Free Hospital EMR and EHR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to Hospital EMR and EHR for FREE!

Meaningful Use Drove the Data Gathering

I recently heard an interesting comment that “meaningful use drove the data gathering.” As you look at meaningful use, it has been the driver of data gathering in healthcare. I’m not sure any other technology has gathered more healthcare data than EHR software (I guess the health plans might have a case here, but it’s different healthcare data). Much of the EHR adoption is attributed to meaningful use.

While it’s great that we’re gathering all of this healthcare data, it’s worth asking the question of what’s being done with this data. Are we meaningfully using the data we’ve gathered? Is the data in a format that we can use the data?

The past 3-5 years of EHR has been defined by EHR systems that converted the paper chart world into an electronic chart world. I believe this is a great step forward, but it’s only a step. The next 5 years we’re going to start using the data that’s been gathered into EHR software and that will change healthcare.

One challenge we face is that many EHR vendors are locking in the data. They’ve gathered the data, but they haven’t set it free so it can be used for good. I believe locking in the data is bad for healthcare, but I also believe that it’s a bad business decision by EHR vendors.

In the future, EHR vendors will be differentiated more on the marketplace of third party applications they support than on their own in house developed apps.

I think we can barely imagine what benefits will come from the proper use of the data we’ve collected in EHR software. EHR data is a treasure trove of opportunity. We just need EHR vendors to start acting like the database of healthcare and stop trying to be the end all be all solution. Then, we’ll see innovation that we haven’t even imagined come into view.

February 5, 2014 I Written By

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

Healthcare CIOs Braced For Regulatory, Infrastructure Challenges

As we all know, CIOs of US healthcare systems are facing a convergence of challenges more difficult than many faced by their predecessors, including Meaningful Use, Affordable Care Act pilot programs, adapting to mobile health trends, and hiring enough IT pros to make all this happen.

To get a sense of how CIOs are managing these difficult problems, the Deloitte Center for Health Solutions conducted interviews with 12 CIOs, representing four academic medical centers, seven regional not-for-profit health and hospital systems, and a Catholic hospital system.

To cope with the onslaught, they learned, CIOs are focusing on complying with regulations, building out their IT infrastructure to meet coming demands, and preparing for an accountable care–centered business environment, Deloitte found.

When it comes to regulatory preparation, the CIOs interviewed by Deloitte seem to have their act together. In fact, 11 of 12 CIOs interviewed rated their organization’s preparedness for meeting Meaningful Use requirements is “very prepared” or “prepared.”

However, this preparedness is coming at a high price. CIOs are investing major amounts of time and energy in complete updates to their current systems, including EMRs, practice management systems, billing systems and more. This work is made more difficult by the need for hospitals and health systems to implement ICD–10.

Other key activities cited by the CIOs including using new systems effectively and efficiently, updating and enhancing management capabilities, and strengthening oversight and governance. The CIOs are also upgrading the protections against fraud and abuse and securing PHI more aggressively, Deloitte reports.

Yet another challenging initiative undertaken by the CIOs – one which should eat up perhaps the most money and time long-term – is preparing for an accountable care environment which will require providers to demonstrate the quality and value of the care their institutions provide.

To meet these needs, CIOs are acquiring applications which can support clinical integration, population health management, disease management and care coordination across all of the institutions’ services, Deloitte notes.

September 17, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Government Regulations Overwhelming Hospital CIOs

I was recently talking with a hospital CIO about the challenges that he faces as a hospital CIO today. This hospital CIO has been doing it for a long time and so I was quite interested to hear his perspective on the changes in his job.

His response was telling. He recounted how he kept a powerpoint slide which covers all of the areas and projects he’s responsible for as a hospital CIO. Over time that slide had grown into a lengthy list of responsibilities, but he’d also modified the slide into two different lists. The new list he created was all the government regulations he was required to deal with as a hospital CIO. He then told me that the list of government regulations was as long as the rest of the list.

This is not surprising for those of us in the healthcare space. Without even effort I can list the alphabet soup of government health IT regulations: MU, ACO, ICD-10, EHR, 5010, etc. Plus, that doesn’t even include all of the various healthcare regulations that tangentially impact healthcare IT.

No doubt all of these government regulations can be overwhelming to any healthcare IT organization and its leaders. Although, I’m also concerned at the impact this will have to innovation in these hospital IT organizations.

We’ve seen how meaningful use has nearly stopped innovation in EHRs. It seems that wave after wave of government healthcare regulations are doing the same. When does a hospital CIO have time to do innovative things when they can barely keep their head above water dealing with government regulations?

