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ED Alerts Help Health Plans Cut Costs

Posted on February 4, 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.

As readers of this publication know, many hospitals are interested in participating in HIEs, but are buried in projects already and not so sure the investment will pay off.  But here’s an instance where a very modest HIE application helped a health plan save real money in just six months without having to do an expensive buildout.

According to iHealthBeat, a new study by the Agency for Healthcare Research and Quality has found that simply sending near real-time alerts to health plans when a member is admitted to the hospital ED could help the health plan save money and get patients into primary care.

To do the study, Indiana Health Information Exchange programmers developed an application which sent daily alerts about health plan members who visited EDs at nine Central Indiana hospitals. As part of the pilot, the alerts were sent to the participating health plan within 24 hours. The health plan then used this data to replace non-urgent ED visits with primary care visits, iHealthBeat reports.

During the six-month pilot, the health plan was able to reduce nonemergency ED visits at participating hospitals by 53 percent; the same time primary care visits among plan members jumped to 68 percent during the pilot period.

The bottom line in all of this was that after using the daily updates to guide patient behavior, the health plan was able to save $2 million to $4 million over six months. While I could be wrong, I don’t believe there are many test cases out there that can demonstrate the effectiveness of hospital to plan communication and brag of this much success.  While this isn’t exactly an argument for all hospitals to have HIEs, this does suggest that shared, timely information on important patient behaviors can be extremely valuable.

Hospital CIO Challenges at CHIME13

Posted on October 11, 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.

For those who haven’t discovered my new EHR video website, you should go check it out now and sign up for it’s email list. I’ll be doing regular interviews with some of the top healthcare IT leaders in the country. I think many of you will enjoy it.

This week however, I knew I’d be at the CHIME Fall CIO Forum and so I decided to twist things up a little and have our very own Anne Zieger interview me about what I’d seen and heard at CHIME. We talk a lot about the challenges hospital CIOs face when it comes to meaningful use, ICD-10, HIEs and changing reimbursement. I think you’ll enjoy the insights that are shared. Enjoy the video embedded below (please excuse the poor lighting, but maybe that’s better since it’s me on camera).

Also, let us know if there are other people you’d like to see us interview. We’re always interested in hearing our readers/viewers thoughts on where we should take it.

Trusting Healthcare Data

Posted on August 9, 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.

Healthcare is generating data at an unprecedented rate. EHR software is becoming a large repository of healthcare data. Patient portals are starting to get data from patients. Labs are creating large amounts of data. Insurance companies have been collecting and playing with data for years. We’re surrounded by healthcare data. The question is: How do we make sure they trust the data?

Anyone who has worked with an Enterprise Data Warehouse (EDW) realizes what a challenge it is to make sure that the day you pull in from multiple systems can be trusted. It’s really hard to trust data that’s coming from a system that you don’t understand or use regularly. When you use the system regularly you have an idea of how it captures the data and the strengths and weaknesses of the data. When the data is in the EDW, you don’t often know those details.

With all of this said, the EDW is a walk in the park when it comes to trusting the data when you compare it to data coming from an outside source. One example is from an HIE, from the patient, or even from some patient device. The irony is that doctors have trusted outside data for quite a while. They receive chart notes faxed over from a specialty doctor all of the time. They trust that note and act on the data presented in the note. So, we shouldn’t act like the idea of trusting outside data is impossible. We just have to learn from the existing sources of trusted data and see how we can make that data flow easily and in a trusted way.

A great example of this is with HL7 lab interfaces. For some reason those interfaces have reached a level of trust where doctors receive lab results and trust that the data in those results is correct. I think we’ll get there with other forms of data transfer from outside entities. It will just take time to build up those networks of trust.

Being able to trust the data that a doctor receives or that’s stored in their data warehouse is one of the most important things we can do. Without the trust in the data, the data has little to no value and won’t provide the benefit to healthcare that we need it to produce. Healthcare big data is happening, but we need trusted big data.

Study: Meaningful Use Drives Hospital EMR Adoption

Posted on July 12, 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.

If there was any doubt, the following data may remove it: Meaningful Use is driving hospital EMR adoption. A new report by the Robert Wood Johnson Foundation concludes that the number of hospitals which  have implemented at least a basic EMR has tripled since 2010, when the MU incentive program kicked off, Reuters reports.

