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We Share Health Data with Marketing Companies, Why Not with Healthcare Providers? Answer: $$

Posted on November 20, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

For those who don’t realize it, your health data is being shared all over the place. Yes, we like to think that our health care data is being stored and protected and that laws like HIPAA keep them safe, but there are plenty of ways to legally share health care data today. In fact, many EHR vendors sell your health care data for a pretty penny.

Of course, many would argue that it’s shared in a way that complies with all the laws and that it’s done in a way that your health record isn’t individually identified. They’re only sharing your health data in a de-identified manner. Others would argue that you can’t deidentify the health data and that there are ways to reidentify the data. I’ll leave those arguments for another post. We’ll also leave the argument over whether all this sharing of health data (usually to marketing, pharma and insurance companies) is safe or not for a future post as well.

What’s undeniable is that health data for pretty much all of us is being bought and sold all over health care. If you don’t believe it’s so, take a minute to look at the work of Deborah Peel from Patient Privacy Rights and learn about her project theDataMap. She’ll be happy to inform you of all the ways data is currently being bought and sold. It’s a really big business.

Here’s where the irony comes in. We have no trouble sharing health data (Yes, even EHR vendors have no problem sharing data and lets be clear that not all EHR vendors share data with these outside companies but mare are sharing data) with marketing companies, payers and pharma companies that are willing to pay for access to that data. Yet, when we ask EHR vendors to share health data with other EHR vendors or with an HIE, they balk at the idea as if it’s impossible. They follow that up with a bunch of lame excuses about HIPAA privacy or the complexity of health care data.

Let’s call a spade a spade. We could pretty easily be interoperable in health care if we wanted to be interoperable. We know that’s true because when the money is there from these third party companies, EHR vendors can share data with them. The problem has been that the money has never been there before for EHR vendors to be motivated enough to make interoperability between EHR vendors possible. In fact, you could easily argue that the money was instructing EHR vendors not to be interoperable.

However, times are changing. Certainly the government pressure to be interoperable is out there, but that doesn’t really motivate the industry if there’s not some financial teeth behind it. Luckily the financial teeth are starting to appear in the form of value based reimbursement and the move away from fee for service. That and other trends are pushing healthcare providers to want interoperable health records as an important part of their business. That’s a far cry from where interoperability was seen as bad for their business.

I heard about this shift first hand recently when I was talking with Micky Tripathi, President & CEO of the Massachusetts eHealth Collaborative. Micky told me that his organization had recently run a few RFPs for healthcare organizations searching for an EHR. As part of the EHR selection process Micky recounted that interoperability of health records was not only included in the RFP, but was one of the deciding factors in the healthcare organizations’ EHR selections. The same thing would have never been said even 3-5 years ago.

No doubt interoperability of health records has a long way to go, but there are signs that times are changing. The economics are starting to make sense for organizations to embrace interoperablity. That’s a great thing since we know they can do it once the right economic motivations are present.

The Future is Now – Physician Discontent and Adopting EHRs Today – Breakaway Thinking

Posted on November 18, 2015 I Written By

The following is a guest blog post by Carrie Yasemin Paykoc, Senior Instructional Designer / Research Analyst at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Carrie Yasemin Paykoc

In the movie Back to the Future II, a young man named Marty McFly and his time-traveling companion Doc Brown travel thirty years into the future—October 21 2015—to unite his parents and correct the space-time continuum. Although this “future” date occurred several weeks ago, the technological advancements presented in the movie are not far off from reality.  In the “future” Marty cruises around his home town on a new hoverboard and the sky is filled with mechanical drones. There are a few hologram images and people are dressed in brightly colored, plastic outfits. Aside from the fashion statement, many of these technological advancements are well under way. The future is now!

Not all technology has advanced as rapidly as depicted in the movie, though. From a health information technology (HIT) perspective, it often feels like we are back in 1985 dreaming of better technology.  Electronic health records (EHRs) present one of the biggest opportunities for improvement in healthcare.

