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Are ACOs More About Good Accounting and Reporting Than Improving Care?

Posted on August 28, 2015 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 was recently reading David Harlow’s analysis of the recently released data from CMS on ACO performance and found a lot to chew on. Most people have found the results underwhelming unless they’re big proponents of ACOs and value based reimbursement and then they’re trying to spin it as “early on” and “this is just the start.” I agree with both perspectives. Everyone is trying to figure out how to reimburse for value based care, and so far we haven’t really figured it out.

These programs aside, after reading David Harlow’s post, I asked the following question:

The thing I can’t figure out with ACOs is if they’re really changing the cost of healthcare or if they’re mostly a game of good accounting and reporting. Basically, do the measures they’re requiring really cause organizations to change how they care for patients or does it just change how organizations document and report what they’re doing?

I think this is a massive challenge with value based reimbursement. We require certain data to “prove” that there’s been a change in how organizations manage patients. However, I can imagine hundreds of scenarios where the organization just spends time managing how they collect the data as opposed to actually changing the way they care for patients in order to improve the data.

Certainly there’s value in organizations getting their heads around their performance data. So, I don’t want to say that collecting the right data won’t be helpful. However, the healthcare system as a whole isn’t going to benefit from lower costs if most ACOs are just about collecting data as opposed to making changes that influence the data in the right way. The problem is that the former is a program you can build. The later is much harder to build and track.

Plus, this doesn’t even take into account that we may be asking them to collect the wrong data. Do we really know which data we need to collect in order to lower the costs of healthcare and improve the health of patients? There is likely some low hanging fruit, but once we get past that low hanging fruit, then what?

In response to my comment, David Harlow brought up a great point about many of the ACO program successes not being reproducible. Why does an ACO in one area improve quality and reduce costs and in another it doesn’t?

All of this reminds me of the question that Steve Sisko posed in yesterday’s #KareoChat:

There are a lot of things that seem to make sense until you dig into what’s really happening. We still have a lot of digging left to do in healthcare. Although, like Steve, I’m optimistic that many of the things we’re doing with ACOs and value based care will provide benefits. How could they not?

Flow – A Spoken Word HIE Piece by Ross Martin

Posted on August 27, 2015 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.

Want to see brilliance in action? Check out this spoken word piece about HIEs by Ross Martin.

Here’s the background Ross Martin shares about the piece:

On Monday, August 17th, 2015 I begin a new chapter as Program Director for the new Integrated Care Network initiative at CRISP, Maryland’s health information exchange. We will be providing data to healthcare providers to enhance their care coordination efforts and providing additional care coordination tools to some of those providers who don’t already have these capabilities in place.

To mark the transition, I decided to make a video of this spoken word piece I wrote in 2012 (originally entitled “A Man among Millions”) for my last day consulting for the Office of the National Coordinator for Health IT while I was working at Deloitte Consulting. This piece explains why I am so passionate about making health information exchange work for all of us.

I am grateful for the opportunity to make a difference with an amazing team of collaborators and look forward to providing updates on our progress over the coming months and years.

Words: http://rossmartinmd.blogspot.com/2015/08/flow.html

Health Information Governance of 3rd Party Vendors

Posted on August 26, 2015 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 love when my eyes are opened to an issue that I haven’t heard people talking about. That’s what happened when I heard Deborah Green from AHIMA say that health information governance includes your third party vendors. I’m not sure how many organizations realize this and treat it appropriately.

What’s ironic is that we definitely do this with HIPAA. This is particularly true in the HIPAA omnibus world. Healthcare organizations have a certain expectation around security and privacy when it comes to their third party vendors. It’s a major part of every RFP I’ve ever seen in healthcare.

Why then don’t we treat information governance with third parties the same as we do with HIPAA?

My guess is that some organizations do, but they haven’t really thought about it in this way. It’s an informal part of how they deal with third party vendors. For example, how are third party vendors storing your organization’s health data? Do they dispose of it properly? etc etc etc. These are all great health information governance questions that we’re asking ourselves, but are we asking our third party vendors these questions as well? Should we be asking them?

One challenge I think we face is that we assume that if we’re paying a vendor to do something, that the vendor is going to do it the right way. We assume that a paid service is going to be done in the best way possible. I’m sure your experience like mine is that just isn’t the case. Was it Reagan that said, Trust but verify? That seems appropriate in this instance.

What’s clear to me is that health data is going to become more and more valuable to healthcare organizations. Making sure you have a handle on that data is going to be an important part of ensuring your financial future. That includes making sure that your third party vendors use good health information governance principles as well.

3D Printed Stethoscopes for Just 30 Cents

Posted on August 25, 2015 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.