The number of hospitals with some form of EMR in place hit 44 percent in 2012, climbing 17 percentage points from 2011. Hospitals most likely to have at least a basic EMR in place are large, non-profit teaching hospitals in urban areas, found the report.

Meanwhile, twenty-seven percent of hospitals are now linked via some form of HIE to other hospitals, up from just 14 percent in 2010, according to researchers. They found that test results and summary patient care records were most commonly exchanged

The study, which was coauthored by the Harvard School of Public Health and Mathematica Policy Research, also found that doctors have come a long way toward greater EMR use, with roughly 38 percent having at least a baseline EMR in place.

All that being said, the growth in EMR adoption isn’t exactly burning up the track. While there’s clearly been significant progress in EMR adoption over the past few years, the fact that adoption among hospitals is still below 50 percent despite the incentives and industry pressure in place speaks volumes.

And if my colleague John Lynn is right, we’re already past the “Golden Age” of EMR adoption in which the early adopters and even much of the majority come board. In his view, getting those on board who haven’t come yet is going to be akin to climbing Mount Everest:

“The reality is that those who wanted to adopt EHR already have adopted EHR. That means we have left a group of practices and hospitals that for the most part aren’t EHR convinced.”

If John’s right, and I suspect he is, we’re looking at a whole new battle to win EMR hearts and minds. It’s going to be a struggle to be sure.

Adolescent Data Needs Stronger EMR Protections, Group Says

Posted on November 13, 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.

The American Academy of Pediatrics is calling for changes to EMRs to protect the privacy of adolescent patients, whom, it says, don’t currently get the same level of protection as adults.

According to the AAP, there are several reasons adolescents don’t enjoy the same privacy protections as adults.

For one thing, there are the legal issues. HIPAA doesn’t provide specific guidance on adolescent privacy, and the medical industry hasn’t put clear standards in place outlining when adults can access an adolescent’s health records either.

What’s more, states vary in how they handle this issue, according to the AAP report. State laws typically allow minors to consent for their healthcare on the basis of their status — for example, if they’re a pregnant or parenting teen — and on the basis of the services they seek  — such as STI diagnosis and treatment or contraception. However, while state and federal laws provide protection of privacy when minors  consent for their own care, privacy protections differ widely.

To make sure adolescent privacy is protected across all data platforms, the AAP is recommending a set of principles that it feels should ideally govern not only EMRs, but also PHRs and HIEs. These include :

*  Creation of a set of criteria for EMRs that meet adolescent privacy standards

*  Creating and implementing technology for EMRs which would allow determination of who has access to, or ability to control access to, any part of the adolescent medical record.

* Making it possible for adolescents to record consents and authorizations according to privacy laws using the HL-7 Child Health Profile DC.1.3.3 standard

*  Flexibility within standards to allow for protection of privacy for diagnoses, associated lab tests, problem lists and any other documentation containing confidential data.

* EMR systems must be able to apply state and federal confidentiality rules when assembling aggregate data to prevent identification of individuals.

The AAP has a lot more to say, but in summary, it seems to be putting the burden for protecting adolescent privacy largely on EMR vendors, though I believe it’s hoping members will advocate for these changes as well.

Either way, it doesn’t work well if there’s a protected class (certain adolescents) whose rights simply can’t be protected adequately with today’s technology.  Time to get on this issue, I’d say.

Health Information Exchange

Posted on November 2, 2012 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.

In an email response to my EMR and HIPAA post on HIE Waste, Edward Fotsch, M.D. and CEO of PDR Network offered these insights into the state and some history of Health Information Exchanges:

The fundamental question for HIEs is two-fold: 1) what is their purpose and 2) who benefits and will pay for them- the latter is a question of revenue model not grant funding which always runs out sooner or later. Relevant facts include:

1. HIEs are not a new concept. I was around when Community Health Information Networks; or CHINs (The ‘C’ in CHIN stands for communism where we all do the right thing because it’s for the good of the order) came and went. Then RHIOs came and went. Now HIEs. What these have in common is grant funding but generally no business model.

