News 4/9/13

From SensibleShoes: “Re: Walgreens. This is absolutely insane. Walgreens has no idea what they are doing but they just found a way to sell more of their drugs on their shelves!” Walgreens becomes the first retail store chain to to offer diagnosing and treatment for patients with chronic conditions. Walgreens officials say they are not trying to take over primary care but instead are offering patients more access points for testing and care management. The AAFP does not welcome the news, saying it’s difficult to manage care when patients are treated in various settings. I am sure that AAFP’s objections have nothing to do with the fact that the 300+ retail clinics are staffed by PAs and NPs and not FPs.

Baylor Quality Alliance (TX) selects Greenway Medical to participate in its EHR program, which aids community physician practices in the evaluation, selection, and implementation of EHR applications.

The producers of NPR profile several physicians in rural Missouri, most of whom lack the necessary funds to transition to EHRs. Many practices are turning to large health systems for financial support while older providers are choosing to opt out of EHRs and use paper records until retirement.

The Chicago HIT REC introduces LAUNCH, an extension of its EHR adoption and training assistance program and available to both primary care physicians and specialists.

American Medical News offers physicians some tips for buying an EHR the second time around. I agree that one of the first things practices should do before jumping into a new system is identify what went wrong the first time to avoid repeating mistakes. Providers then need to prioritize their buying criteria and commit fully to the sometimes painful implementation process.

The AAP and AHRQ develop a set of instructions for EHR vendors that defines functionality and more than 700 requirements that are considered essential to pediatrics.

E-mail Inga.

Bowtie Confidential 4/7/13

Revisiting Healthcare Service Line Strategy and Development

In the past 10 years, service line development has proliferated. The topic was on the cover of the latest HealthLeaders and has been presented at several industry conferences. The heart of the issue is the need to collaborate internally and develop an integrated approach to service line development  versus a siloed approach.

The intent of service line operations is to provide better quality of care with focused resources while managing costs in an effective manner. Typically, service lines are limited to a group of well-defined sets of services and/or interventions. Examples include orthopedics, surgery, cardiovascular services, and oncology. If designed well, they provide pathways to increased operational efficiencies and financial success.

Developing and implementing a service line requires a significant amount of planning. The planning effort needs to take into account ongoing monitoring, evaluating, and modifying operations. Key components of service line development include:

• Governance and organizational structure
• Executive sponsorship – alignment with organizational goals, objectives, and mission
• Physician sponsorship
• Capital budget allocation
• Market analysis (brand management, competition, community need, pricing/cost, ROI, etc.)
• Continuum of care process: vertical vs. horizontal care delivery
• Resource analysis and requirements (clinical, financial, operational, etc.)
• Patient/community input
• Workflow and dataflow analysis
• Data analysis and requirements
• Reporting metrics
• Systems and technology analysis
• Evaluation and tracking methodologies/processes

I have experienced changes in service line modeling over the past few years  — specifically, a trend from vertical to hybrid vertical/horizontal models, which leverage a multidisciplinary approach. Models continue to focus on improving the coordination of operations and data acquisition, which allows organizations and executives to analyze the health and status of the service line(s) for greater profitability and enhanced operations. This is predominantly due to changing regulations, policies, costs, information technology, and other environmental elements.

Strategically, service line thinking needs to be re-evaluated to gain the full benefits that it can offer. Physician, patient, and community participation needs to be considered and included. Clinical service lines provide an opportunity for a comprehensive integrated care delivery model. This model can address patient and community needs throughout the delivery process by enhancing clinical quality and patient satisfaction and simultaneously improving operational efficiency and lowering the cost of care delivered.

In addition, more organizational attention needs to be placed on data governance and management. If your organization is developing a new service line, I recommend the following action steps:

• Use the key component bullets above as an evaluation checklist
• Commit to a well-structured strategic planning effort
• Develop a data governance planning and management strategy
• Build in a periodic service line assessment that provides metrics and dashboards to leadership

The importance of data cannot be minimized or overlooked. Data governance, management, and infrastructure are keys to service line success. Data provides the eyes for information on populations, best practices, overall operations, improving patient experiences, etc. Without a well-structured data governance process, the quality of data and information is suspect, potentially leading to errors in critical decisions.

The key to success in service line operations is to rethink current service line operations and data management. Review current service line strategies, operations (tactics and metrics). Seek support and involvement from the organization’s constituency – physicians, executive leadership, community, staff, and others within the sphere of influence. Look for synergy and integration between service lines and providers to obtain the best path for efficiency, effectiveness, and improvements in the continuum of care (quality). Lastly, seek external support, guidance, and direction for industry best practices and strategy development.

Rob Drewniak is vice president, strategic and advisory services, for Hayes Management Consulting.

News 4/4/13

Vitera launches Intergy Mobile, the iPad companion app to Intergy EHR.

CMS provides updated stats on the MU program, which has paid EPs and hospitals $12.7 billion in incentives though the end of February. A few other interesting tidbits:

• Of the estimated 527,000 EPs, 384,000 (73 percent) have registered to participate
• Over 230,000 EPs have been paid $4.5 billion in incentives. That’s almost 44 percent of all EPs and 57 percent of those registered
• Drug formulary, immunization registries, and patient list are the most popular menu objectives for EPs; transition of care summary and patient reminders the least popular.

Seven New York practices using MEDENT EMR are live on the Southern Tier HealthLink’s RHIO platform and able to use protocols for the Direct Project.

