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Interoperability Problems Undercut Conclusions of CHIME Most Wired Survey

Posted on November 11, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Most of you have probably already seen the topline results from CHIME’s  “Healthcare’s Most Wired: National Trends 2018” study, which was released last month.

Some of the more interesting numbers coming out of the survey, at least for me, included the following:

  • Just 60% of responding physicians could access a hospital network’s virtual patient visit technology from outside its network, which kinda defeats the purpose of decentralizing care delivery.
  • The number of clinical alerts sent from a surveillance system integrated with an EHR topped out at 58% (alerts to critical care units), with 35% of respondents reporting that they had no surveillance system in place. This seems like quite a lost opportunity.
  • Virtually all (94%) participating organizations said that their organization’s EHR could consume discrete data, and 64% said they could incorporate CCDs and CCRs from physician-office EHRs as discrete data.

What really stands out for me, though, is that if CHIME’s overall analysis is correct, many aspects of our data analytics and patient engagement progress still hang in the balance.

Perhaps by design, the hospital industry comes out looking like it’s doing well in most of the technology strategy areas that it has questions about in the survey, but leaves out some important areas of weakness.

Specifically, in the introduction to its survey report, the group lists “integration and interoperability” as one of two groups of foundational technologies that must be in place before population health management/value-based care,  patient engagement and telehealth programs can proceed.

If that’s true, and it probably is, it throws up a red flag, which is probably why the report glossed over the fact that overall interoperability between hospitals is still very much in question. (If nothing else, it’s high time the hospitals adjust their interoperability expectations.) While it did cite numbers regarding what can be done with CCDs, it didn’t address the much bigger problems the industry faces in sharing data more fluidly.

Look, I don’t mean to be too literal here. Even if CHIME didn’t say so specifically, hospitals and health systems can make some progress on population health, patient engagement, and telehealth strategies even if they’re forced to stick to using their own internal data. Failing to establish fluid health data sharing between facility A and facility B may lead to less-than-ideal results, but it doesn’t stop either of them from marching towards goals like PHM or value-based care individually.

On the other hand, there certainly is an extent to which a lack of interoperability drags down the quality of our results. Perhaps the data sets we have are good enough even if they’re incomplete, but I think we’ve already got a pretty good sense that no amount of CCD exchange will get the results we ultimately hope to see. In other words, I’m suggesting that we take the CHIME survey’s data points in context.

MRI Installation Slip Disables Hospital iOS Devices

Posted on November 9, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

The following is the story of an MRI installation which took a surprising turn. According to a recent post on Reddit which has since gone viral in the IT press, a problem with the installation managed to shut down and completely disable every iOS-based device in the facility.

A few weeks ago, Erik Wooldridge of  Chicago’s Morris Hospital, a perplexed member of the r/sysadmin subreddit, posted the following:

This is probably the most bizarre issue I’ve had in my career in IT. One of our multi-practice facilities is having a new MRI installed and apparently something went wrong when testing the new machine. We received a call near the end of the day from the campus that none of their cell phones work after testing [the] MRI… After going out there we discovered that this issue only impacted iOS devices. iPads, iPhones, and Apple Watches were all completely disabled.

According to Wooldridge, the outage affected about 40 users. Many of the affected devices were completely dead. Others that could power on seemed to have issues with the cellular radio, though the Wi-Fi connections continued to work. Over time, the affected devices began to recover, but one iPhone had severe service issues after the incident, and while some of the Apple Watches remained on, the touchscreens hadn’t begun working after several days.

At first, Morris and his colleagues feared that the outage could be due to an electromagnetic pulse, a terrifying possibility which could’ve meant very bad things for its data center. Fortunately, that didn’t turn out to be the problem.

Later the vendor, GE, told the poster and his colleagues that the problem was a leakage of liquid helium used for the MRI’s superconducting magnets. GE engineers turned out to be right that the leak was the source of the problems, but couldn’t explain why Android devices were untouched by the phenomenon.

Eventually, a blogger named Kyle Wiens with iFixit.org seems to found an explanation for why iOS devices were hit so hard by the helium leak. Apparently, even Apple admits that exposing iPhones to evaporating liquefied gases such as helium could take them offline.

While no one’s suggesting that liquefied helium is good for any type of microelectronic device, the bottom line seems to be that the iOS devices are more sensitive to this effect than the Android devices. Let’s hope most readers never need to test this solution out.

The Leadership Demands of Value Based Care

Posted on November 8, 2018 I Written By

The following is a guest blog post by Mary Sirois and Heather Haugen PhD from Atos Digital Health Solutions.