A recent study published by the RAND Corporation and sponsored by the American Medical Association (AMA) examined how satisfied physicians are with their EHRs. It found that they approve of the concept of EHRs and are largely satisfied by the ability to remotely access patient information at any time. Most physicians, practice leaders, and staff also agreed that advancements in EHR technology such as improved interoperability and improved interfaces have great potential to improve care as well as physician and patient satisfaction. On the other hand, the current state of EHRs worsened overall professional satisfaction among respondents. Data entry, usability, inefficient workflows, and lack of interoperability were a few of the main pain points mentioned in the study.

A recent parody of Jay Z’s Empire State of Mind articulates many of these same frustrations. “Just a glorified billing system with patient info tacked on,” is one of the poignant lyrics mentioned in the video.  Many physicians are fantasizing about going “back to the future” or using a more sophisticated system.

In order to move forward in advancing EHRs and HIT, clinicians, support staff, and administration need to take responsibility for their organization’s initial technology investment. If data entry, usability, and inefficient workflows are causing pain, it is time to re-revaluate those clinical workflows and escalate system issues and enhancements to their vendors.

Each time I am onsite with a client preparing for go-live I am reminded of all the energy spent on implementing these systems. But it is equally important that clinical leaders re-evaluate their initial workflows and develop a plan for sustained use after the initial excitement has faded. And during this time, leaders must provide feedback and escalate system issues to their vendor.

Engaged clinical leadership is required to not only adopt the current state of EHRs but to transform the future of health information technology. How can clinical leaders do both? First, realize an EHR is not something you can throw-away or easily replace without enormous costs.  In our consumer-based culture, old technologies like cell phones or televisions are often thrown out for the latest advancements. Although EHRs are in many ways less sophisticated than some consumer-based applications, most of those applications (if not all) do not have the ability to improve patient care or patient safety. If using today’s EHR technology saves more lives than using paper alone, it is our collective responsibility to adopt these systems.

Once this paradigm shift has occurred and clinical leaders have made a sustained commitment to using EHRs, progressive and impactful change can occur. Conversations can begin to shift to improving clinical workflows, enhancing interfaces, improving interoperability, and utilizing health information exchanges. But these later conversations will never occur if the focus is on the initial difficulties and stress associated with implementing and using these systems. In order to live up to our vision of the “future,” we must accept the realities of today.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

The Benefits of Real-Time Locating Systems in Healthcare

Posted on November 16, 2015 I Written By

The following is a guest blog post by Stephanie Andersen, Managing Partner at ZulaFly.
Stephanie Andersen
“It is frustrating to not be able to find things you need when you need them.”

This is a recurring theme from professionals I interact with across the entire healthcare spectrum.

The healthcare industry is a setting where assets are seemingly in constant motion. With this movement comes increased possibility for assets to be misplaced or leave the building, creating unnecessary replacement expense that can negatively affect your organization’s bottom line.

Real-Time Locating System, or RTLS, has been on the scene as a dependable solution to tag and locate important, valuable assets that easily go missing and has increasingly become more important to a hospital’s bottom line.

Stop Replacing, Start Locating

Where are assets and how are they being utilized? RTLS answers this question in ways no other technology has been able to before.

In my conversations with healthcare leaders, many express concern over how often valuable assets walk out the door. RTLS possesses the strength to know if assets are moving at hours or in areas they should not be, as well as when assets reach the door.

In the healthcare industry, assets such as PSA and infusion pumps, beds, wound vacs, ventilators, Doppler systems, and workstations on wheels are just a few items staff members are tagging and keeping closer tabs on thanks to RTLS.

Staff can also use RTLS to evaluate whether an asset should be moved from one area to the next to increase utilization, compared to simply buying another one.

As a whole, replacement costs are reduced and the amount of dollars sunk into unused or forgotten rental equipment becomes remedied thanks to RTLS.

