News 4/1/14

The one year delay for the mandatory implementation of ICD-10 is almost a done deal following the Senate’s approval of the legislation on Monday. The bill primarily addresses a Sustainable Growth Rate fix that prevents a 24 percent reduction on physician Medicare payments as of April 1 and will now go to the President for signature. I wonder how many of the 535 voting members of Congress had a clue that the legislation included the ICD-10 date change, much less understood its potential impact to the industry. For all the gloomy predictions about disruptions in cash flow and lack of readiness by various stakeholders, shifting the deadline will come with a whole new set of issues and expenses. For example, what about all the ICD-10 ready software releases that likely include unrelated enhancements? Will vendors have to invest more money to re-engineer updates so that the unrelated enhancements work with ICD-9? And then there is the question of how we can wait one more year without having a specific code for things like being hit by an object falling from an aircraft (V96.31XA) or for an injury caused by a sea lion bite (W56.11XS).

Specialists who are late in adopting EHRs may struggle to meet the patient portal requirements to satisfy Stage 2 MU requirements, according to a study published in the American Journal of Medical Quality. Researchers found that 87 percent of primary care physicians would have met the email communication threshold for Stage 2 in 2013, but only 37 percent of specialists, probably because specialists that don’t provide chronic care generate fewer emails. The authors conclude that other avenues of patient engagement, such as providing patient education or online post-op instructions, would be more appropriate for specialists. This particular Stage 2 requirement is just one of several that is well-intentioned but difficult, if not unrealistic, for specialists to achieve. Is it any wonder that a significant number of specialists are predicted to “drop-out” of the MU program before attesting for Stage 2?

HHS releases a security risk assessment tool for small to medium physician practices. It’s available for the desktop, iPad, or as Word documents and produces a report that can be provided to auditors.

Insight Software will integrate DrFirst’s Rcopia e-prescribing platform into its My Vision Express EHR.

Through February, 2014, a total of 343,204 EPs have been paid $4.4 billion in MU incentives under Medicare,  $2.7 billion under Medicaid, and $315.7 million under Medicare Advantage.

From across the pond: 60 percent of GPs in European Union nations were using eHealth tools in 2013, a 50 percent increase since 2007. Interoperability issues, a lack of regulatory framework, and inadequate resources are some of the most common barriers to adoption (sound familiar?) The Netherlands, Denmark, and the UK led other nations in efforts to digitize patient records.

Best Doctors, which offers remote second opinion services, launches Medting, an online physician collaborative platform that allows doctors to collaborate to make correct diagnoses and to seek guidance for patient treatment plans.

The Government Accountability Office recommends that CMS expand performance benchmarks that assess Medicare physicians to include state or regional averages. In addition, as CMS implements and refines its physician feedback and Value Modifier programs, it should follow the example of private entities that use multiple benchmarks and should disseminate feedback reports more frequently than once a year.

An Alabama legislator reads a letter from constituent Marlin Gill, MD, who clearly is not a big fan of Washington and its “war on doctors.” I wonder how many other physicians share his views and believe all the government’s various initiatives to improve quality and trim costs is wasted effort.  Among his list of complaints:

• Being “forced by ill-informed bureaucrats to implement electronic medical records” that cost is four doctor practice “well over $100,000 plus continuing yearly operational costs . . . all of which does not help take care of one patient while driving up the cost of every patient’s health care.”
• “Destructive regulations” that add costs and “force doctors to focus on things other than patient care and reduce the number of patients we can help each day.”
• The cost of migrating to ICD-10, which is costing his practice $80,000 “without one iota of improvement in health care quality.”

Email Inga.

DOCtalk by Dr. Gregg 3/31/14

HIT’s Next Big Role

MU has done its duty. Providers are adopting EHRs.

Patient charts are no longer merely a massive collection of indecipherable scribbles within mountains of paper. Great. Providers are digitizing. Great. Healthcare data is becoming mineable. Great. But what movement in the outcomes needle has been driven?

Notes in legible digital format are of little more value than paper records if EHR X can’t share digitally equivalent data with EMR Y. Digital data is worthless without aggregation, analytics, and evaluative proceedings.

Thank goodness HIEs are starting to connect, even though mostly with hospitals thus far. But, we are finally starting to see signs of data sharing, and buzz terms like “data analytics” and “big data” are replacing “meaningful use” and “interoperability.”