2. The idea of providers paying for the opportunity to share their patient (‘read “Client”) information with competitors is novel I must admit. But in the old days when I was seeing patients, when you sold your practice you largely sold your charts. It was the charts as much as anything else that kept patients coming to the new doctor after the sale- ‘it still works this way for many dentists. Now docs are supposed to pay for the privilege of having their charts opened to competitors? Now I know that the hospital execs all salute this flag when the discussion of HIEs occurs at the rubber chicken dinners. But when I was on the exec committee at a community based hospital we spent time trying to compete with, not empower, competing hospitals. You may say that is not right- but that’s a fact.

3. HIEs I’ve seen that have any hope serve a specific business purpose and often exist within an economic entity. Kaiser has a large HIE- they just don’t call it that.

4. Data exchange between competitors has worked in many venues- the obvious example is ATMs where competing banks collaborate. BUT this occurs because customers demand it. Unless or until patients/consumers begin to select healthcare providers who participate in some level (i.e. CCD-level sharing at least) of basic patient information exchange (i.e. refusing to go to providers who hand them a clipboard), the HIE concept is massively challenged. ‘Though it’s always fun right up until the grant funding runs out.

Massachusetts HIE Kicks Off With Golden Spikes

Posted on October 25, 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.

If you’re a history buff, you may know of the Golden Spike connecting the eastgoing and westgoing tracks of the First Transcontinental Railroad in 1869. It’s hard to overestimate how important that day was in the history of U.S. industry and transportation, despite the fact that it didn’t actually mark the day a seamless coast-to-coast rail network was completed.

This week, another big link-up was celebrated with ceremonial golden spikes, with some comparably high hopes attached. This one, however, was between disparate EMRs in Massachusetts, writes John Halamka, MD in Life As A Healthcare CIO:

Today we made history in the Commonwealth of Massachusetts.   At 11:35am Governor Deval and his physician sent the Governor’s healthcare record from Massachusetts General Hospital to Baystate Medical Center.   It arrived and was integrated into Baystate’s Cerner medical record.

Lots of other demonstrations followed, pingponging data from hospitals to payers to physicians to the Massachusetts eHealth Collaborative (which measures quality and performs data analytics).

Among the most interesting facts Dr. Halamka noted was the list of varied EMRs that shared data, including Partners Healthcare’s LMR, eClinicalWorks, a custom payer system and self-built analytics applications.

What took place was no less than a revolutionary event, suggested Dr. Halamka:

Within seconds, we broke down silos, demonstrating that care coordination, population health, and quality analytics based on healthcare information exchange is now possible in Massachusetts.  

By the way, for those who haven’t crossed paths with the indefatigable Dr. Halamka, he’s Chief Information Officer of Beth Israel Deaconess Medical Center. So his institution is central to this new effort (of which he’s quite justifiably proud).

My question is just how this trick was pulled off. Did the participants use the CCD format, Direct Project protocols, discrete data or something else?  Regardless of how the data’s being exchanged, it seems to me that the rest of the country should consider following suit.

Senators Join Initiative To Scrutinize Meaningful Use

Posted on October 23, 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.

A couple of weeks ago, four House GOP leaders wrote a letter to HHS head Katherine Sebelius demanding that she account for perceived failures in the Meaningful Use program.

The four congressmen had written a letter to HHS head Kathleen Sebelius to recommend that until MU Stage 2 rules require “comprehensive interoperability,” and hospitals can prove they’re capable of exchanging data, the agency shouldn’t hand out incentive payments.

Politics being what it is, the other shoe had to drop, and now a group of senators have offered their own objections.

Sens. John Thune and Dr. Tom Coburn of the Finance Committee, and Richard Burr and Pat Roberts of the Health, Education, Labor and Pensions Committee have formally requested that CMS and ONC staffers meet with the latter committee regarding the final rule for Stage 2 of Meaningul Use.

In a letter to HHS, the senators raise several questions:

* Do EMRs sometimes increase utilization of diagnostic tests, and if so, how should the government respond?

* Have some providers gotten subsidies for EMR systems they had in place prior to the kickoff of  Meaningful Use? If so, what is HHS doing to claw back such payments and prevent future outlays of this kind?

* Has the use of EMRs boosted providers’ billing of Medicare, and thereby raised the cost of the program?