The topics of Population Health and Value Based Care continue to swirl through nearly every healthcare conversation.  Leaders across the healthcare provider and payer industries are looking for strategies to reduce costs and improve quality in hopes of improving the bottom line and increasing the viability of the organization within the community; and every vendor has a solution. We recently formed an expert panel to study and better understand the current state of work being done across healthcare provider organizations.  We explored the topics of leadership strategy and commitment, data aggregation, data analytics, and consumer engagement.  Our conversations reinforced the importance of developing a research-based approach to help healthcare leaders navigate the breadth and depth of this critical initiative: value based care.  Our findings continue to drive our work in defining solutions that meet healthcare leaders’ needs to better serve their organizational missions as care providers and employers in their communities.

The expert panelists included Zach Goodling, Director, Population Health and Care Coordination at Multicare; Randy Osteen, VP Applications, Information Management at CHRISTUS Health; and Ruth Krystopolski, SVP of Population Health at Atrium Health.

The panel discussion gave attendees the opportunity to:

  1. Understand experiences and lessons learned from industry population health and informatics leaders in preparing for value-based care opportunities to improve care quality and reduce costs in their communities
  2. Learn about approaches to data aggregation and analytics to support population health’s strategic and operational priorities
  3. Gain an understanding of various care models deployed by different organizations to manage high risk populations
  4. Appreciate the organizational culture and leadership challenges faced within each of the value-based care journeys of three different dynamic organizations

The discussion began by recognizing that the current state of healthcare is isolated and disconnected; it has interoperability challenges, misaligned incentives for employers, payers, providers, and community services; it tends to focus on sickness for an uninformed and confused user population; and it places accountability on providers that often results in duplication or even scarcity of services.

The opportunity here is tremendous!  We can find ways to:

  • Enhance the ability to improve care quality and consumer (patient, member, employee) quality of life and reduce the cost of care.
  • Come together in consumer-centric manner, using interoperable, technology-enabled, data-driven, innovative business models that cross stakeholder boundaries and focus on quality of life across the continuum of care and services, acknowledging shared risk and creating a more accountable consumer population.

Key messages from the group were enlightening and reflected the progression of the entire healthcare industry.

We heard from all three panelists about the arduous work required to make even small amounts of progress. “We have been on a five-year journey to create capabilities in population health management, managing plans to assist members, identify care gaps, and develop care plans.”  The topic of data arose throughout our interviews.  The panel discussed various concerns around data aggregation. “The biggest hurdle is aggregating data from non-affiliated places and various systems.”  “Data is vital to supporting a broad view of each patient; without it, it is very difficult.” And they cautioned organizations about relying on too much data. “When it comes to analytics, being more actionable is better than gathering more data.”

Many leaders find the array of solutions and systems available to healthcare organizations overwhelming. Our experts provided some insight on platform strategy. “Must identify consistent, reliable, scalable solutions.  It is difficult when you have too many solutions/platforms. If you can get users onto the same system, even if it is not the best of class, using the same governance model and tools creates important consistency and scale.”

The panelists had some ideas about other success factors beyond the tool set.  “Social determinants are often the biggest impact when managing a population. We joke that we are all social workers. We are putting these resources in place and able to monitor 400-450 patients with some of the highest risk patient populations.” They encouraged a paradigm shift for those setting strategy for value based care. “I am often impressed by the level of expertise in healthcare, but surprised by the lack of awareness about the macro environment.  We need to ensure we help our people understand the “why” behind the need for change. The organizational work pales in comparison to the cultural changes required to make progress.” Several panelists also reinforced the long-term focus required for value based care programs to succeed. “This is an iterative process that will evolve over time, not a program with a beginning and end.”

Key Themes from Panelists

  1. A clearly defined leadership strategy and commitment are imperative.
  2. Most organizations are still in the early stages of defining their value based care processes. They are working to improve their understanding of consumer engagement and activities that potentially influence consumers. They are exploring new ways of leveraging technologies to engage consumers and provide new models of care.
  3. The lack of interoperability makes data aggregation difficult and the application of meaningful analytics even more challenging.

A Value Based Care Model

Understanding these key themes provides healthcare leaders with a better understanding of where to focus their efforts, but they still need a model to navigate the various domains of value based care.  The model below includes five areas of consideration for healthcare leaders to use as they continue to define their value based care efforts.

  1. Leadership Strategy & Commitment: Define, refine, and commit to a strategy that allows the organization to realize the benefits of value based care. Leadership engagement is imperative and has the power to accelerate or limit the amount of progress in every domain.
  2. Data Aggregation: Compilation of disparate clinical, financial, social, supply chain, administrative, public, and consumer data is vital for supporting clinical and business decisions.
  3. Data Analytics and Business Intelligence: The ability to utilize aggregated data to make informed clinical and business decisions that improve quality, reduce costs, and offer value to consumers
  4. Models of Care: Leveraging digital technology as appropriate, selection of a care delivery model based on collaboration and communication among all health care providers, payers, consumers, and community resources that contribute to individual consumers’ health and well-being
  5. Consumer Engagement: Connection and engagement between external stakeholders (consumers) and organizations (company or brand) through various channels of correspondence. This connection can be a reaction, interaction, effect, or overall customer experience that takes place online and offline.

