.” This point was illustrated brilliantly by one of the attendees who said, “An ACO should be the way we live and breathe healthcare every day and not just a reimbursement program.” I think we often need a reminder to not let the business of healthcare overwhelm the care provided.

Finally, for those of us who love EMR and EHR, Farzad offered this incredible perspective on where we are at when it comes to EHR progress, “We are at about 50% EHR adoption and about 5% workflow adjustment.” It’s the first time I’ve seen him acknowledge the idea that EHR adoption isn’t enough. In fact, the initial implementation of an EHR is just the very first step in a process of really optimizing the EHR for your workflow and for improved patient care. It does make me wonder what things ONC might do in the future to try and address the 95% of EHR workflow adjustments that remain.

I’m sure I’ll be pulling nuggets of information out of Dr. Jennifer Brull, Bill Rieger, Dr. CT Lin, Ashwin Ram, and Heather Haugen’s talks in future posts. They all offered some unique insights into quality of care, EHR leadership, patient engagement, patient portals, and EHR implementation.

Here’s the list of themes from the day as identified by those who attended:

  • Using Data
  • Transparency
  • Need for Leadership to Change
  • Adoption vs. Implementation (EHR)
  • Patient and Family Involvement in Care (through social media often)
  • Change Happens at a Different Pace for Different People

And then we identified the following important future healthcare topics:

  • Interoperability
  • Social and Mobile
  • Patient Engagement
  • How Do We Ask the Best Questions
  • Make the Right Thing to Do, Easy
  • Big Data, Small Actions (for doctors and patients)
  • Changing Reimbursement

The Healthcare Forum at TEDMED was a well organized event that provided a lot of food for thought. My only complaint from the experience was that pretty much everyone in the room could have been a speaker at the event. Thinking about that makes me wish there had been more time to hear from those in the audience. Although, it isn’t a bad thing to leave us thirsting for more.

Read more coverage from TEDMED from Xerox on the Real Business at Xerox blog and follow@XeroxHealthcare.

ACOs Need Population Health Help From EMRs

Posted on February 13, 2013 I Written By

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

It’s hard to argue that without an EMR, Accountable Care Organizations would be somewhat adrift. After all, any structure that demands a high level of coordination between multiple organizations benefits from a shared EMR backbone.

But do EMRs do a good job of managing population health, the other key responsibility of ACO clinicians?  Let’s take a look at the criteria suggested by David Nash, MD, MBA, who’s Founding Dean of the Jefferson School of Population Health at Thomas Jefferson University. Dr. Nash notes that primary care physicians in an ACO need the following:

  • A registry to monitor and evaluate my patients – not just individually but as a population
  • Relevant data on my patients who share a specific diagnosis such as hypertension or asthma
  • Information on how my medical management and patient outcomes compare with other local practices
  • Information on where my practice stands in comparison with national benchmarks

Let’s see.  Do leading EMRS offer a registry to monitor patients as a group?  Automatically serve up data on patients who share a specific diagnosis?  Offer means of benchmarking outcomes with other local practices or national standards? No, no and no.

I can hear EMR vendors out there saying, “Hey, wait a minute. That stuff is not our problem!”  And historically, they’d probably be right.  After all, it’s a formidable enough job creating usable, flexible, reliable medical record analogues in digital form.

The truth is, however, that population health measures are central to the medical home, ACOs and the future of medicine generally.

My guess is that for the next few years, hospitals and large medical practices — even those who have launched an ACO — will be preoccupied enough with meeting Meaningful Use  measures that they won’t be demanding more extensive population measures soon.

Still, enterprise EMR vendors will need to offer tools that meet broad population health goals eventually, as the large organizations that buy their products will soon be demanding these types of functions.  The only question is when.

Hospital-Backed HIE On The Rocks

Posted on January 2, 2013 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 an all-too-familiar tale of conflict, turf wars and financial doubts, a three-year effort to bring some of the Chicago area’s largest hospitals into an HIE seems on the verge of collapse.

The proposed HIE is backed by the Metropolitan Chicago Healthcare Council, a nonprofit group of about 150 hospitals and healthcare providers. But despite industry backing, the effort hasn’t gotten any momentum. Though the Council has been flogging the HIE concept since 2009, just 18 hospitals and physician groups have agreed to join, according to a report in Crain’s Chicago Business.

In theory, the massive, sophisticated health systems that serve the Chicagoland area would see the value in sharing medical records if anyone would. If nothing else, they’re doubtless thinking about or already participating in risk-bearing ACO contracts, so cutting down on needless duplicated tests would be a plus.

But apparently, potential HIE members are balking at the cost of sustaining the HIE, which can run to six figures annually depending on the institution. Apparently, they’re not sure that they’ll get a decent return on their investment. And of course, there’s little doubt that these systems are already investing many, many millions in EMRs and supporting systems, tying up most if not all of their IT investment budget.

What’s more, while Crain’s doesn’t mention this issue, I’d argue that hospitals are also skittish about cooperating with their competitors. Particularly in an intensely competitive market like Chicago, hospitals and health systems may feel that HIEs are a step too close to the enemy.

Now, even if the major hospitals refuse to invest in the HIE, the Council does have other ways that it might be able to pay for the exchange.  For one thing, the group has begun discussions with health insurers to see if they might be interested in helping to fund it. And there’s always government grants, which are available to help kick off startup HIEs.

The bottom line, though, is that hospitals are still conflicted when it comes to HIE involvement. Though most CIOs say that they’re interested in being involved, financial — and let’s not forget competitive — issues prevent them from getting on board.

Expanding HIEs Taking Role As Backbone For Reform Efforts

Posted on December 3, 2012 I Written By

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

It looks like we may be seeing a tipping point for HIEs, which for many years have seen only isolated successes. According to a new report from the eHealth Initiative, the number of HIEs has grown meaningfully between last year and this year, and this year should see many new HIE organizations form.  Perhaps more importantly, it looks like HIEs are taking their place as the backbone for up and coming reform efforts.

When eHI reached out to survey HIEs, it found 322 organizations to survey, up from 255 last year.  Of that group, 88 HIE initiatives are at the highest stages of development on eHIs HIE development scale, an increase of 13 from last year.  As researchers see it, we’ll see even more growth and maturing technologies in 2013.

Over the last several years, the HIEs which have stayed on their feet and matured have almost all been propped up by federal dollars. Twenty-seven of the advanced HIEs surveyed said that the single most substantial source of funding they had was from the federal government; also, 22 of these HIEs were classified as state designated entities.

Unlike the past, however, it seems that HIEs believe they can survive without grant money from the government.  Of 39 state-designated entities responding to the study, 37 said they believe it is ‘very likely’ or ‘likely’ that they will remain operational after the HITECH dollars stop flowing.  An additional 31 of the SDEs said t hat it is ‘very likely’ or ‘likely’ that they will be financially sustainable three years from now even without additional federal dollars.

Now, here’s where it gets really interesting (to me at least). As part of the study, the eHealth Initiative asked some questions about how HIEs were playing into preparations for the full rolllout of health reform.

What they found out is that HIEs are increasingly playing a major role in health reform-related efforts such as ACOs and/or Patient-Centered Medical Homes.  More than half (109) of the HIE respondents said that they are supporting ACOs or PCMHs.

The HIEs aren’t just dumb pipes either;  not only are they offering technical infrastructure, they’re providing data analytics services around cost efficiencies and quality improvement.

Looks like 2013 should be a pivotal year for HIEs. I for one am excited to see what HIE organizations will be able to accomplish over the next 12 months prior to full rollout of health reform.  Go team HIE!