We’ve written about 3D printing a number of times before including the 3D printed hand, 3D printed hearts, and even 3D printed blood systems to name a few. Plus, we’re just getting started with the 3D printing revolution.

Another example of the amazing work of 3D printing in healthcare is this story about a doctor in Gaza that’s developed a 3D printed Stethoscope. Here’s a quote from the article which highlight the healthcare challenges he faces:

“I had to hold my ear to the chests of victims because there were no good stethoscopes, and that was a tragedy, a travesty, and unacceptable,” Loubani told the Chaos Communications Camp in Zehdenick, Germany. “We made a list of these things that if I could bring them into Gaza, into the third world in which I work and live, then I felt like I could change the lives of my patients.”

In order to solve this problem Loubani turned to the Glia Free Medical hardware project in order to develop the 3D printed stethoscope. They estimate that it cost them about $10,000 to develop. Here’s the quote about the 3D printed stethoscope that’s astounding:

“This stethoscope is as good as any stethoscope out there in the world and we have the data to prove it,” Loubani says.

I’m sure the FDA won’t let them say that, but when your alternative is putting your ear to the chest of the patient, it’s hard to argue with a 30 cent tool that will be an improvement over no stethoscope.

It’s also exciting that the Glia team is also working to develop pulse oximetry equipment, a gauze loom, otoscope, and other surgical tools. Plus, as you can probably imagine from the name, anything that the Glia Free Medical hardware project develops will be released as open source to the community.

It’s worth noting that prominent people like Dr. Eric Topol have been saying that he no longer carries a stethoscope since he can just do an ultrasound and see the heart or an EKG with his cell phone. This reminds me of the hashtag #FirstWorldProblems The hashtag doesn’t quite work for this, but it reminds us of the difference between what’s available in a first world country versus the developing world. It’s amazing what we take for granted. A doctor having a stethoscope nearby has been a standard forever in the US. Hopefully now it will become a standard in Gaza thanks to the new 30 cent innovation.

What do Right to Try Laws Mean for EHR Vendors?

Posted on August 24, 2015 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 received an email from the Goldwater Institute which outlined the passing of “right to try” laws across the country. For those not familiar with this, right to try laws basically gives a terminally ill patient the option to try a drug that’s currently in clinical trials, but isn’t yet approved for public use. There are a lot more intricacies to the law, but you get the idea. Here’s the details of which states have passed it or are working on right to try laws:

Right To Try has passed in:
Alabama, Arizona, Arkansas, Colorado, Florida, Illinois, Indiana, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Montana, Nevada, North Carolina, North Dakota, Oklahoma, Oregon, South Dakota, Tennessee, Texas, Utah, Virginia, and Wyoming

The bill is still under active consideration and could pass this year in:
California, Pennsylvania, Wisconsin, and the District of Columbia

Right To Try has also been introduced in:
Connecticut, Delaware, Georgia, Hawaii, Kansas, Kentucky, Maine, New Hampshire, New Jersey, New York, Ohio, Rhode Island, West Virginia

With 24 states having passed a right to try law, that’s almost a majority of states. As I see this unfold, I wonder what it means for EHR vendors. My guess is that most of the right to try paperwork is still done on paperwork and EHR vendors have almost nothing to do with it. I wonder if that’s the best thing. Should EHR vendors facilitate things like right to try?

One challenge with getting EHR vendors involved is that no EHR vendor wants to implement a regulation that’s essentially different in 50 states (or at least different in 24 states today). I’m sure there are some legal and political reasons why these laws are being passed by states. I have to imagine it has to do with our dysfunctional government in Washington. However, a state by state path to right to try means no EHR vendor will consider implementing a streamlines application process. It’s just too complex and won’t add enough value to their users.

It’s too bad that a national right to try law can’t be passed. Then, I could see an EHR vendor streamlining the application process. They could integrate a database of current clinical trials so that they could make doctors aware of what clinical trials are available and could be considered for their patient in this situation. I guess this piece is possible on a state by state basis, but it certainly wouldn’t be as elegant as one national standard.

As it stands, I don’t see any EHR vendor really building out this functionality on a state by state basis. Maybe that means it’s a great opportunity for a startup company. Then, they can integrate the functionality into the EHR using an EHR’s API (once those finally happen).

Do You Periscope?

Posted on August 21, 2015 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 started to play around with Periscope. Have you been using it? Or have you been watching other people’s Periscopes? For those not familiar with the technology (or its competitor Meerkat), Periscope is a super simple way to live stream video from a mobile device. In literally a few clicks of your mobile screen, you can live stream pretty much anything.

