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Contest Offers Prizes For CCD Redesign

Posted on November 19, 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.

When EMRs are the gossip of the week at TechCrunch (a popular tech startup website), you know our little EMR thang has gone mainstream. And TechCrunch is indeed one of a series of sites trumpeting the news of a design challenge intended to make the Continuity of Care Document more usable.

The White House’s Health Design Challenge, working with a community of philanthropic angels and mentors known as Designer Fund, asks designers to transform the CCD (and by extension the Blue Button output) from a consumer-hostile mess into something easily used by the following groups:

  • An underserved inner-city parent with lower health literacy
  • A senior citizen that has a hard time reading
  • A young adult who is engaged with technology and mobile devices
  • An adult whose first language is not English
  • A patient with breast cancer receiving care from multiple providers
  • A busy mom managing her kids’ health and helping her aging parents

The ONC and VA, which seem to be spearheading the effort, are providing for twelve winners. First place for best overall design gets $16K, second place $6K and third place $4K. They’re also distributing $8K per category across winners for best medical/problem history section, best medication section and best lab summaries.

The design is expected to not only improve the visual layout of the record, it’s also supposed to make it easier for a patient to manage their health, enable medical professionals to digest information more efficiently and help caregivers support patients. Tall order for a messed-up text file?  Well, we’ll see what design superbrains can do.

In part because the VA hopes to use the new designs to support its Blue Button initiative and its MyHealtheVet patient portal, all entries have to be submitted under a Creative Commons license.   Curators will select a final design — which may include elements from various winning entries — and open source the code on code-sharing commuity Github.

Healthcare Cloud Spending Slated For Major Growth

Posted on October 30, 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.

Hospitals may still be ambivalent about using the cloud for clinical data transport, but attitudes are likely to undergo a major change over the next few years, according to research firm MarketsandMarkets. The firm projects that the healthcare cloud market will expand by about 20.5 percent per year over the next five years, hitting $5.4 billion by 2017.

Right now, healthcare cloud spending has hit roughly $1.8 billion, which represents penetration of four percent, MarketsandMarkets found.  That’s just a drop in the bucket, particularly given the big competitors who are aiming their guns at the healthcare cloud market today. (Other estimates put healthcare cloud penetration at 16.5 percent of the marketplace, still a small number though meaningfully larger than MarketsandMarkets’ number.)

As our sister site EMRandHIPAA.com previously noted, Verizon’s Enterprise Solutions division is offering five “healthcare-enabled” services, including colocation, managed hosting, enterprise cloud, an “enterprise cloud express edition” and enterprise cloud private edition. Verizon hopes to capture healthcare IT managers who are worried not only about HIPAA-secure clinical data transport, but also HIPAA-appropriate data protection on site, as it’s training hosting workers to be HIPAA-ready.

Another set of deep pocketed healthcare cloud vendors are AT&T and IBM, who are partnering to capture what they deem to be a $14 billion healthcare cloud market.  Under the terms of an agreement announced in early October, IBM will provide data storage facilities and services, while AT&T will provide the network.

What could possibly hold back the advance of such giants?  Well, a number of issues, MarketsandMarkets notes. While vendors large and small may promise to be compliant with healthcare regs, healthcare data is challenging to manage, given that it requires special security, confidentiality, availability to authorized users, traceability of access, reversibility of data and long-term preservation.

My guess is that hospitals will respond to the efforts of vendors to attract cloud business, but that the market for public cloud services in particular won’t shoot upward as MarketsandMarkets predicts, as there’s just too many things that worry CIOs.  How about you, readers?

ONC Wants 1,000 More Smaller Hospitals To Be Meaningful Users

Posted on October 12, 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.

As I’ve written about here in the past, small rural/critical access hospitals are struggling to keep up with Meaningful Use. These hospitals — typically 50 beds or less — are isolated, underfunded, short on staff and clinicians and sometimes without affordable connectivity options.

That’s a shame, because having telemedical functions and EMR connectivity may be far more important for these hospitals than for big academic or urban behemoths. In situations where the nearest specialist may be a day’s drive away, being able to communicate and collaborate with remote specialists can be a lifesaver.

Aware of these concerns, ONC has launched a campaign intended to get 1,000 critical access and small rural hospitals meaningfully using certified EMR technology by the end of 2014.

To help small hospitals get their legs under them, ONC has committed to spending up to $30 million for Regional Extension Centers targeting these facilities.  Though ONC is shooting for 1,000 new Meaningful User hospitals , it’s willing to fund services for up to 1,501  of them. That would bring the total to more than 2,700 rural/critical access hospitals on the MU roster.

The obvious question, given the obstacles the smaller facilities face, is just how realistic ONC’s expectations are. Sure, getting them hooked up with REC services is a good thing, but is it enough to get them across the finish line?

One comment on the ONC blog had this to say on the subject of the CAH/rural hospital campaign:

The best chance for success (in my humble opinion), is a joint effort between public (REC) and private sectors. There are consulting firms with specific MU experience sitting on the bench that can provide incredible value to this process. The RECs are trying to keep up with demand while servicing thousands of ambulatory providers. If there is a way to facilitate collaboration between pubic & private sectors in a way that fosters success of this initiative, that would ensure the ONC would hit their goal of 1,000 hospitals to MU by 2014. 