As a whole, EHRs may not be beautiful, nor fully functionally friendly, but that’s mainly an issue of refinement. As a whole, our collected data isn’t very well connected, but that’s a “yet” thing; it’s happening. Data input and capture, data sharing, and data analytics are important – nay, vital – to changing healthcare, to be sure. Most of these are on a roll, and there are some up-and-comers in process to take this data and its analyses to exciting new heights. The challenges of grabbing and scrutinizing data are becoming overcome.

Well then, now that we’re seeing reports of some 60% or so of providers gathering data digitally, and now that HIEs are starting to show signs of respectable life beyond the mostly (or wholly) defunct RHIOs and CHINs, the question becomes: what’s the next big step for HIT? If changing healthcare is all about improving outcomes – and who can argue that good outcomes should always be the goal for healthcare? – will digitized data and its analyses be enough to drive us to, and through, that hoop? (Can you tell I’ve been catching some March Madness?!) Will better measurements yield better results?

Maybe. Some, anyway. I’m a huge fan of smart data used smartly. However, we’re talking about human beings here, not just manipulable metamessages and figurable facts.

People are full of subtext, subplots, and subtly subversive subterfuge, especially when it comes to lifestyle choices, and healthy – or non-healthy – behaviors. We all have our daily rationalizations and self-interest self-deceptions. We say we want one thing, but proceed to act in complete contraindication to that end.

HIT’s next big challenge will be more about the marketing to, and motivation of, the men and women of healthcare, both in front of and behind its delivery. How do we persuade human beings to change their health habits, and healthcare delivery habits, given the inherent difficulties of being human?

How will the 40% of providers not yet on EHRs become driven to adopt? Obviously, the MU carrot-stick thing hasn’t been enough.

How will we motivate independent or non-institutional providers to connect to HIEs? There won’t be any more MU-esque goodwill monies flowing from the feds.

How will providers be motivated to continue to collect data? It seems inefficient to think that “prizes” and “beatings” (i.e., carrots and sticks) will suffice to keep the data collectors feeding the data miners.

How will providers be inspired to change communication habits (with other providers and with patients) and alter longstanding workflow patterns to capitalize on the new values that connected HIT can bring? Change is hard, even if it’s good change; changing habits is even harder.

Lastly, how will Jane and Joe Sixpack become aware of the advantages of connected data and motivated to both gather and share it? Beyond the tech-heads, fitness-buffs, early adopters, and fad-focused, there’s a whole wall of folks that will need inspiration before the full-bore, major-shift, healthcare-change tipping point is reached.

This challenge – the inspiration of consumers – may just be the key to all the rest. If HIT can motivate and massage consumers to become fully actualized healthcare participants on a grand scale, their participation will spur the remaining provider change.

Providers are inspired by need; they respond to it. That’s what got most healthcare folks into the field in the first place. If consumers of health services display or voice a specific need to their healthcare providers, their providers respond. That’s what they (we) do.

Here’s where HIT has its next big role. We must develop more user-friendly patient portals, portals that are less one-way, more interactive, and which become integral to the consumers’ thought processes for healthcare information and communications. We must tie these portals to the nascent but burgeoning world of wearable tech and smart phone tools that measure body metrics and provide insights into behavior patterns. Then, we must bring HIT analytics into the mix to enable a massive shift in personal health data that can be aggregated and utilized for both provider scrutiny and patient empowerment. And, it’s imperative that dashboards presenting this info be made human eyes-friendly.

Consumers need a new, friendly, non-intimidating healthcare face. They have had enough of the world of medicine’s non-transparency and egoism. They want to understand health issues without obtaining a degree in medical terminology. The whole patient empowerment movement arose from such needs.

If HIT steps up to help fill that order, consumers will find unprecedented empowerment. When they do, they will begin to spur their providers with new needs to which the providers must, by training and by inclination, respond. If healthcare consumers start expecting easier, more understandable access to healthcare data, if they begin to demand simpler communications via IT, if we all share with our healthcare providers the need to empower us as partners, not paternalized patients, then providers will respond. As I said: that’s what providers do.

The unadopted providers will adopt or die. The unconnected will connect or fail. The old style communicators will learn new methods or face extinction.

HIT can motivate change in consumers that will drive transformation in providers. That’s its next big role. When the men and women both behind and in front of healthcare delivery are playing together in a friendlier and more equitable sandbox, well, that’s when the outcomes needle starts its shift.

