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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.

Department of Defense (DoD) EHR Project Opens Doors for HIT Vendors and Non-Vendors – Breakaway Thinking

Posted on August 19, 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
Numerous medical advances can be traced back to development and research conducted by the U.S. military. In most instances, these developments were directly related to mitigating casualties and disease during times of war. The U.S. Civil War is seen as one of the most influential military events to advance modern medicine. Life-saving amputations, anesthesia, thoracic surgery, wound treatment, facial reconstruction, and the inception of the ambulance-to-ER transport system all originated with military intervention. While today’s medical advancements have certainly surpassed anything ever imagined by Civil War surgeons a century and a half ago, the model of healthcare innovations spurring from military initiatives remains steadfast. In fact, the U.S. military is one of the largest payers and providers within the modern day healthcare system, and the Department of Defense’s (DoD) current Electronic Health Records (EHR) project presents an unparalleled opportunity for development and implementation of an innovative solution that will inform advancement in both the military and private health systems. With this DoD decision, the contracted vendors will have opportunities and challenges to fulfill the reality of this EHR, and all other vendors will have an opportunity to innovate and capitalize on the private sector.

While the massive undertaking to update the DoD’s EHR system holds great promise, many health information technology experts have expressed skepticism surrounding the approach and associated costs of implementation via a complex public-private partnership model. Skeptics also continue to point to the failed implementation of HealthCare.gov as a litmus test for potential success. Potential pitfalls aside, the DoD EHR project does create opportunity for health information technology (HIT) vendors and start-ups across the industry who recognize that disruptive innovation can easily erupt in the private sector, and new market opportunities will arise as a result of this government-private sector partnership. Both critics and supporters should pay attention to the developments in the coming months.

The DoD contract will likely span 10 years with the aim of creating a new electronic health system to replace the DoD’s Armed Forces Health Longitudinal Technology Application (AHLTA). This collective effort, referred to as the Defense Healthcare Management System Modernization (DHMSM),  or “Dimsum” as commonly called by health IT insiders, creates opportunity for development of a commercial, off-the-shelf version of the government system. The price tag for this contracted venture is $4.34 billion, but that certainly may increase as development evolves. Compared to prior attempts by the DoD and the U.S. Department of Veterans Affairs (VA) to create an integrated electronic health record at an estimated costs of $28 billion, the $4.34 billion price tag appears to offer staggering savings; however, the two projects differ greatly. The initial integrated EHR was scrapped due to cost estimates and disagreement between DoD and VA leadership, ultimately leading to DHMSM and the VA moving forward with a separate update to that EHR, which later became known as the Veterans Health Information Systems and Technology Architecture (VistaA) program.  Despite leadership disagreements and technological difficulties, one of the goals of DHMSM is interoperability between the new DoD system and the VA system.

Dr. Jonathan Woodson, assistant secretary of defense for health affairs, articulated the need for interoperability between both military and private systems during a July 29 briefing. He stated that the goal is for the new military system and the private sector systems to become interoperable. If private sector health IT vendors – whether partners in the contract or not – figure out how to easily exchange data and communicate with other platforms, they will truly capitalize on this opportunity and improve care simultaneously.

Interoperability between private and military systems is underway. For example, the Military Health System in Colorado Springs, Colorado joined efforts with the Colorado Regional Information Organization (CORHIO) and is making progress with interoperability and data sharing through the utilization of Health Information Exchanges (HIEs). They are able to share patient information and data in both private and military health systems. As presented at this years’ HIMSS conference, the initial collaboration and efforts between the two organizations have shown promising results.

Dr. Karen DeSalvo, federal health IT coordinator, echoes further support and enthusiasm for DHMSM and private system interoperability. “[The DHMSM is] an important step toward achieving a nationwide interoperable health IT infrastructure.” As contributors to the Office of the National Coordinators Interoperability Roadmap, Dr. Karen DeSalvo and her cohorts appreciate the potential impact of establishing interoperability on such a large scale. It will be an incredible milestone in HIT history to attain true interoperability of military and private systems. Conversely, if large-scale interoperability is not achieved, it may lead to more spending and potentially the demise of the project altogether. To the chagrin of DHMSM supporters, this failure would only support assertions that the failed Healthcare.gov website was only the beginning of a litany of government HIT challenges. But given the track record of medical advances related to military research and development, the DHMSM project will likely achieve some level of interoperability and attain the goals set during the initial request-for-proposal phase.