At ZulaFly, I am often asked if there is a way for hospitals to track ambulances and other care transport vehicles so that hospitals can have a 360 degree view of what is happening inside and outside of the facility. We have developed a GPS offering that combines with RTLS to create this comprehensive view.

Increased Staff and Patient Safety

A quality RTLS system gives staff members a device that allows them to easily call for help in real-time.

Additionally, RTLS affords patients a button-press solution in case of an emergency. Because the RTLS tag allows staff to quickly locate where the issue is occurring, the situation can be quickly attended to and remedied.

Industry leaders are seeing the value of RTLS within their healthcare facilities, quickly realizing how reduced replacement cost and time saved searching for assets create considerable return on investment.

About Stephanie Andersen
Stephanie Andersen is a 17+ year professional within the software industry, spending over ten of those years working at Microsoft. Through various roles and responsibilities that range from technical support, to project management, to driving sales, to business operations and even product development, Stephanie has become focused on sales, marketing, and business development. This strong skillset and unparalleled experience has been key in developing the go-to market strategy that has brought ZulaFly from concept to completion, and most recently to market.

On-Demand and Just in Time: Healthcare CIOs Respond to an On-Demand World

Posted on November 9, 2015 I Written By

The following is a guest blog post by Eric Rice, Chief Technology Officer, Mach7 Technologies.
Eric Rice CTO Mach7 Technologies
Doesn’t it feel at times like we’re living in a total “on demand” world? How did we survive before DVRs, push notification to our pockets and, my current favorite, voice on-demand ordering with “Alexa” (no commercial here for a certain on-line/on-demand retailer).

Consider our on-demand workforce. A recent Intuit survey suggests that the number of Americans working as providers in the on-demand economy will more than double to 7.6 million in 3 years. Our culture is “demanding” on-demand and this trend is naturally impacting healthcare. CIOs must be on-demand-ready both in their delivery of services and in providing access to patient care data.

As a provider of healthcare information technology (i.e., a software and services vendor), our customers are the CIOs and IT directors of hospitals and imaging centers, but the clinical customer has always been the patient.

In our connected world where consumers expect to obtain information easily, shop for the best prices, and control how and where personal information is managed (i.e., financial data, shopping data, exercise data), it’s not surprising that the highly-regulated, compartmentalized world of hospital IT and information management is facing a groundswell for on-demand images and just-in-time information from all corners of the market.

This demand is more than a cry for convenience and personal preferences; in healthcare, on-demand access to patient information and timely decisions can have life-altering impacts. Access to accurate information “on demand” isn’t just a nice-to-have feature, it’s a necessity.

Health IT Standards Meet the Demand for “On Demand”

Adopting a standards-based, robust infrastructure for healthcare data collection, storage, access, sharing, and workflow management is key to handling an on-demand healthcare IT world. CIOs must be able to deliver patient data in all of its formats, from all of its sources, to meet a growing set of regulations, requirements, and constituents. From Meaningful Use to EHR/EMR demands to referring physicians, specialists and, oh yes, patients!

Here’s my take on healthcare transformation for CIOs.

Patient Self-Service: Enabling patients to pay their bills online is a no-brainer, but in an on-demand world, patients want more control and greater visibility. Why should we be surprised? Beyond appointment reminders and bill payment, patients want to “self-schedule”, upload new content, be more in control of their health and involved in their healthcare. They want to review lab and test results and make those data points available to other providers for second opinions. They want to shop for healthcare like they shop for any other retail products – and they want to communicate electronically with their doctors and expect those providers to have full access to a full healthcare history – complete with images, pictures and video. We have the technology today to provide this level of self-service, on-demand access; we need to transform our thinking to make the vision a reality.

Access and Sharing of a Complete Health Record:  We may recognize “show me the money”, but how about “show me the images!” The transition in patient record management made by EHR/EMR deployment was huge. The next step is building and providing a complete patient record that includes image sharing with both referring providers and patients. We are seeing these requirements promoted by regulatory bodies – nationally, CMS and ONC are pushing these requirements through avenues like Meaningful Use. Some states, such as Florida, are mandating that Level 1 and 2 trauma centers have the ability to share images to and from referring organizations.