June 3, 2013 I Written By

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

Hospital EHR Subsidies

In response to Anne’s post on Senator’s questioning the meaningful use EHR incentive money, Gary Colvin emailed me the following comment:

I would argue for the case where the only reason some providers are in the M.U. game is due to their Hospital subsidies. Instead of paying approx $1,200/ month to lease out their Epic E.M.R., they are enjoying its benefits for under $300 per month. What happens when the subsidy goes away for good? I think you would be hard pressed to see a four doc family practice paying $4,800 / month to enjoy that system — so, when the subsidy goes away (maybe it will be extended to 2016?) it will surely have an impact on who stays in the game.

I did question Gary on his algebra of the cost of Epic per doctor and he said that he got numbers from his hospital which is a public hospital where the pricing has to be transparent. It actually makes me wonder what other EHR pricing data could be uncovered from various publicly available sources. I wonder if data geek Fred Trotter has ever worked on this.

Regardless, I think the EHR subsidies is an important topic. I’ve known many doctors that are afraid of the hospital EHR subsidy because of the lock in it creates with the hospital. However, in many areas the lock in is already there so it doesn’t matter.

I wonder if hospitals are worried what it will mean for them once the EHR subsidies are no longer available.

May 17, 2013 I Written By

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

Healthcare Big Data vs Skinny Data

I have heard a number of people talk about healthcare big data was all the buzz in the healthcare IT world. There’s little doubt that there’s a lot of conversation happening around big data and analytics in healthcare. While I think there’s tremendous value to be found in healthcare big data, I’ve been more intrigued by what Encore Health Resources calls skinny data.

You can read more about the Encore Health Resources CoreANALYTICS announcement, but the approach is what I find really interesting. Instead of trying to create a huge enterprise data warehouse that can be all healthcare data for everything, they instead decided to focus on created a smaller solution that just focused on one major problem: meaningful use.

Encore Health Resources was open about the reason why they chose to go with a skinny data model as opposed to a full enterprise data warehouse model, time and budget constraints. They basically were asked to produce a result with a limited budget and so there wasn’t time or money to do anything but achieve the desired results. One of the architects of the system said, “If you can give me the extra data for free, then give it to me. If it costs [time or money] more to get that data, then don’t do it. Although, if you don’t give me these other data elements, then I’m going to have issues.”

It seems like a pretty simple concept to me that makes me wonder why I haven’t seen more of it in healthcare. Encore has taken these concepts and started to expand beyond meaningful use and into other areas like at-risk populations, clinical analytics for care coordination, and financial analytics.

I asked them if CoreANALYTICS would eventually grow into what essentially becomes an enterprise data warehouse. They suggested that it wouldn’t likely ever get that large, but I can see a path to that type of result.

What I do love about skinny data is that it’s user the information a hospital has available and creating actual results. It’s one thing to have the data, but it’s what you do with that data that really matters.

April 2, 2013 I Written By

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

Patients Question Clinical Decision Support Use

Using clinical decision support technology (CDS) is such a standard and helpful health IT approach – not to mention a central Meaningful Use feature — that we almost take its existence for granted. Apparently, however, patients aren’t as tolerant of computer-assisted decision making as clinicians and IT experts are, according to a new study published in Medical Decision Making.

The study suggests that patients actually distrust physicians who use CDS, labeling them as “less professional, less thorough, and having less diagnostic ability,” according to a report by EHR Intelligence.

The study, done by University of Missouri researchers, showed participants vignettes depicting an exam for an illness or injury. These participants were then asked to rate their reactions to the physicians showed in the vignettes.

The results suggest strongly that potential patients are unnerved by the notion of physicians making use of CDS.  Researchers found that the study subjects were less likely to trust computer-driven diagnoses, and moreover, less likely to be happy with a positive outcome if that outcome involved CDS use.

Perhaps the only social benefit to physicians using CDS was that subjects were less likely to blame a doctor for a negative outcome if the doctor relied on CDS to make a decision.  If a doctor used CDS, ignored its conclusions then had a negative outcome, patients felt strongly that he or she was deserving of punishment.

It’s not exactly good news for healthcare providers that patients are likely to be squeamish about their using CDS. That being said, my guess is that doctors can do a lot to make patients comfortable simply by explaining what they’re doing and making patients feel confident about the process. In the end, after all, patients care most about their relationship with the provider, computer-aided or not.

January 30, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

What HIMSS Told Congress

This week, a House subcommittee held a hearing entitled “Is ‘Meaningful Use’ Delivering Meaningful Results?: An Examination of Health  Information Technology Standards and Interoperability.”  The hearing follows a recent furor over Meaningful Use’s benefits, in which HHS head Kathleen Sebelius was written a stinging letter by a quartet of Congressman arguing that the program might not be pulling its weight.

Lots of interesting discussion took place at the hearing — see a report from the indefatigable HIT blogger and expert Brian Ahier for more background — but for the purposes of this item, I’m focusing on what HIMSS had to say.