Maturity and Organizational Evaluation

An example of the progression in organizational competency within each dimension is shown below, focusing on the most important dimension: Leadership Strategy and Commitment.

Value based care domains establish a critical foundation for assessing progress.  Organizations can then begin to evaluate their maturity within each domain. Atos is developing an innovative algorithm to rank organizational maturity within each domain, as seen in the following chart:

This type of insight helps healthcare leaders to think more strategically about where they invest and how they prioritize the many competing initiatives that impact value based care. This strategic view often results in new operating models and elucidates new ideas, innovative approaches, and ultimately better outcomes for consumers, both inside and outside of the healthcare system.

Atos believes that the digital transformation in healthcare is facing three shockwaves:

  1. Shockwave 1: Requires leaders to rationalize and streamline existing systems, notably through real-time clinical delivery and an EHR, in addition to the integration of financial, revenue cycle, and clinical data to fully understand care quality and costs that impact overall revenue and the organization’s financial viability
  2. Shockwave 2: Interconnect and increase collaboration between all ecosystem players, notably through collaboration and digital solutions. Deeply analyze and optimize treatments with new big data and cognitive technologies for population health (achieve early detection of epidemics, discover new risk factors, uncover new treatments, etc.). This is also at the heart of the research in which Atos is participating.
  3. Shockwave 3: Leverage the latest advances in artificial intelligence, machine learning, and genomics analysis. Leverage high performance computing solutions to enable precision medicine. This is probably the most striking advance on the healthcare horizon.

It will be no small feat for organizations to navigate these shockwaves, respond to ongoing payment reform, and address a changing consumer population; it will require discipline and focus. A complete, thoughtful approach will enable healthcare organizations to move from systems of reactive, disconnected care to a global health system that supports individuals throughout their lives.

About the Authors:

  • Mary Sirois is the Vice President of Integrated Solutions Delivery, focused on population health and value-based care services and technology delivery across all of Atos’ solutions. In addition, Ms. Sirois is a member of the Atos Scientific Community.
  • Heather Haugen is the Chief Science Officer for Digital Health Solutions for Atos.
  • Inbal Vuletich serves as the editor for Atos Digital Health Solution publications.

About Atos Digital Health Solutions
Atos Digital Health Solutions helps healthcare organizations clarify business objectives while pursuing safer, more effective healthcare that manages costs and engagement across the care continuum. Our leadership team, consultants, and certified project and program managers bring years of practical and operational hospital experience to each engagement. Together, we’ll work closely with you to deliver meaningful outcomes that support your organization’s goals. Our team works shoulder-to-shoulder with your staff, sharing what we know openly. The knowledge transfer throughout the process improves skills and expertise among your team as well as ours. We support a full spectrum of products and services across the healthcare enterprise including Population Health, Value-Based Care, Security and Enterprise Business Strategy Advisory Services, Revenue Cycle Expertise, Adoption and Simulation Programs, ERP and Workforce Management, Go-Live Solutions, EHR Application Expertise, as well as Legacy and Technical Expertise. Atos is a proud sponsor of Healthcare Scene.

New Reporting and Interop Features Hit The Right Note for PointClickCare

Posted on November 6, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

The new reporting and data sharing capabilities of PointClickCare‘s LTPAC EHR platform were a big hit with the 2,000 users gathered on Day 1 of the company’s annual #PCCSummit18 being held in Nashville TN.

In the opening session, Co-Founder and COO of PointClickCare, Dave Wessinger, bravely walked through the company’s new report engine in a live demo. He started by showing off the new searching capability that will allow users to quickly find the report they need by simply typing a keyword into the search bar. Any report with a matching word in its description appears in the results. This one feature replaces dozens of weekly calls to systems administrators who have to help end-users find the right report to run because the current system has limited ability to organize and find reports. There was an audible “Yes” and collective fist pump from many in the audience.

Wessinger then went on to demonstrate the new data visualization tools and data export capabilities in the report engine.

“The export capabilities alone are a game changer for me,” said Timothy Carey, Director of Data and Performance Analytics at BaneCare. “Right now it’s not that easy to export data from a report into Excel where it can be further analyzed or combined with other data sources. The new export capabilities will cut out many hours from our work week.”

Skilled Nursing Facilities (or SNFs) like BaneCare have to produce detailed reports on the patients (residents) that are transferred to them from their acute care partners. These reports are required by the case managers at the acute care organizations – who need them to ensure their patients are getting the post-acute care their physicians prescribed.