Imaging access lags the IT advances made in most other industries. With the rollout of EMRs, care record access and sharing may be improved but often a key component is still missing, the specialty images. As one of our customers is fond of saying, ‘an EHR without images is like a museum without paintings.’ Patients and clinicians demand access to a complete healthcare record, and that complete record must contain images – yes, on-demand.

Interoperability in Merger Mania:  Healthcare consolidation is on the rise with increased merger and acquisition activity every year. Connecting, consolidating, and managing patient records across consolidated facilities is a significant challenge. CIOs understand that on-demand access to patient care records requires interoperability for seamless access and sharing of information across HIT vendor solutions.

Proactive Healthcare CIOs and IT professionals are getting in front of this transformation with new thinking, open, flexible technologies, standards, and policies. They know that “on demand” access is a key driver of care delivery, clinician satisfaction and patient satisfaction. After all, we’re all living in an on-demand world.

About Eric Rice
Eric Rice has 12 years of systems architecture and design, engineering and management experience, with the most recent 7 years focused on medical imaging IT. His team is focused on medical imaging workflow and interoperability across disparate RIS, CVIS, PACS, and reporting solutions. He brings strong software engineering techniques, a solid understanding of R&D processes, and excellent medical imaging domain skills to Mach7. Eric holds a Bachelors of Science degree from Virginia Polytechnic Institute and a degree in Management Science & Information Technology with a specialty in Decision Support Systems from the State University (Virginia Tech).

A Vision for Why and How We Make the Science of Health Care Shareable

Posted on October 30, 2015 I Written By

John Lynn is the Founder of the 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 and 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 heard Stan Huff, CMIO at Intermountain, talk at the Healthcare IT Transformation Assembly about the Healthcare Services Platform Consortium. As he presented what they’re working on he highlighted so well the challenges that I’ve been seeing in healthcare IT. I’ve long be asking people how healthcare IT innovations that happen in one hospital or practice are going to get shared with all of healthcare. Turns out, Stan has been thinking a lot about this problem as well.

In his presentation, Stan framed the discussion perfectly when he said, “No matter what you do, you can’t teach people to be perfect information processors.” I’d also mentioned in a previous post that the human mind can’t detect the difference between something that causes errors 3 in 100 versus 4 in 100. However, with the right data, computers can tell the difference. Plus, computers can assist humans in the information processing.

These points illustrate why building and sharing clinical decision support is so important. The human mind is incredible, but medicine is so complex it’s impossible for the human mind to process it all. Ideally all of the work that Stan Huff and his team at Intermountain are doing on clinical decision support should be “plug n play interoperable” with the rest of the healthcare system. That seems to be the goal of the Healthcare Services Platform Consortium.

Many might wonder why Intermountain would want to share all the work they’ve been doing with the rest of healthcare. Isn’t that their proprietary intellectual property? It’s actually easy to see why. Stan described that Intermountain has implemented or is currently working on ~150 decision support rules or modules. Given their organization’s budget and staff constraints he could see how those 150 could be expanded to 300 or so, but likely not more. That sounds great until you think that there could be 5000+ decision support rules or modules if there was enough time and budget.

The problem is that there was no path for Intermountain to go from 150 to 5000 decision support rules or modules on their own. The only way to get where they need to go is for everyone in healthcare to work together and share their findings and workflows.

Stan and the Healthcare Services Platform Consortium are building the framework for creating and sharing interoperable clinical decision support apps on the back of FHIR and Smart Apps. This diagram illustrates what they have in mind:
HSPC for 2015 Healthcare Transformation Assembly 151026
I think that Stan is spot on in his assessment of what needs to be done to get where we need to go with clinical decision support in health care. However, there are also plenty of reasons for being cautiously optimistic.