From the trenches…

“Step with care and great tact, and remember that Life’s a Great Balancing Act.” – Dr. Seuss

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 3/27/14

A newly posted bill to patch the SGR for 12 months includes a minimum one year delay for the adoption of ICD-10. The bill, which was negotiated by House and Senate leaders, is expected to go for a vote Thursday, March 27,  four days ahead of a scheduled 24 percent cut in physician Medicare pay. If passed, the ICD-10 adoption date will be pushed until October 1, 2015 and legislators would have another year to pass a permanent repeal of the SGR payment provision. AHIMA quickly announced opposition to the ICD-10 delay saying it will cost the industry money and wasted time implementing the new code set. Can I just say I am tired of all the politics? Few people want to see doctors getting a 24 percent pay cut so look for the legislation to pass and ICD-10 to be delayed – unless the ICD-10 provision is somehow stripped from the bill.

Aprima Medical and Etransmedia announce an upgrade program for Etransmedia customers using the Allscripts MyWay platform. Etransmedia customers, which include providers that purchased MyWay through Costco, have the option to become an Aprima client, or, to use the Aprima system but remain a hosted client of Etransmedia. Both options provide current Etransmedia customers with one free Aprima licenses for each existing MyWay license.

Surescripts awards e-MDs its White Coat of Quality award for applying best practices to the use of e-prescribing technology.

The 220-physician Summit Medical Group (TN) names Ed Curtis (Hattiesburg Clinic) COO and Joseph Ortiz (4D Imaging Systems) CIO.

CMS reminds Medicare EPs that the deadline to attest for MU to receive a 2013 incentive payment is March 31 at 11:59 p.m. ET. The deadline for Medicaid EPs varies by state. This part of the notice is a bit troubling:

Due to the large volume of providers attesting, please submit your data as soon as possible and during non-peak hours to avoid system delays.

CareCloud launches CollectiveIQ, a billing rules platform that is embedded within the CareCloud platform to improve claims accuracy.

Athenahealth adds Precyse University to its More Disruptive Please program and will offer users access to Precyse’s ICD-10 educational tools.

The American Academy of Ophthalmology launches IRIS Registry (Intelligent Research in Sight), a centralized data repository and reporting tool that aggregates outpatient clinical data from EHRs for practice benchmarking, for monitoring patient care, for tracking interventions, and for evaluating outcomes.

More medical schools are expected to include some EHR requirements in their curricula because the exposure to IT systems is increasingly considered a crucial element of the medical education experience.

California Health Report looks at EHR adoption among the state’s physicians and clinics and finds the process is not always smooth. Implementation issues are related to technology and to human factors and most physicians take two years to become competent on EHRs. An official with the California Healthcare Foundation notes, “there’s still a lot of room for improvement.”

A local paper profiles Sanford Health’s (SD) e-visit program, which is available to  patients for $55 and connects them with a Sanford provider who will prescribe medications and/or offer medical advice within four hours. Currently the only patients eligible for e-visits are adults enrolled in the clinic’s MyChart patient portal program who present with one of seven non-emergency conditions.

Email Inga.

DOCtalk by Dr. Gregg 3/26/14

Is Being OK OK?

In the fields of healthcare and technology, perfection is essential. In healthcare, anything less may get you sued. In the tech world, if it doesn’t get you sued, you certainly won’t be in business for long if your tech offerings are filled with glaring flaws. (Imagine how long you’d keep using your iPad or smart phone if it remained annoyingly glitchy.)

Contrast this with the popular mantra, “Don’t let perfection become the enemy of the good.” This is such a perfectly human sentiment; it recognizes both our penchant for overthinking and our inherent inability to ever be truly perfect.

Whether you’re OK with “OK,” “O.K.,” “ok,” or “okay,” being OK implies acceptability. It implies good enough. It implies sufficiency. It implies decent. But, is it OK in healthcare IT to be OK?

Trying to make everyone happy is quixotic. It’s never going to happen. Someone won’t like how you did this, or they won’t like how you said that, or they just won’t like your approach. Thus, you just know that all of your best efforts are, at some point with some person, going to fail. Despite all the minutia minding and detail addressing, someone will be displeased with you.

In healthcare, you try to do your best. You try to address your customers’ needs as best you can, try to make sure to “do no harm,” try to attend to the pertinent details, all while hoping that payment reform and insurance requirement changes and federal or state regs will allow you to keep trying to serve your patients…and pay your bills.

In the land of HIT, it’s pretty much the same. There’s no health IT vendor on the planet who has 100 percent customer satisfaction. No matter how good your tools are, no matter how cutting edge your designs, no matter how responsive your tech support, someone somewhere is going to find fault. (I must admit that sometimes I’m one of them!) No HIT vendor anywhere does everything well…despite what their marketing folks may say.