“Having the right data and providing it quickly to our acute care partners is what differentiates us from competing facilities,” continued Carey. “The goal is to be the preferred LTPAC partner to acute care organizations and being able to provide timely data is a key criteria of being a good partner. Having good data also helps our own organization determine where to invest additional resources.”

BJ Boyle, VP of Product Management at PointClickCare followed Wessinger on the main stage where he proceeded to give a live demonstration of the company’s new data sharing module called Harmony. Harmony was first announced at HIMSS18 and was something Boyle and I spoke about in this interview.

One of the main components of Harmony is a customizable dashboard that allows case managers at acute care organizations to see how their referred patients are faring at the SNF. Through Harmony, the case mangers and SNF staff can see the same patient data in real-time. This allows for unprecedented collaboration between the organizations.

“Right now we spend a lot of time making phone calls, sending emails and in meetings with our acute care partner,” said Cyndi Howell, Lead RNAC and PCC Clinical Liaison at Willow Valley Communities. “This is needed to keep each organization informed of what’s happening with patients that we are both responsible for. We do it because we are both committed to providing the best care possible. We love working collaboratively with our partners at Lancaster General Hospital (part of Penn Medicine). It’s just what we have to do to take care of people in our community.”

When Willow Valley Communities implements Harmony, they will no longer have to manually pull data from their PointClickCare system in order to facilitate the discussions with Lancaster. Instead, staff from both organizations will simply log onto Harmony and view the same data together in real-time.

“We are very excited and happy about Harmony,” explained Howell. “It’s going to make all our lives so much easier and patients will end up benefitting from better and more coordinated care.”

The real-time dashboard isn’t the only feature of Harmony. The module also featured a robust data integration engine, powered by Redox, that will allow PointClickCare to quickly connect it’s cloud-base system to EHRs at acute care organizations.

“PointClickCare wanted to get off the integration treadmill,” said Boyle. “It simply wasn’t scalable to connect to each hospital system one by one. We are happy to partner with our friends at Redox and leverage the power of their engine and the network of providers/vendors they work with.”

Through the Redox engine, patients transitioning from an acute care organization to a SNF or other LTPAC facility will have all their data seamlessly sent as part of the discharge process. No more faxes or paper-based binders of medical information.

“Part of our vision is for everyone in healthcare to have a complete view of the patients they are taking care of,” stated Luke Bonney, CEO and Co-Founder of Redox who presented with Boyle in a breakout session later on Day 1 of #PCCSummit18. “That can only happen when every member of the healthcare ecosystem can share data in an easy way and in a format that is meaningful to everyone involved.”

Luke Bonney, CEO at Redox (left) and BJ Boyle, VP Product Management at PointClickCare

“I am totally bought into the vision,” said Carey. “All of us here at BaneCare want patients to have the best possible experience while in our facilities. That means we need all the relevant information right at the point of transition from the acute care organization – medications, care plans, etc. Harmony will automate this entire step.”

I must admit I did not expect to meet so many people here at #PCCSummit18 who were excited about interoperability. I was also truly surprised that there are so many organizations actively working together on practical interoperability use cases that are true win-win-wins (for acute care organizations, LTPAC facilities and patients).

But then again, when you are in Nashville (aka Music City) you’d expect a little harmony.

Many Providers Lack Dedicated Budget For Connected Medical Device Security

Posted on November 5, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new vendor survey has concluded that while most providers haven’t dedicated much of their budget specifically to managing and securing connected devices, most are convinced they have the situation under control.  Rightly or wrongly, this seems to be part of a larger picture in which support for connected health devices hasn’t matured as much of the rest of the IT infrastructure.

The survey, which was conducted by Zingbox, developer of a healthcare Internet of Things analytics platform, collected responses from about 200 healthcare IT professionals in 200 clinical/biomedical engineers in the U.S., weighting results to US census levels for age, gender, region, and income.

According to Zingbox researchers, 87% of healthcare IT professionals responding to the survey said they were confident that their connected medical devices were protected from cyberattacks, and 79% said that their organization had real-time information of which on these devices might be vulnerable to cyberattacks.

Also, 69% said they believe that existing security solutions using secure laptops and servers were capable of securing their connected medical devices. Not surprisingly, the vendor’s report argued that this may not be the case, given that they aren’t designed to support on-device security solutions like anti-virus software, and that the blocking ports or protocols via gateways lead to problems that include device malfunction.

When asked whether their organizations had a budget allocated specifically to securing connected medical devices, 53% said yes, and that the amount was sufficient, while 41% said no, that they didn’t have dollars allocated to the problem or hadn’t set aside enough dollars. (I’d be interested to know how they decided whether their device security was adequate; given the relative youth of this category their standards might be worth a look.)