As Stan told us at the event, “If everyone says that their workflow is the only way, we won’t get very far.” Then Stan passionately argued for why physician independence allows the opportunity for doctors to take improper care of patients. “If we allow physicians to do whatever they want, we’re allowing them the right to take improper care of patients.”

Obviously Stan isn’t saying that there shouldn’t be rigorous debate about the best treatment. By putting these algorithms out to other organizations he’s actually inviting criticism and discussion of the work they’re doing. Plus, I have no doubt Stan understands where health care is an art and where it’s a science. However, I believe he rightly argues that where the science is clear, proclaiming the art of medicine is a poor excuse for doing something different.

In my mind, the Healthcare Services Platform Consortium should be focused on making the science of health care easily shareable and usable for all of health care regardless of EHR system. That’s a vision we should all get behind.

EHR Data Hostage Wouldn’t Exist if EHR Were Truly Interoperable

Posted on October 20, 2015 I Written By

John Lynn is the Founder of the 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 and 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 talking with Mario Hyland, Founder and Senior Vice President of AEGIS (or better known on social media as @interopguy), about various healthcare IT certifications and really a follow up discussion to our previous look at achieving continuous healthcare interoperability. Next month I’ll be launching the Healthcare Scene podcast and I’ve invited Mario to join me as a guest. So, more to come on EHR testing in the future.

However, as we were discussing my vision for what would be a “meaningful EHR certification” I suggested that it would be meaningful to doctors if an EHR vendor was certified as able to export all of the EHR data. It would be meaningful to doctors if an EHR vendor’s contract was certified to not hold EHR data hostage if a doctor chooses to go to another EHR. I think many EHR vendors would do it as a way to instill trust in the doctors who choose their EHR (Translation: We’re so certain you’ll love our EHR that we’ve made it possible for you to leave our EHR if you want to leave).

As I recounted this idea and others, Mario Hyland made a great observation: If EHR software were truly interoperable, an EHR vendor couldn’t hold a practice’s EHR data hostage.

Think about the concept. If there was true EHR interoperability, you could just buy a new EHR, connect it to your old EHR, and all the data would be available in the new EHR. We’re not even close to getting there yet, but the concept is right.

One challenge is that in practice, we’re only sharing a small subset of the data in the EHR. Even if we got the entire medical chart interoperable, there’s still a bunch of other data in an EHR that would be beneficial to retain. For example, things like audit logs from the old EHR might come in valuable if an old record comes under scrutiny in some legal case.

I still love the concept. I also think it’s one extra reason why we don’t see EHR vendors running towards interoperability. I only know a few EHR vendors that have enough trust in the EHR software they’ve built that they’d be ok building the functionality for their doctors to leave.

Connected Care and Patient Experience Survey Results

Posted on September 30, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Surescripts recently put out the results of a survey they did on Connected Care and the Patient Experience. If you’re like me, whenever you see a survey, you want to see the questions and raw data from the survey. The good news is that Surescripts has shared the survey result data here.

We could dig into a lot of the data, but this chart was the one that really stood out to me:
Patient Engagemnt and Healthcare Information

No doubt Surescripts has a bit of bias when it comes to wanting to get organizations to share healthcare data. They started with sharing prescription data, but they’re working on sharing much more data. This Surescripts bias aside, aren’t we all biased towards wanting the right information to be shared in the right place at the right time? That’s the nirvana of healthcare data that all of us as patients want.

Put another way, can I please fill out a health history form one time and never have to fill one out again?

This is a feeling that resonates with so many patients. It’s felt particularly strong when you fill out essentially the same paperwork possibly on the same day for 2 specialists that both work for the same company. Brutal to even consider, but it’s the reality of healthcare data sharing today.

I understand many of the reasons why this isn’t happening and it is a very complex problem with no easy solutions. There are a lot of organizations and people involved and many of them aren’t motivated to change. Change is hard when you’re motivated. Change is almost impossible when you’re not motivated.