A report from the American Academy of Pediatrics recommends adoption of e-prescribing systems with pediatric functionality, noting that pediatric data supports the role of e-prescribing in mitigating medication errors, improving physician-pharmacist communications, and improving medication adherence.

Nearly 40 percent of physicians are burned out, according to Medscape’s Physician Lifestyle Report. ER and critical care physicians express the highest burnout levels; pediatricians, ophthalmologists, psychiatrists, and pathologists were among the least burned-out.

CMS posts the 2011 PQRS and eRx Incentive Program Experience Report, which summarizes program trends, including  participation and penalties breakdowns by specialty and geographic region.

Rep. Jim Dermott (D-WA) asks HHS to consider renewing its safe harbor provision that allows hospitals to subsidize EHR technology for its affiliated physicians under the federal Anti-Kickback Statute. The provision is set to expire at the end of 2013.

One last plea: please take a moment to complete our annual HIStalk Practice reader survey. Thanks.

E-mail Inga.

DOCtalk by Dr. Gregg 4/1/13

Sunny Side Up? Nope. Scrambled.

I’ve started to see that the world healthcare information technology is just one big pile of scrambled eggs – metaphorically speaking, of course.

Consider the metaphor: scrambled eggs are an amorphous conglomeration of congealed albumen and yolk, nutritive albumin protein and embryo all swirled up into one, often incompletely cooked, goo. Scrambled eggs often have lots of other non-egg-related matter thrown in – like ham, or onions, or cheese, maybe some spices or a little milk – all swirled together and intermingling haphazardly.

Now, compare and contrast time:

Consider the cooked egg world’s opposite – the sunny side up egg. It also may be incompletely cooked sometimes, but it is a structural antonym to its scrambled cohort. It has the lovely yellow yolk nestled serenely in the center, caressed and protected by the surrounding proteinaceous white. The two components are discrete, yet complementary. Together they make the dish, but their borders are well-defined.

Either scrambled or sunny side up eggs can be cooked fully or served up with just a touch of “slime” left. Some folks prefer the drier, “well done” type while some of us are happy with a little remaining mucusy texture. (I admit it sounds less appetizing when written as such.)

Now, metaphor hop back with me to the world of HIT:

Look through the multitude of realms which HIT involves or touches: healthcare, technology, legislative, financial, legal, and more. All of these can be further broken down into subgroups such as mHealth, telehealth, inpatient, outpatient, e-patient, privacy and security, insurance and billing, regulatory, education, etc. Each of these can be subdivided even further into things like mobile apps or client server tools, real-time or store-and-forward, acute care or long-term care, primary care or urgent care, empowerment or engagement, HIPAA or data sharing, and so on and so on and so on.

There is nothing about MU or HITECH or HIT (or, perhaps, even US healthcare in general!) that comes even close to a sunny side up, well-defined and harmonizing balance of distinct collaborative elements. It’s a mishmash. It is one giant pan full of goo and goop and value-add ingredients all churning about and “intermingling haphazardly.” And, it’s anything but fully cooked; there’s a slew of slime.

I know lots of well-intentioned folks are busy trying to get some regulations and some standards into place to help define and refine the hootenanny of interplaying elements in the enormous HIT space. And that’s probably good. But when I look around the massive HIT frying pan, I’m pretty sure we’re going to have to be happy eating our “eggs” scrambled for quite some time – and with plenty of mucus.

It’s been said that you can’t put toothpaste back in the tube. You actually can, but it’s a major pain in the tukhus. Similarly, it’s pretty near impossible to unscramble your eggs.

If the good folks trying to regulate and standardize are trying to regenerate sunny side up HIT eggs from our current scramble…well, doubtful. If they’re trying to harmonize the ingredients…well, that’s probably possible.

Of course, we could always throw away the current batch and start – more gently – with some new, fresh “eggs.”

(Yeah…right.)

From the trenches…

“The world is wrong side up. It needs to be turned upside down in order to be right side up.” – Billy Sunday

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 4/2/13

Rep. Diane Lynn Black (R-TN) proposes legislation that would amend certain requirements and penalties for the MU program. Some of the provisions  in the Electronic Medical Records Improvement Act include:

• An option for certain providers to participate in specialty registries that offer real-time data instead of reporting on nine or more clinical quality measures
• A shortened reporting period for Medicare EHR payment adjustment applications from two years to no more than one year
• An exemption from penalties in years 2015 to 2017 for EPs who are solo physicians or near retirement
• The ability for rural healthcare providers to be defined as EPs and participate in the MU program
• A more formalized appeals process for providers that receive penalties

Our HIStalk Practice reader survey will be open for just a few more days. Your feedback is important to us, so thanks for taking a moment to answer a dozen easy questions.

Legal experts recommend that physicians pay closer attention to requirements under the Americans with Disabilities Act (ADA) as practices shift to EHRs and other computerized tools. To avoid violations and lawsuits, providers must consider whether such tools as online scheduling, bill payment, or Webcasts will accommodate disabled patients and employees.

St. Louis Oncology will implement Benchmark Systems’ practice management system.

More physicians are suing former patients and their relatives over negative ratings and reviews posted on the Internet. Personal blogs, as well as consumer-driven Websites like Angie’s List and Yelp, allow patients to write critical comments about their physicians. Some lawsuits have resulted in patients removing the negative comments; other cases were dismissed because judges ruled that patients’ comments are protected under the First Amendment. Sounds like the real winners here are the attorneys.

E-mail Inga.