Charles Webster is officially a Periscope addict and wrote a great post about why he’s become an addict and some of its healthcare IT uses. Here’s a section of that post:

I’ve fallen hard for Periscope, Twitter’s new live video streaming app. Despite a long list of “But…”s (privacy, flakey clients, low rez video, difficulty finding the best videos in real-time, trolls…), the idea itself — “Explore the world in real time through someone else’s eyes” — is great, perhaps even, dare I say, revolutionary. For example, yesterday I explored the world of EHR and health IT medical office workflow through the eyes of a patient and her physician. (By the way, the Periscope link is only good for 24 hours, so will cease to work today around 2PM EST. See further below for YouTube archive. The Periscope is to be preferred, because it includes comments and hearts.) I’ve surfed off the coast of Australia. I’ve admired kittens online (now, that IS revolutionary!).

Personally, I’m not as taken by Periscope as Chuck. The video quality isn’t as good. It’s not as fun for me to do by myself, but it is fun to do at a party where there are a lot of people. If you’re on a busy periscope, the chat messages get lost in the wave of messages. The hearting in periscope is nice unless you’re in a busy periscope where the hearts just never stop.

I’ll admit that the few periscopes I’ve done personally have felt really awkward. Dr. James Legan described it this way:

All of this said, I love to try new technologies and understand what’s going on by getting my hands a little dirty. Periscope is part of a trend around live streamed video that’s been happening for a lot of years now. Periscope has just taken it to another level of ease. Before it took a bit of technical skill to live stream video everywhere. Now anyone can do it with Periscope and it takes almost no effort. That’s something to watch.

Still don’t believe me? According to a post which is a few weeks old, there are over 10 million periscope accounts. Plus, they’re seeing over 40 years of video watched every day. I’m sure that’s number even larger today. Will this be a passing fad? I don’t think so since it’s really just the continued evolution of live streamed video.

I’m still not sure all the impact for good and bad of all this live streamed video. However, there’s something compelling about someone taking you live into their life. The list of Periscopes I’ve seen is quite different than Chuck’s list above. However, it’s just as broad of a spectrum of things and it’s great that we each have a customized experience of what’s interesting to us. There’s something really exciting about the discovery of something new or a look into something you’ve never seen before. It’s like going backstage into someone’s life. Everyone likes a behind the scenes look into something.

Consider this the start to my exploration of new technology. I’d love to hear your thoughts on Periscope. Have you used it? Have you found it valuable? Does it scare you? How will we see it used in healthcare?

A Practice Fusion IPO?

Posted on August 20, 2015 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 just did a search on this blog and I found that I’ve mentioned the name Practice Fusion in 88 different posts over the years. Needless to say, Practice Fusion has been one of the most interesting EHR vendor stories out there. I’ve seen it first hand since they started advertising on EMR and HIPAA very early on in their life. I was even on stage talking about meaningful use at the first Practice Fusion user conference. We didn’t know very much about meaningful use at the time, but we put on a good show and shared what we knew at the time.

In the early days, many EHR vendors were really scared by Practice Fusion. Offering a Free EHR is a drastic thing to do and absolutely shook up the EHR industry. Much like Dell did in the PC market (and probably some others), Practice Fusion’s low price forced most other EHR vendors to lower their prices in order to compete. I saw the drop in price first hand as EHR after EHR dropped their price. At the same time as these price drops, EHR vendors were shifting from these massive front loaded EHR purchases to monthly price models that could compete with SaaS EHR pricing. The mix of pricing model changes and competition with a Free EHR was great for the industry.

With this as background, I definitely am intrigued by the news that Ryan Howard has been replaced as CEO of Practice Fusion. Tom Langam, Practice Fusion’s Chief Commercial Officer has taken the helm as interim CEO. The article I linked to above suggested that this and other personnel changes point to Practice Fusion possibly preparing for an IPO. In fact, they’ve had so many personnel changes over the years, most of the people I’ve gotten to know have left.

I’m not sure if Practice Fusion is preparing for an IPO or not, but I wouldn’t be surprised if they’re running out of money. Yes, it’s crazy to think that they could be running out of money after raising $70 million about 2 years ago along with $15 million more a few months later. CrunchBase has their funding to date at $157.5 million. However, I’m sure they have a high burn rate. Their leadership and investors have set ambitious goals for Practice Fusion to own the healthcare market (A goal which I’ve said is impossible. The EHR market will be heterogeneous!). I’m sure their spending habits match those ambitious goals. An IPO would be one way to fund that continued ambition. If they did do an IPO, we’d get some really interesting insights into their business model.

There’s some mystery surrounding how Practice Fusion makes money. I think you can summarize their income streams into three categories: advertising, data, and third party apps. Most people glob onto the first piece, but from what I understand it’s far from being their largest source of revenue. In fact, I wouldn’t be surprised if it was their smallest. The second piece is quite interesting. I once heard someone say that Practice Fusion made their money from selling health data, but then they were corrected by someone saying that Practice Fusion doesn’t sell data. Instead, Practice Fusion sells the insights from that data. A subtle difference, but an important one. The question remains, how valuable are insights from EHR data? Many other EHR vendors sell their EHR data. Is it just a matter of time until Practice Fusion does too? Will they be forced to in order to meet revenue goals?