Back to the graphic above, I love how it frames the issue. The challenge of poor information is bad on multiple levels including: slowing down the patient visit and improper care. The graphic above illustrates so well how much better we can do at getting the right information to the doctor. Doing so will make a doctor more efficient and help them provide better care.

Sharing Medical Records Cartoon

Posted on September 18, 2015 I Written By

John Lynn is the Founder of the 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 and 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 healthcare IT humor courtesy of The New Yorker:

Sometimes reality has to make you laugh even if it’s a sad situation. Or as Health IT Policy wonk Steven Posnack said:

CMS Redefines Telemedicine by Bringing Better Care to 15 Million Patients and Huge Profitability to Medical Facilities

Posted on September 17, 2015 I Written By

The following is a guest blog post by Donald Voltz, MD.
Donald Voltz - Zoeticx
Telemedicine is about reaching out to patients in remote locations, but limited to videoconferencing between patients and health providers. It is similar to a face-to-face service with the exception that the patient and primary care provider are not physically together. Such efficiency is limited in term of scope and only addresses the geographical challenge and scarcity of physician availability, a far cry from what CMS wanted for its Chronic Care Management Services (CCM) which would fundamentally change telemedicine as it is practiced.

CCM services bring the telemedicine definition to the next level – a quiet continuous monitoring and collaboration from all care services to the patient, given the ability to anticipate and engage in care issues. Such ability not only curbs care costs, it would also increase care provider bandwidth, giving them the ability to cover more patients with better efficiency. The challenge is not on the requirements part of CCM services, but the lack of an IT solution to really address all CMS guidelines, including its intent to enforce the concepts through the healthcare industry.

The New England Journal of Medicine has covered the major challenges from the new CCM guidelines, touching on all the major shortcomings in today healthcare IT offerings.  Healthcare providers recognized that the fee-for-service system, which restricts payments for primary care to office-based visits, is poorly designed to support the core activities of primary care, which involve substantial time outside office visits for tasks such as care coordination, patient communication, medication refills, and care provided electronically or by telephone.

The time has come for a paradigm shift to reengineer how we deliver care and manage our patients. To arrive at a new plateau requires rethinking the needs of our patients and how to meet these needs in an already resource constrained system. Unless we develop solutions that both integrate with and enhance the technologies currently available and those yet to be realized, we will not realize a return on health IT investment.  This needs to be an area of focus for hospital CEOs, CIOs and CMOs.

Huge Market Opportunity

According to the 2010 Census, the number of people older than 65 years was 40 million with increasing trends to 56 million in 2020 and not reaching a plateau until 2050 at 83.7 million.  With two-thirds of Medicare beneficiaries having two or more chronic conditions while one-third has more than three chronic conditions according to CMS data, putting the number of patients who qualify for CCM services at 15 million. This number is predicted to continue on an upward trend until 2050.

The World Health Organization (WHO) recognized the growing burden this trend in chronic disease places on the healthcare system and addressed the need for innovative solutions in their 2002 report. While the potential market is huge, in the billions of dollars yearly, healthcare organizations have been struggling to address the CMS guidelines with key requirements from CMS. We can no longer afford not to address the needs of patient with chronic medical conditions along with engaging them in their healthcare decisions.

CMS’ CCM guidelines are as follows:

  • 24×7 access to clinical staff
  • Patient care continuum
  • Collaboration, coordination between primary care providers and other care services
  • Electronic management of care transition among care providers
  • Coordination between home and community care services
  • Patient engagement

Here is how these guidelines are now being addressed:

The Patient-Centric Model

While each patient has a primary care provider who is responsible for CCM service, they are not confined to receiving care in a single practice or institution. The primary care provider assumes the role of care coordinator, but care is likely to be distributed between multiple care providers, often across different care locations. In a patient-centric care model, care services can come from any care providers – geographically and organizationally diverse, necessitating an accountable provider to coordinate and orchestrate high-quality care across multiple chronic conditions.