I think the poster is on to something. While the RECs are fine, and have the best of intentions, they’ve already got their hands full. Whether it’s a public/private partnership, an assist from state government, additional grants or other mechanisms, I think it will take more than REC funding to get the job done here.

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.

FCC Says Wireless Health Should Be “Routine” Within Five Years

Posted on September 28, 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.

This week, the FCC made an announcement which, I think, is likely to have far-reaching implications, including for providers, hospitals, wireless vendors and medical device makers. *So* much is going on in this announcement that I think I’ll have to parcel it out into a series, so stay tuned.

But let’s start with the basics. In the announcement, the FCC said that it plans to implement on the key recommendations made by an independent mHealth task force.

Perhaps the most dramatic news is that the FCC seems ready to push for making mHealth “a routine medical best practice” by 2017.  Despite doctors’ increasing reliance on mobile devices, that’s a tall order — or even a nearly impossible one depending on how comprehensive your definition of mHealth is.  Regardless, this looks like a watershed moment.

The agency has already taken several steps that advance wireless healthcare networking, including:

*  Medical Body Area Networks:  The FCC recently released an order allocating spectrum for Medical Body Area Networks, networks of small sensors attached to a patient that continuously report results.

*  Medical Micropower Networks:  Last year, the FCC adopted rules enabling a next generation of  wireless medical devices used to restore functioning to paralyzed limbs. The MMN is an ultra-low-power wideband network consisting of transmitters, which are implanted in the body to take the place of damaged nerves.

FDA/FCC Partnership:  Since 2010, the FCC has been working in partnership with the FDA to help bring communications-related medical devices quickly and safely to market.

But this is just the beginning, folks. As you’ll see over following installments, the FCC is taking on not only the broad policy goal of “mHealth by 2017″ but taking several steps that should help to lay the groundwork to make this happen.

Are they enough?  Let’s talk about it. I’ll get into what some of the proposals are, and how much impact they’re likely to have, in coming HospitalEMRandEHR.com articles.  So don’t turn that channel!

Feds Claim Hospitals Are Using EMRs For Upcoding

Posted on September 26, 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.

Geez, you can’t win for losing these days. First the feds put enormous pressure on hospitals to near-bankrupt themselves buying sophisticated EMRs and meet Meaningful Use standards.  Now, as a piece in The New York Times notes, the feds are going after hospitals which are allegedly using EMRs to upcode Medicare and Medicaid claims.

As my colleague John notes, the key finding that The New York Times article discusses is that Medicare costs have gone up substantially for those using an EHR. This has the feds’ knickers in a twist. The administration now plans to look aggressively for providers who are committing coding fraud, while also considering whether it needs to change the way it pays for care.

In a letter signed by U.S. Attorney General Eric Holder Jr. and HHS secretary Kathleen Sebelius, the Obama administration said that their are “troubling indications” of abuse in how hospitals are using EMRs to bill for services.

The letter, which went out to five major hospital trade associations, warned that it was aware of abuses such as “cloning” of medical records — in which information on one patient is repeated in other records to inflate reimbursement. CMS has also gotten reports that hospitals are upcoding the intensity of care or severity of a patient’s condition.

The American Hospital Association, for its part, says the problem is partly on CMS’s own shoulders. As it noted in a letter responding to the administration, hospitals have been using CPT and E/M codes to report utilization at clinics and emergency departments.  The AHA has asked CMS to implement a set of national hospital E/M visits developed by an independent expert panel, but to date, CMS has neither implemented those guidelines nor proposed its own, the association says.

You know what? I think the AHA has a very good point. Unless CMS issues a single national standard for reporting such visits, coding is going to all over the place. That’s just reality.

Meanwhile, as to whether hospitals are trying to put the squeeze on CMS by fraudulently upcoding, it’s anyone’s guess, but my theory is that hospitals are merely doing a better job of capturing what they’re already doing . So while I appreciate the need for CMS to be vigilant, they might want to do some studies before they accuse hospitals of criminal misbehavior.

Things You Won’t Hear Hospital EMR Customers Say

Posted on September 24, 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.

My colleague John recently wrote an item offering a list of comments you’re not likely to hear EMR-using doctors say to one another. (It’s a great read — you should check it out! ) Not to be outdone, I’ve pulled together a list of things you (too) seldom hear hospital EMR customers say:

Gosh, the EMR rollout took a lot less time than we expected.”

“Our IT staff has plenty of time to implement and manage our new EMR. No sweat.”

“We went with our vendor because it was the most affordable option.”

“Now that we have our EMR in place, connecting to an HIE will be no big deal.”

“What impresses me about Epic is how experienced their staff is.”

“I don’t care what other hospitals do, we’re going with the EMR that’s right for our hospital.”

“If doctors don’t like our EMR, it’s probably because there’s something wrong with it.”

“Open source EMRs and enterprise tools really deserve a second look.”

What about you, readers?  Can you add to this list?