Meanwhile, roughly 85% of clinical/biomedical engineers said they were confident they had an accurate inventory of connected medical devices in their network, with 64% of respondents noting that such device inventories were completed manually. Thirty-four percent said they did a manual room-to-room audit to get this job done, and about 30% said they did static asset management.

To determine which devices were in use, 55% of respondents said they did so manually, while 38% said they used an automated solution. Of those clinical/biomedical engineers doing manual checks, 28% walk over to the device location to check in person, and 27% find out by contacting someone.

To keep these devices online, 73% of these engineers said they conducted maintenance on a fixed schedule, including 29% that followed manufacturer recommendations, 27% adhering to internal schedules and 17% taking a cue from reseller recommendations.

Five Guiding Principles for Leveraging the Healthcare Contact Center

Posted on November 2, 2018 I Written By

The following is a guest blog post by Mike Wisz, Director, Analytics – Healthcare, Advisory Services, and Melissa Baker, Business Analyst, Healthcare, Advisory Services, at Burwood Group.

Consumer experience is more critical than ever for healthcare organizations. Today, the financial performance of health systems increasingly depends on converting consumers into patients and retaining patients within network—patients who now have expanding options for urgent, primary, and elective care. A contact center is a critical component of an inviting “digital front door” for consumers—which is why forward-looking healthcare organizations are envisioning how to transform call centers into patient engagement centers.

As part of an enterprise approach to patient access and experience, each organization will chart its own path in building out contact center capabilities. Healthcare CEOs increasingly recognize that consumers want to interact with their healthcare services as they do with companies in other industries, such as retail or hospitality.

The following are five guiding principles for developing a consumer-grade contact center experience.

First do no harm.

A poorly performing call center can result in frustrated patients or guests whose experience prompts them to look elsewhere for services. So first, deal with current problems, even if they are not easily discoverable. Using all available data sources, assess call handle times, customer effort required, and call routing accuracy against established targets or external benchmarks. If service levels are not acceptable, these problems must be resolved.

Make it easy for patients to connect.

Health systems should make it very easy for customers to access services using their preferred channel of communication. This access should be aligned from the customer’s perspective across touchpoints such as consumer-facing websites, patient portals and self-scheduling applications, and mobile applications offered to patients.

Remember: Productive agents create happy customers.

Consolidating contact center operations should result in more efficiency. Improving efficiency while offering additional services across more medical groups requires automation. Domain-specific knowledge support including scripts and protocols, empowers agents to rapidly resolve service requests. Skills-based routing gives managers the ability to staff flexibly while ensuring target service level performance. Desktop integrations with scheduling, billing, and clinical systems inform agents of highlighted information to reduce contact handle times and increase first-contact resolution rates.

Focus on outcomes. Measure and monitor.

Identify the business outcomes that are most important to determining success. These will likely focus on customer experience, agent productivity, and overall operational effectiveness. Many KPIs and metrics can be measured, but pick a few that will highlight performance against your most important outcomes. Ensure reports are available that provide visibility into key metrics and that reporting is timely enough to be actionable.

Align to enterprise vision and objectives.

It is not always clear in healthcare organizations who owns the “consumer experience.” Leaders from groups representing marketing, population health, clinical quality, and revenue cycle management should align and work together to ensure the contact center serves as a vital component of the organization’s comprehensive approach to patient experience.

In this new environment driven by consumerism, competition for patients will only continue to escalate. Successful health systems will learn to better leverage their contact centers as a way to attract and retain patients and optimize physician utilization, and to tackle a complex set of new challenges.

About Burwood Group
Burwood Group, Inc. is an IT consulting and integration firm. We help forward-thinking leaders design, use, and manage technology to transform their business and improve outcomes. Our services in consulting, technology, and operations are rooted in business alignment and technical expertise in cloud, automation, security, and collaboration. Burwood Group was founded in Chicago, IL and is celebrating over 20 years in business. Today, Burwood includes 250 employees and seven U.S. offices including a 24×7 Operations Center in San Diego, CA. Whether you are developing strategy, deploying technology, or creating an operational model, Burwood is a dedicated partner. To learn more, visit www.burwood.com.

Hospitals Sharing More Patient Data Than Ever, But Is It Having An Impact On Patient Care?

Posted on November 1, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Brace yourself for more happy talk in a positive interoperability spin, folks. Even if they aren’t exchanging as much health data as they might have hoped, hospitals are sharing more patient health data than they ever have before, according to a new report from the ONC.

The ONC, which recently analyzed 2017 data from the American Hospital Association’s Information Technology Supplement Survey, concluded that 93% of non-federal acute care hospitals have upgraded to the 2015 Edition Health IT Certification Criteria or plan to upgrade. These criteria include new technical capabilities that support health data interoperability.