The last piece of revenue is the one that most people ignore. However, it probably is the largest piece of the revenue pie. My guess is that their practice management system vendor partners are one of the most significant portions of their third party revenue. Practice Fusion doesn’t have their own PM and so they refer their users to an outside PM vendor. When they do so, Practice Fusion gets a cut. I’m sure this is not an insignificant number. It’s not hard to imagine Practice Fusion doing something similar with a whole marketplace of third party offerings that tie into their Free EHR.

Over the years, I’ve talked to a lot of investors and potential investors about Practice Fusion. I’ve always told them that Practice Fusion has definitely created value. They’ve done a good job leveraging the Free EHR to bring doctors in. What’s not as clear to me is whether they’ve created enough value to justify the $157.5 million they’ve raised. If they really are preparing for an IPO, then I guess we’ll find out soon. The revenue numbers that come out during the IPO process and how the street reacts to those numbers would be fun to watch. Yes, I know. I am an #HITNerd.

7 Strategies for Revenue Cycle Management Success

Posted on August 17, 2015 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.

Today I came across a whitepaper called 7 Strategies for Revenue Cycle Management Success. I continue to be amazed by how many practices can benefit from better revenue cycle management. So much so that hundreds of companies thrive on the back of a practice’s revenue. This is true for a number of EHR companies as well.

For those who don’t want to download the full whitepaper with all the details on the 7 strategies, here’s the list:

Strategy #1: Monitor Payments
Strategy #2: Perform Financial Clearance
Strategy #3: Collect from Patients
Strategy #4: Manage Denials
Strategy #5: Establish Employee Expectations
Strategy #6: Avoid the Snowball Effect
Strategy #7: Report on Key Performance Indicators (KPIs)

As I look through this list and read through the whitepaper, all of it just points to quality management of processes. There’s nothing on the list that’s rocket science. It’s just taking the time and effort to make sure that all of your practice’s processes are well organized and thorough. As you can imagine, that’s a problem for many organizations. That’s why so many practices outsource this work to another company.

When I consider where revenue cycle management is headed, I wonder how these new value based reimbursement models will impact revenue cycle management companies. My guess is that many of them will just see it as the same process applied to new clinical values and measures. However, I think that value based reimbursement is going to require companies to go much deeper with a practice. If the practice is now responsible for a population of users and not just the ones they’ve seen in their office, that’s going to take a very different skill set.

What is clear to me is that many practices are going to need some help from an outside company even in a value based reimbursement environment. I’m just not sure which companies will be providing those services.

Uptown Funk Parody by Med Students at WashU Medical Students

Posted on August 14, 2015 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.

It’s Friday! Time for a little fun Friday video to start your weekend off right. This great parody video from WashU Medical students called “First Year Funk” will work:

From the comments, it looks like this summarizes the First Year Funk for medical students quite well. I love the chorus that keeps repeating, “First year funk you up. First year funk you up.” Must have been a nice break from the challenges of med school.

Do You Use a Waterproof Keyboard in Your Practice or Hospital?

Posted on August 13, 2015 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 remember when I first saw a waterproof keyboard at HIMSS many many years ago. It was pretty amazing to see. Even back then, the argument for why you’d want a waterproof keyboard was compelling. When you think about the germs that are floating around every healthcare organization, the keyboard is the perfect haven for germs to collect. Without a waterproof keyboard, there’s really not a great way to clean the keyboards.

While waterproof keyboards have been around for a bunch of years, I haven’t seen them really take off in most organizations. I imagine cost plays one role, but I think the bigger role was the waterproof keyboards just weren’t as good. Most of the waterproof keyboards I’d seen were silicon keyboards. While they were certainly waterproof, they didn’t work quite as well as their plastic counterparts.

I was reminded of this when I got an email from Seal Shield about their new 100% waterproof, back-lit plastic keyboard.
Waterproof Keyboard
No doubt, this keyboard looks like any other regular keyboard. That’s a great thing. Although, it’s impressive that they’ve added not only the waterproof, but the back lighting as well. This is important in many hospitals where patients might be sleeping and the nurse or doctor might be working in the room.

Seal Shield has a wide variety of “dishwasher safe” products like this keyboard for a while. I wonder if healthcare is just waiting for a lawsuit to finally invest in some washable peripherals like these. I’m sure a simple swab of any keyboard in healthcare would make for a compelling story.
Waterproof Keyboard in Water