When I look at EMRs or EHRs, one of the most important things I look for is a sufficient number of “happy factors” that make my overall user experience pleasant enough that I can overlook the missed or poorly addressed elements. Honestly, there haven’t been that many systems that engender a feeling of “Oooo…this is cool” often enough. Many have some of those moments; few have enough of them.

When HIT consulting, I try to stress the end user experience to the vendors, even while understanding their resource limitations and developmental timeframe restraints. Vendors can spend all of their resources trying to make each little detail perfect. But, there are so many darn details in any EHR/EMR, that I’m sure even Epic doesn’t have the resources to attend to each one completely, despite its Fort Knox of cash and (not so) small city of employees. Top off all the medical minutia with the seemingly endless requirements for MU, ICD-10, PCMH, ACO, HIPAA, P4P, PQRI, and a laundry list of other acronyms requiring attention, and it’s easy to see that the details demanding developer deliberation are virtually limitless.

Is it possible, then, in either healthcare or health IT to decide that good enough is good enough? Can you be OK with being OK?

You can. I’m certain of it. (Frankly, I don’t see any other option most days!) And, OK is good. You may not be able to “please ‘em all,” but if you strive for perfection and achieve OK-ness, that’s really an accomplishment. Humans are not, almost by definition, perfect. You can sometimes be great, sometimes be not-so-great, and overall be perfectly OK. You take your best shot each day and hope you hit somewhere in the good part of the old Pareto’s Principle (80/20 Rule.)

The hard part isn’t achieving perfection. That’s a pipe dream. The hard part is learning to be OK with being OK, even as you still strive for more. You always want to try for perfect, but you have to be able to see that less than perfect can still be good.

Good.

Fine.

OK.

Psychiatrist Dr. Thomas Harris once told us that we’re all OK in “I’m OK – You’re OK.” Even if you don’t agree with his overall approach, the sentiment stands: it’s just fine to be OK, in healthcare IT or anywhere. Just be a grand OK. Be an exceptional OK.

OK?

From the trenches…

“I’ll lean on you and you lean on me and we’ll be okay.” – Dave Matthews

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 3/25/14

EHR usage in small physician offices has helped spur overall EHR adoption to 61 percent, according to an SK&A report on physician office EHR use. Other key findings:

• The adoption rate for single doctor offices grew from 42.3 to 53.7 percent from 2013 to 2014.
• EHR adoption rates increase as the number of physicians practicing at each site rises; as the number of exam rooms at each site increases; and, as average daily patient volume rises.
• Physicians working for integrated health systems have higher adoption levels than providers working under other type ownership models.
• Epic, eClinicalWorks, and Allscripts lead other vendors in terms of market share.

St. Francis Health System (OK) will go live across its 70 physician offices in May and at its hospitals in June.

The AAFP offers an online PCMH planner to help practices achieve medical home practice transformation by assessing a practice’s current program and identifying specific goals to fill any gaps. The subscription-based planner starts at $100 for members and $149 for non-members.

How do these things still happen? A Topeka, KS man opens a dumpster in his office complex and finds discarded medical records, complete with patient names and social security numbers. Perhaps not coincidentally a document scanning service has an office in the same complex. The state attorney general’s office have removed the charts for further investigation.

The Naval Branch Health Clinic Albany (FL) announces the availability of secure email between patients and providers using RelayHealth’s secure messaging service.

GMed introduces a revenue cycle management service that complements its existing gastroenterology-specific EHR and practice management, report writing, and patient portal platform.

The Robert Wood Johnson Foundation launches Flip The Clinic, an initiative meant to transform the average doctor visit to be more satisfying. The idea is to have the Flip The Clinic website serve as a hub for patients, providers, and other stakeholders to share ideas for improving the physician visit experience so that it’s more satisfying for patients and optimizes physician expertise. I like the concept and the mission, but I’m not convinced it’s something the average patient (or physician) will take the time to find and participate in. I hope I’m wrong.

The use of copy and paste functionality in EHRs should only be permitted in the presence of strong technical and administrative controls, which include organizational policies and procedures, requirements for participation in user training and education, and ongoing monitoring. That’s the recommendation of AHIMA in a newly published position paper that warns users that the efficiency and time savings benefits of copy/paste functionality should be weighed against the potential for creating inaccurate, fraudulent, or unwieldy documentation. The use of copy and paste functionality is too entrenched in EHRs to be eliminated so kudos to AHIMA for offering solid and realistic recommendations to reduce the potential risks.

The Federation of State Medical Boards is considering a policy that could impact the delivery of telemedicine services by requiring a physician to be licensed where the patient is located. The policy also requires the same standards of care apply for both virtual and face-to-face encounters.

Email Inga.