Today, most hospitals (88%) can send patient summary of care records electronically, and receive them from outside sources (74%), ONC’s analysis concluded. In addition, last year the volume of hospitals reporting that they could query and integrate patient health data significantly increased.

Not only that, the volume of hospitals engaged in four key interoperability activities (electronically sending, receiving, finding and integrating health data) climbed 41% over 2016. On the downside, however, only four in 10 hospitals reported being able to find patient health information, send, receive and integrate patient summary of care records from outside sources into their data.

According to ONC, hospitals that work across these four key interoperability domains tend to be more sophisticated than their peers who don’t.

In fact, in 2017 83% of hospitals able to send, receive, find, and integrate outside health information also had health information electronic available at the point of care. This is a 20% higher level than hospitals engaging in just three domains, and a whopping seven times higher than hospitals that don’t engage in any domain.

Without a doubt, on its face this is good news. What’s not to like? Hospitals seem to be stepping up the interoperability game, and this can only be good for patients over time.

On the other hand, it’s hard for me to measure just how important it is in the near term. Yes, it seems like hospitals are getting more nimble, more motivated and more organized when it comes to data sharing, but it’s not clear what impact this may be having on patient care processes and outcomes.

Over time, most interoperability measures I’ve seen have focused more on receipt and transmission of patient health data far more than integration of that data into EHRs. I’d argue that it’s time to move beyond measuring back and forth of data and put more impact on how often physicians use that data in their work.

There’s certainly a compelling case to be made that health data interoperability matters. I’ve never disputed that. But I think it’s time we measure success a bit more stringently. In other words, if ONC can’t define the clinical benefits of health data exchange clearly, in terms that matter to physicians, it’s time to make it happen.

The Wisdom of Yogi Berra in Medical Benefit Appeals

Posted on October 31, 2018 I Written By

The following is a guest blog post by Keith J. Saunders, Esq., Founder & CEO of FHAS.

“This hearing will now come to order.  For the record, today’s date is…and the following parties are present…”

I have repeated this sentence thousands of times over the past twenty three years while serving as a hearing officer for the Federal Medicare program and as an Administrative Law Judge (ALJ) for the Commonwealth of Pennsylvania Medicaid program.  Serving as an adjudicating official for medical benefit appeals can provide one with a unique perspective on human nature and the shortcomings of the medical appeals process. 

In this post, I would like to share three takeaways from my experience in order to assist you in being a successful participant in the appeals process, whether you participate from the side of the payor or appellant.

Know the medical facts.

My first piece of advice is inspired by a quote from the great New York Yankees baseball player and manager Yogi Berra: “You can observe a lot just by watching”.  Most participants in medical benefit appeals fail to perform the requisite watching.

If you are going to successfully defend or pursue your appeal, you must know the medical facts of the case. This might seem obvious, however you would be shocked to learn how many times a claim denial is appealed and it is very apparent that the parties don’t know or understand the condition of the patient, underlying the facts of their case. For medical provider appellants who are part of large health systems, the need to survey all records within your system pertaining to the subject of the appeal is critical.

For third party payers it is likewise critical to ensure that you possess a complete understanding of the condition of the patient.  I once presided over a hearing where the health insurer was challenging the necessity for the patient to have a wheelchair.  They indicated that the medical information submitted with the claims failed to indicate that the patient could not walk.   If they had performed a survey of the medical records contained within the file they would have ascertained that the patient was a bilateral AKA. For those of you who do not frequently traverse through medical records, this acronym stands for bilateral above the knee amputee; this patient had no legs.

Understand why the claim was denied.

Turning again to Yogi Berra for my second piece of advice: “You’ve got to be very careful if you don’t know where you are going because you might not get there.” In order to be an effective advocate for your position, you must thoroughly understand why a claim for reimbursement has been denied by the third party payor.  One of the most frequent bases advanced for denials in both the Medicare and Medicaid programs is the blanket catchall basis of, “a lack of medical necessity”.  This basis is utilized to deny submitted claims which lack a valid physician’s signature on the order, claims which fail to meet specific medical necessity criteria, or even claims that were not submitted in a timely manner.

As an appellant, you must possess a thorough understanding regarding what has transpired from the reimbursement standpoint, end of story.  If you are an appellant, please read the basis for the claim denial being put forth by the third party payer. To take my Yogi quote further, it is impossible for you as an advocate to get where you want to go, that is, get paid, if you do not know why the claim has been denied. When you as an appellant receive a denial notice, whether it is an explanation of benefits or a remittance advice, review the basis for denial.  If it indicates that critical medical necessity evidence is missing, review your records to find it.