Secure Electronic Care Transition

CMS clearly states these CCM care plans must be electronically available at all times to all care providers who will be delivering care to these patients, not available by faxing, or scanning as patient data is currently shared. The chronic care management plan must be available to all healthcare providers who might take care of these patients 24×7. In addition, the primary care provider who assumes the care coordinator responsibility for a patient is expected to follow-up on the care delivered, additional needs of the patient and changes in chronic condition that may have been addressed by a healthcare professional remote to the patients’ primary practice.

CMS neither authorizes how such a CCM system is designed nor enforces how efficient the implemented care service is. The monthly reimbursement limits the time and additional resources physicians are able to allocate for the development, implementation and daily operations of a CCM program in their practice. The manual implementation of a system that meets all of the requirements defined by the CMS will far exceed the reimbursement recovered. It is also likely to be inferior to one with some degree of automation coupled with messaging when a patient’s condition changes or their chronic care management plan is accessed by other providers. Efficiency along with automated logging of time spent on care coordination are critical requirements for a service to be effective.

A CCM service solution must meet the requirements defined by CMS while integrating into the current operational structure of primary care practice and integrate with current health IT systems and manage the secure documentation flow.  It must also offer a built-in notification system to alert physicians to changes in patient status and/or access to the care plan while maintaining an efficient operation in clinics with a lower overhead and no need for additional infrastructure.

While CMS does not enforce the efficiency of a CCM care service, the monthly payment must represent an increase of revenue to care providers. Care providers cannot implement a new potential code while increasing its cost due to manual labor increase. So, efficiency must be part of the solution requirements.

The answer to CCM service would be a new healthcare application offering secure documentation flow, built-in notification and collaboration services to support a low cost, efficient operation for clinics.

The CCM application must address the following requirements:

  • No disruption of existing services. The application must operate and integrate seamlessly with any existing EHR so to not change provider workflow or disrupt current processes; defining a very stringent requirement to keep the existing EHR systems untouched and unchanged while allowing for this new service to co-exist.
  • Secure electronic care transition with CCM care plan sharing. Patients can engage with this new care service even when the service may not be contained within the same network as the primary care provider. Patients ultimately maintain control of what information and with whom this information is shared. The primary care provider is responsible for maintaining the CCM care plan, as well as the patient, and should expect any information shared will be used for a single care session and not beyond it. Although the CCM care plan is expected to contain the most up-to-date medication information, primary care providers are not interested in opening up their entire system to others, but instead need to maintain control and secure access while allowing for access to these protected documents.
  • Automation, automation and automation. Efficiency of the whole CCM service must be at the core so that primary care providers can enhance patient care without adding expense and resources to implement it. Consider a patient with Congestive Heart Failure (CHF) where continuous monitoring of weight is critical for early intervention and the avoidance of hospitalizations. To engage patient’s in their care, they must be given a mechanism to report daily weight to their primary care provider. The primary care provider must have a solution where attention is given if the patient’s condition so it not has exceeded a certain threshold. Automation is required so that primary care providers can be efficient and only given attention when attention is required. Automation must be in place so that no activities such as follow-up would be omitted.
  • An EHR-agnostics solution. Implementation of a CCM service must address the constraints of a non-homogeneous environment. Healthcare organizations and physician practices are not able to control the EHR environments when patients receive care outside of their primary practice. The requirement for electronic document exchange along with the expectation of the latest patient health data being contained in the CCM care plan goes beyond a static solution offered by a data duplicated HIE (Health Information Exchange) infrastructure.
  • Visible value to a patient. A critical requirement for CMS reimbursement is a patient’s opting into a CCM management program that includes out-of-pocket monthly co-pay for the service of 8 dollars per month. A patient must see the value for CCM services which can be demonstrated through enhanced engagement, access to providers and the assurance that their condition is being overseen each month by their chronic care coordinator. Anticipation of an early intervention for potential problems along with the ability to inquire and receive feedback on their condition(s) brings added value to patients and their loved ones. This value can only be delivered if such a service can be developed in an efficient manner with a low cost of operating and a limited expansion of personal to bring it about.
  • Documentation of discontinuous time spent on care coordination. CMS requires at least 20 minutes are spent on care coordination activities each month in order to bill for this for patients enrolled in the program. Without a seamless component to log such activity, the efficiency of the overall process comes into question. A comprehensive CCM application must address the practice management side to account for and generate monthly reports of the CCM activities completed.