* What is HHS’s strategy for “meaningful interoperability”?

Interestingly, the senators’ letter stops short of demanding a halt on MU payments, which the congressmen did in no uncertain terms.  But they’re clearly antsy about the future of the Meaningful Use program, which has paid out $6.6+ billion in incentives to date.

And you know what?  It’s about time that Congress got interested in the future of EMRs and Meaningful Use specifically.  Better to have them breathing down HHS’ neck now than further down the line when there’s far less opportunity to turn the MU battleship.

The Dawn Of “Compliance As A Service”?

Posted on October 5, 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.

A few days ago, I posted a quick report on our EMRandHIPAA.com sister site discussing Verizon’s plans to offer a HIPAA-compliant cloud service.

Verizon, which has beefed up on security services over the past few years, seems to see its role as being compliance vendor rather than just a mere business associate.  The carrier notes that not only does it offer super-secure data centers, it has trained staffers on HIPAA-specific data handling issues.

But Verizon obviously isn’t the only cloud vendor out there capable of offering HIPAA-compliant services. Could this be the dawn of CaaS (compliance as a service) for healthcare? (Others industries, like banking, are already well into this approach.)

According to reader Scott Gardner, who commented on the story, this concept has legs. “I’ve been pitching [Compliance As A Service] to cloud-based persistency vendors targeting mobility for some time,” writes Gardner, whose company Inyago focuses on private practice IT services via MacPractice. “Offering this service makes perfect sense, especially in private practice healthcare. And you get interoperability (core #14) right out of the box for all users on the platform.”

The burning question here, I suppose, is whether CIOs feel safe trusting outsiders with clinical data flow. Right now the answer seems to be “no.” As my colleague John noted in a related blog post, at present even those providers who are cloud users are more prone to access it for “commodity” services such as e-mail, file storage, videoconferencing and online learning, according to a CDW survey.

With providers needing interoperability under Meaningful Use Stage 2, the landscape may change, however. Whether or not they’re terribly comfortable with Verizon and its rivals, CIOs might find it easier to delegate compliance than cope with the difficulties of build-your-own-interoperability schemes. So perhaps CaaS really does have a chance at achieving rapid uptake — unless someone invents the insta-install HIE!

Providers Behind The Eight Ball On HIEs

Posted on October 4, 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.

ONCHIT is demanding them. Patients are beginning to understand them. But poor ol’ beleaguered HIEs still aren’t getting the attention they deserve, it seems.

A new survey by patient care organization ECRI Institute, done with strategic partner s2a, has concluded that while they understand the importance of HIEs, only 54 percent of providers have formally assessed their HIE and interoperability needs. (See the study here.)

Given the speed at which Meaningful Use data exchange requirements are barreling down on providers, that seems like a pretty low number to me.  After all, the final rule for MU Stage 2 requires providers to at least be able to electronically transmit a Summary care record using a certified EMR system or HIE for 10 percent or more of care transitions and referrals.

It’s also a pretty low number given that 93 percent of hospitals surveyed agreed that interoperability of health systems was one of their top strategic priorities.  Provider CIOs are well aware that getting HIE connectivity in play is a long and difficult process, and while they can’t do everything at once, one would assume that most providers would have a team in place to at least begin the assessments by this point.

The ECRI analysts conclude that two major factors are holding providers back:

*  Working with non-employed physicians:  For the moment, hospitals are focused largely on interoperability with their employed physicians, who typically use the same EMR as the facility does. Working with non-employed physicians is a major challenge for many reasons, including that they typically aren’t using the same EMR as the hospital.  There’s also legal issues that come into play: for example, what happens is non-employeds end up sharing data intended for Hospital B with Hospital A?

* Medical device connectivity:  Meaningful Use is putting great pressure on hospitals to exchange information between medical devices and EMRs.  However, interoperability even between a blood pressure cuff and and EMR is no picnic.  ECRI found that 40 percent of respondents hadn’t established policies and procedures for EMR interoperability with medical devices.

Of course, the sheer work and expense involved in becoming an HIE participant is immense, as well. Given those expenses, time demands, and the issues in connecting with physicians, I have to believe that a fair number of hospitals won’t be ready when Meaningful Use Stage 2 requirements hit.