Arguments that the medical policy is foolish or that the payor doesn’t understand what the patient needs may make you feel better for having given the adjudicator a piece of your mind, but are ultimately ineffective. I once had an appellant argue to me that requiring a physician’s order was a foolish requirement for an orthotic device.  When I asked the gentleman making that arguments how a payor was to ascertain if an item was medically necessary, he indicated that they should just ask him, the vendor.  Needless to say that was not an effective argument.

If you have received a blanket denial, such as a lack of medical necessity, please reach out to the third party payor to ascertain what exactly is missing or unclear.  Once you have determined what the problem is, you are then in a position to solve it.

Know the coverage and payment guidelines.

My final recommendation is that you acquire an in-depth knowledge of the coverage and payment guidelines or medical policies which govern the items or services for which you are seeking payment.  As a hearing officer or ALJ, I would find myself frequently asking appellants or payor representatives to furnish the basis within the policies for the denial of items.  More often than not on both sides of a case, neither party could articulate why an item should or should not have been paid.

I suppose in those situations they turned to another quote from Yogi: “If you ask me a question I don’t know, I’m not going to answer it.” Today there is no reason for any party to be unaware or unknowledgeable regarding medical policies or coverage and payment guidelines. All commercial health insurers and government programs, such as Medicare and Medicaid, publish their policies online.  Knowledge of the rules is one of the cornerstones to being a strong advocate for your position. From the provider standpoint, it is one of the critical components needed in order to have an item covered by a payor.

My advice may seem rather basic, but years of experience have shown me that it is a failure to address the fundamentals which causes most claims to be denied. In summary: 1. Know your patient and the medical records surrounding a claim; 2. Know the facts surrounding why reimbursement has been denied; 3. Know the rules which govern payment criteria for your claim.

If you pay attention to the foregoing you will be a much stronger advocate for your position and will likewise achieve and maintain a higher success rate in your appeals. In medical benefit appeals, as in baseball, “It ain’t over until it’s over.”

About Keith J. Saunders, Esq.
Keith J. Saunders, Esq. is the Founder & CEO of FHAS, a leading provider of medical review analytics and support services to government and commercial sectors. Weaving together over 30 years of experience working on behalf of health plans, providers, and government agencies, Mr. Saunders furnishes his clients with valued-based solutions that minimize administrative waste, maximize return on investment, and yield holistic results for all stakeholders. A former General Counsel to Blue Cross Blue Shield Plans, Mr. Saunders was an Air Force Judge Advocate proudly serving in Operation Desert Shield/Desert Storm. Mr. Saunders attained his Juris Doctorate from Duquesne University and is a long-time member of the American Health Lawyers Association (AHLA).

About FHAS
FHAS, a URAC accredited IRO and ISO 9001 certified company, is one of the largest independent providers of “healthcare as a service” (HAAS) for government and commercial clients with a particular focus on adjudication services and medical claims’ review services. In 1996, FHAS began furnishing Medicare Fair Hearing Services to Durable Medical Equipment (DME) Administrative contractors located throughout the United States. Since that time, FHAS has expanded its scope of appeals services to include complex medical reviews for the following: Medicare Parts A, B, PDRC Appeals, and DME Appeals, internal and external health plan appeals, and the entire Pennsylvania Medicaid fair hearing process. FHAS utilizes a network of board certified physicians, legal professionals, and other healthcare professionals with diverse specialties, who have the expertise to render decisions for external review requests. In addition to professional services, FHAS provides enterprise-grade software solutions to healthcare and insurance industries. Their newest product Cogno-Solve is a comprehensive, RPA software platform that automates claims and appeals decision-making functions.

What Precision Medicine Is Today and Where Is it Heading?

Posted on October 30, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In our latest series of Healthcare Scene interviews, we had the chance to learn about precision medicine with Nino da Silva, Executive Vice President at BC Platforms. For those not familiar with BC Platforms, they’re a company that has been working in precision medicine for a long time and one thing that makes them unique is their ability to marry genomics with other clinical information.

In this interview, Nino shares more information about BC Platforms and the work they’re doing and then we dive into where he really sees healthcare organizations having success with genomics and precision medicine today. We also ask Nino what a healthcare organization’s strategy should be for precision medicine and whether precision medicine is going to just be something done by large organizations or if it will be accessible to healthcare organizations of all sizes.

Finally, we dive into what BC Platforms is doing to push genomic medicine to the point of care and what it will take to make this a reality everywhere. And then we ask Nino to take a look into his crystal ball and predict where precision medicine is heading in the future.

If you’re interested in precision medicine, what’s happening with it today and where it’s headed, you’ll enjoy this interview with Nino da Silva, Executive Vice President at BC Platforms

Be sure to check out Healthcare Scene’s full list of healthcare IT interviews and subscribe to the Healthcare Scene YouTube channel.