Future of Healthcare Impacted by Integration, Patient Data and New Modes of Delivery

The future of healthcare will be impacted by the integration of technology, patient collected data, and enhancement of healthcare professionals’ ability to deliver care in modes not yet imaged. With respect to management of chronic medical conditions, leveraging technology to coordinate the care delivered so these patients can lead productive lives at a reduced cost with less time in the hospital for exacerbations of their disease is a goal that is now possible.

Development of tools to coordinate care without additional health IT expense, in either time spent learning a new workflow or cost of such an application, is now available. Finding such an innovate model that works for patients, healthcare professionals and health systems for chronic care management will likely spread into other areas of healthcare. CCM services and care coordination allow remote, discontinuous, non-face-to-face management of patients with complex health conditions when it meets stringent requirements – a quiet, continuous monitor of health status and interventions, collaboration of all care delivered to the patient, an ability to anticipate, engage and alert patients and care professionals of impending issues, along with the administrative side of billing and logging such activity.

This ability not only changes the direction of the chronic care cost curve, it also increases care provider bandwidth, giving them the ability to successfully manage more patient, with better efficiency while delivering high quality, valuable care.

About Donald Voltz, MD
Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.

Board-certified in anesthesiology and clinical informatics, Dr. Voltz is a researcher, medical educator, and entrepreneur. With more than 15 years of experience in healthcare, Dr. Voltz has been involved with many facets of medicine. He has performed basic science and clinical research and has experience in the translation of ideas into viable medical systems and devices.

Thanh Tran, CEO of Zoeticx, also contributed.

Providers Skeptical of ONC Interoperability Roadmap – Talk About an Understatement!

Posted on September 8, 2015 I Written By

John Lynn is the Founder of the 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 and 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 came across this article titled “Most providers skeptical of interoperability roadmap goals”. Here’s the first paragraph of the article.

The vast majority of providers surveyed said they are not confident that the healthcare industry will meet the 10-year goal for nationwide interoperability set by the Office of the National Coordinator for Health IT (ONC).

Of course, the article doesn’t give a link to the survey or really many details of the survey beyond it being 700 providers (which is a decent sample size). Plus, it was done by Scrypt which I know pretty well since they’ve advertised on this site off and on since the beginning. So, I trust that they put together a decent survey.

However, I can assure you that no survey was needed to come to this conclusion. In fact, I think the word “skeptical” is very generous. I believe that most providers don’t think ONC or really anyone else is going to solve the interoperability problem in healthcare. Most are in a wait and see mode as they watch national, state, and regional groups toy with interoperability. Other than a few specific regions, I don’t think many have much hope of the situation changing.

I actually think this is part of the problem with trying to make healthcare data interoperable. Most doctors aren’t involved in it. Many are “too busy” to be involved. Many aren’t sure they want to be involved because they’re not sure if interoperability would be a good or bad thing for their practice. It’s hard to make a financial case for why they should spend time working on interoperability. However, there is a patient care case to be made.

I guess I’m saying that I share many physician’s view on interoperability. I won’t be holding my breathe, waiting for it to happen. Although, I’m certainly open to being surprised. In fact, as a patient, I really hope that someone (probably an entrepreneur?) comes up with a creative way to make interoperability a reality, but so far I’m not that optimistic that it will happen. I guess that makes me skeptical.