37 Seconds To Chart Encounter on Peds EMR

Posted on September 11, 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 like me, you’ll probably be a bit surprised (pleasantly) by the following video, which can be found embedded in an equally interesting blog post on EMR feature-creep or “featuritis” by Dr. Charles Webster.  (I would have shared the video here but it’s only available on Dr. Webster’s site.)

In it, the ever-insightful Dr. Webster details how a peds practice has gotten to the point where a routine encounter takes 37 seconds to chart using the practice’s pediatrics-specialized EMR, as follows:

1:08 I open the chart
1:13 Chart my physical exam, my pharyngitis exam
1:19 Chose my diagnosis of strep pharyngitis
1:25 Make my treatment duracef and follow up in 3 days
1:31 Write my prescription
1:33 Edit my follow up if necessary
1:37 Have created a beautiful chart
1:42 Check my billing
1:44 And I’m finished

That may sound extreme, but it’s not, he says. “I’ve looked at timed studies of our current physicians’ charting at  pediatrics or family practice, and the average chart for a sick visit is 28 seconds,” he notes.

As if that wasn’t sensational enough for an audience expecting EMRs to make everything tougher, he had more to share.
“In reality, with a finger or a stylus you can do this in about a third the time,” Dr. Webster told them.  In this case, that would mean 17 clicks in 12 seconds, but people can generally tap their finger at that pace with little trouble, he says. Not such a big deal.

That being said, it seems likely that going forward, doctors will need to better develop the cognitive motor skills of musicians — the ability to step up eye-hand coordination to be sure —  if they want the best results out of their systems.  Dr. Webster says he’s planning a future post which critiques EMR data and order entry from the point of view of psychological models of musical cognition, learning, and motor skill. I think I’ll want to catch that one!

Study Suggests Most HIEs Aren’t Sustainable

Posted on September 10, 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.

According to an EHR Intelligence piece, most HIEs spend more than $1 million per year on operational expenses. That number is probably well on the low end for regional HIEs with multiple health system partners. All told, I think we can agree we’re talking about a money pit here.

The question is, and has been for many years, whether those investments offer any financial or clinical payback. After all, you can only lay out that kind of money for so long before there’s no business case for the exchange.

Unfortunately, it looks  like the answer may still be “no” in many cases, according to the authors of a study appearing in Perspectives in Health Information Management.   Of the 96 HIEs that responded to the researchers’ survey, the “vast majority” didn’t have a business model in place that would sustain itself even into the near future.

What’s worse, there’s little evidence that things are due to change anytime soon, the authors write:   “The last decade has seen significant progress in HIE technologies and substantial investments in HIT adoption, yet the lack of evidence on the value delivered by such efforts remains a major hurdle in making a strong case for both adoption and investment at the local level.”

Even more troubling is the apparently lack of insight into this state of affairs by HIE leaders, the authors assert.  When asked how they measured ROI, the authors apparently got very squishy answers, such as that they “believed” their HIE was showing positive ROI without having any metrics to make this case.

I don’t know about you, readers, but I’ve been following health data exchanges of various kinds since the early 1990s, and this is just depressing. If the government’s strategy in doling out some HITECH dollars to HIEs was to help build the core of the Nationwide Health Information Network, I think it’s pretty much proving to be a bust.

No, I’ll come out and say it:  I think the government ought to pour massive funding into building out the NHIN and just get it over with without waiting for the politics and competing priorities of healthcare to gum up the works. At this point, I doubt anything else CAN work.

Nurses And PAs Use Digital Resources More Than Docs

Posted on September 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.

Generally speaking, the push toward EMRs is designed to change how doctors use digital resources and structure how they interact with other professionals. As it turns out, though, there may be more enculturation to do. Nurses and advanced practice nurses currently spend a lot more time using digital resources than doctors do, according to a study by market research firm Manhattan Research.

To conduct its study, Manhattan Research reached out to 1,1012 U.S. practicing nurses and physician assistants online during the second quarter of 2012. The researchers found that there were distinct differences in the way doctors and nurses used digital resources.

For example, the research group found that 74 percent of PAs, 67 percent of RNs and 60 percent of APRNs use smartphones at the point of care, as opposed to 40 percent of physicians.

Nurses are also bigger professional users of online resources than doctors. Researchers found that while RNs spend 16 hours online per week on professional activities, APRNs 14 hours and PAs 14 hours, physicians average 11 hours.

A particularly interesting stat dug up by Manhattan was that physicians were far less likely to be interested in using pharma features within EMRs. The survey found that 83 percent of PAs, 79 percent of RNs and 76 percent of  of APRNs were interested, but only 67 percent of physicians.

I’m not suggesting that Manhattan did its work badly, but I am surprised by what I see here.  If nothing else, study after study has concluded that doctors are avid users of mobile technology at the point of care, including both smartphones and tablets.

Of course, doctors and nurses have different workflows, and that alone could be enough to explain the different between their digital consumption habits and doctors’.  But I can’t envision quite as easily why doctors and advanced practice nurses differ so much. It’ll be interesting to see if doctors catch up over the next year or two.