HIMSS, which obviously has a massive stake in the topic discussed, is a big Meaningful Use fan. The trade group argues that “Meaningful Use and the Stage 2 regulations allow the healthcare community to continue the necessary steps to ensure health information technology will support the transformation of healthcare delivery in the United States.”

Not surprisingly, HIMSS showed up in full color at the hearing, ready to defend MU and the progress of health IT generally. HIMSS offered Congress seven recommendations as to how to keep the MU train moving, Ahier reports. Here’s my favorites:

  1. Direct the administration to initiate an appropriate study of a nationwide patient data matching strategy with a report back to Congress.
  2. Support harmonization of federal and state privacy laws and regulations to encourage the exchange of health information across health systems, payers, and vendor systems.
  3. Continue to support and sponsor pilot programs addressing the collection, analysis and management of clinical data for quality reporting purposes to assist providers and provider organizations make informed decisions for public health, patient care and business purposes.
  4. Preclude any additional delay in the nationwide implementation of ICD-10, International Classification of Diseases beyond the current October 1, 2014 deadline.

Other than the ICD-10 recommendation, which will probably be battled down to the last millisecond by some groups, I’m betting most readers would consider these to be reasonable steps. But I could be wrong. And I don’t see a lot here on the nitty-gritty of interoperability, which was the focus of the Congressmen’s ire in the first  place.  Folks, what would you add to/subtract from this list?

November 16, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

HHS OIG Begins Digging Into EMR Overbilling Allegations

Well, it had to happen: The furor over the possible EMR-related Medicare overbilling has moved to its next stage.  After enduring harangues by members of Congress and a widely-read New York Times article alleging that EMRs were upcoding machines, HHS has begun to look into the matter directly.

Fraud investigators within the HHS’s Office of the Inspector General have sent a 54-question survey to hospitals who got Meaningful Use incentive payments between January 1, 2011 to March 31, 2012. The survey looks into assertions that hospitals and physicians using EMRs have been inflating Medicare claims.

The logical next step for the OIG’s office is to issue a report to Congress spelling out whether it has reason to believe EMRs are linked to Medicare overbilling. The OIG will doubtless do some chart pulling and analysis to see whether it finds suspicious-looking patterns.

As I’ve said before — and will continue to say, doubtless — this whole effort concerns me. I’m not suggesting that HHS should ignore any evidence it has that hospitals or doctors are using EMRs to engineer a billing joyride. On the other hand, “overbilling” can be in the eye of the beholder, and conducting an inquisition into EMR user behavior seems premature to me.

I find myself wondering whether the feds have seriously considered hospitals’ response to these charges — that EMRs aren’t generating overbilling schemes, but instead are merely capturing and documenting services which weren’t always captured in the days of paper records.  It’s a credible argument and deserves a closer look.

So, let’s  hope HHS takes a breath and looks at the benign possibilities providers have outlined before it accuses hospitals and practices of wrongdoing. Otherwise, we’ll have a agency simultaneously pushing for EMR adoption and hanging the sword of Damocles over the heads of doctors and hospitals.

November 5, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

EMR Overbilling Investigations Sling Mud At Meaningful Use Program

In the wake of an expose in The New York Times claiming that upcoding and overbilling was increasing with the use of EMRs, and members of Congress riding the claim, I guess ONC had no choice but to take the allegations seriously.  So fearless leader Farzad Mostashari, M.D. has asked the advisory HIT Policy Committee to study whether providers are using EMRs to upcode Medicare bills.

I suppose you can tell from how I put that that I’m far from convinced EMRs are generating massive amounts of illegitimate bills, but the idea is “out there” now and dangerous to the future of HITECH objectives. So I suppose it’s a good thing that ONC is investigating.

Dr. Mostashari wants to find out whether EMRs tend to foster the use of higher billing codes by encouraging doctors to cut and paste information from one patient encounter to another, according to an interview with the Center for Public Integrity. He’s also asking the policy committee to determine whether some EMR functions prompt physicians to overbill.

All of this leaves me sort of uneasy.

Don’t get me wrong, I’m not suggesting that EMRs aren’t generating any upcoding issues at all. We all know that many physicians feel pressured to cut and paste text in an effort to get through their heavy workloads, particularly if they’re not otherwise comfortable with their system.

Also, I can’t deny that there are bad apples in every profession, including medicine, who could conceivably be taking advantage of the newness of the technology to reap a profit.

No, my concerns are more that countless providers will have one more thing to worry about as they use the new technology, and that policymakers will view EMRs with a level of suspicion they hadn’t before.  We’re at a tricky point in the overall EMR adoption curve, and bad vibes and publicity are the last thing we need. Meaningful Use compliance is tough enough as it is.

October 31, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Senators Join Initiative To Scrutinize Meaningful Use

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.

October 23, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.