My MEDITECH MD and CIO Forum Experience

Posted on October 29, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently had the pleasure of attending the annual MEDITECH MD and CIO Forum. Not only was the venue and MEDITECH hospitality great, but they also ordered up beautiful fall weather for the event in Boston. Although, I have to admit that it must be intimidating to speak at an event hosted in the round. Luckily all of the keynotes really delivered (See my post about Ted James, MD’s keynote).

As long-time readers know, there’s almost nothing better to me than attending a user conference. At user conferences, you hear the “from the trenches” perspectives on what’s life really like on the front lines of healthcare and technology. In many cases, you listen to sessions and discussions at lunch that sounds like they’re speaking another language. For the most part, that’s basically what they’re doing. The language of an EMR user is really unique and different and it’s what makes an EHR user conference like this so special. Those attending speak the same language and are able to uniquely help each other.

Given users’ propensity to share the good, the bad, and the ugly, it was really great that MEDITECH invited me to attend their MD and CIO Forum. The good news for them is that I’ve been to enough EHR user forums that I’ve heard it all. Nothing really shocks me anymore and every EHR vendor has their challenges. In one session, someone commented on the 500 open tickets they had with support. I think it kind of scared MEDITECH that I was hearing this. However, I’d recently heard from someone using their competitor’s EHR who had 4000 open tickets. Only 500 tickets sounded quite good comparatively. Perspective and nuance really matter when you talk about problems. That’s something that’s often missed by many media these days.

While at the Forum, MEDITECH made a number of interesting announcements. Read on for details below and check out the 4 video interviews we live streamed from the conference on Facebook. The biggest announcement from my viewpoint was around voice enabling the MEDITECH EHR software. Together in partnership with Nuance, MEDITECH created a simple way for users to request information from the EHR using their voice and even to create orders. On the mobile side, they’re creating similar functionality in partnership with Google’s voice recognition. No doubt this is just the start of voice enabling the EHR.

It’s easy to see how voice will become really valuable if providers are able to get information and create orders while their hands are tied up examining the patient. MEDITECH was also smart about the voice created orders. It doesn’t just order things automatically but queues up those orders for the doctors to approve later. This is a common step we’ve seen smart vendors take when adding voice and other AI to the documentation process. We’ll see over time whether the accuracy and trust reach the point that this human verification process is no longer needed.

MEDITECH also announced a number of things around interoperability. First, outbound FHIR integrations are included in every MEDITECH EHR. Plus, they’re working on inbound FHIR integrations. They didn’t set a timeline on inbound integrations but they did say they’d be “coming soon.” MEDITECH also talked about their new API called MEDITECH Greenfield. If you want more information on Greenfield, be sure to read our interview with Niraj Chaudhry where we cover it in detail.

Another interesting announcement was MEDITECH’s new population health oriented integration with Arcadia.io. It’s great to see MEDITECH embracing outside third party data that can help their users provide better care to patients. Plus, the integration looked really seamless from a physician user perspective.

Another big takeaway for me came from a session on governance and end user buy-in. The takeaway was simple. Enduser buy-in and governance are a challenge regardless of what EHR system you choose. To get more specific insights into how to improve buy-in and governance in your organization, check out the live tweets I shared on the #MDCIO2018 hashtag on Twitter.

A few other observations from the event are that I don’t think most people appreciate what a huge step forward Expanse (their latest EHR platform) is for MEDITECH and their users. I’ve often written that there’s no one feature about EHR software that’s hard to implement. However, it’s the 1000 features you need to create a complete EHR that makes it such a challenge. It was a pretty brave thing for a 50-year-old company, MEDITECH, to go back and start nearly from scratch using the latest technology to create Expanse. That means that Expanse is still a work in progress where they’re adding features as fast as they can. However, it also is true that it might be the only EHR software that was built in the post-meaningful use era.

I was also surprised by a number of users I talked to who commented on how the price of MEDITECH really mattered to their organization. I’m not sure if these organizations had read the many stories of expensive EHR implementations damaging healthcare organizations financially or if they were just more fiscally conservative organizations. Either way, you could tell these users appreciated that MEDITECH charged a much lower price for their software than other EHR competitors out there.

All in all, I had a great experience at the MEDITECH MD and CIO Forum. Their users really reflect the culture of MEDITECH. They’re largely unassuming and just want to do what’s best for their patients. It was actually fascinating to see how the same cultures seemed to attract. No doubt, their users were still suffering from burnout like so many others. That’s common across all of healthcare. They also still had their long list of features and functions they wanted to be implemented. However, I have yet to attend an EHR user conference where that wasn’t the case.

Note: MEDITECH is a sponsor of Healthcare Scene.