The next opportunity and challenge is already happening. The selected DHMSM health IT vendors must maintain their private sector customer base while rapidly developing the new military system. This is no small task. Doing so will require additional resources and new partnerships to successfully manage this effort. It also means that if these vendors are not successful, their customer base may decide to switch EHRs and implement another EHR platform altogether. Either way, there are opportunities for HIT vendors and consultants to innovate and gain entry to new markets and customers.

Alternatively, the HIT vendors not selected for the DHMSM contract are positioned to innovate and create new technologies and supporting systems. Although the military is responsible for many medical advances, numerous technological advances have been developed in the private sector and can be traced to simple beginnings in a garage or dorm room without any direct military or government involvement. Those across the HIT marketplace have the opportunity and motivation to develop new, cutting-edge technology, by capitalizing upon the bright light currently being shone on new health technologies as a means of improving patient safety and health outcomes.

Data security is another area to pay attention to in the coming months. The DHMSM is an excellent opportunity to develop sophisticated systems to protect patient health information. Conversely, creating such a massive interoperable system opens up risk for data security of all integrated systems. In an age where devices, web searching, and systems leave a trail of bread crumbs and create an internet-of-things (ioT) or web of data points, the new DHMSM system must effectively protect this web of data to avoid compromising personal and national security.

We must also consider the ability to successfully implement and adopt the DHMSM system. This type of system will require a coordinated and focused effort of massive proportions. After coordinating logistics, adopting the new system will require another heroic level of effort. Difficulties may lie in establishing proper governance between the selected HIT vendors and military projects and ensuring that all companies involved have the stamina and focus for the entire life cycle of the system. The DoD began laying the foundation for governance structures during the initial proposal process, but it is yet to be seen if all involved parties will be able to adhere to the outlined parameters and work collaboratively to create their new DHMSM system. Additionally, once the system is designed and implemented, if proper funds are not available to sustain the system, the DoD would have to consider a potential redesign.

The military’s track record with medical advances positions them to successfully implement the new DHMSM system. Remarkably, this project has the potential to lay the foundation for interoperability and data security in the U.S. Despite the obvious challenges associated with the DHMSM EHR project, a system that is able to communicate and safely share data for large populations is worth the investment. From a global perspective, many countries are far ahead of the U.S. in designing and implementing national health records (e.g. Denmark, Finland, Sweden, UK, and Australia). There is also the potential for the DHMSM system to evolve one day into a national electronic health record, but doing so would require a national paradigm shift and lot more than $4.3 billion. Additionally, the challenges associated with this initial venture will surely be exacerbated due to the scale of the project and sheer importance. Health IT vendors and start-ups not directly involved in DHMSM should remain optimistic and on the lookout for new opportunities and challenges on the horizon. If the DoD and the contracted health IT vendors can successfully develop and deploy the DHMSM system, new opportunities, research and medical advances will likely follow.  It’s up to both HIT vendors and non-vendors of the DoD contract to decide whether they walk through this “door” of opportunity and make the most of this historic initiative.

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

Is HIPAA Misuse Blocking Patient Use Of Their Data?

Posted on August 18, 2015 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Recently, a story in the New York Times told some troubling stories about how HIPAA misunderstandings have crept into both professional and personal settings. These included:

  • A woman getting scolded at a hospital in Boston for “very improper” speech after discussing her husband’s medical situation with a dear friend.
  • Refusal by a Pennsylvania hospital to take a daughter’s information on her mother’s medical history, citing HIPAA, despite the fact that the daughter wasn’t *requesting* any data. The woman’s mother was infirm and couldn’t share medical history — such as her drug allergy — on her own.
  • The announcement, by a minister in California, that he could no longer read the names of sick congregants due to HIPAA.

All of this is bad enough, particularly the case of the Pennsylvania refusing to take information that could have protected a helpless elderly patient, but the effects of this ignorance create even greater ripples, I’d argue.

Let’s face it: our efforts to convince patients to engage with their own medical data haven’t been terribly successful as of yet. According to a study released late last year by Xerox, 64% of patients were not using patient portals, and 31% said that their doctor had never discussed portals with them.

Some of the reasons patients aren’t taking advantage of the medical data available to them include ignorance and fear, I’d argue. Technophobia and a history of just “trusting the doctor” play a role as well. What’s more, pouring through lab results and imaging studies might seem overwhelming to patients who have never done it before.

But that’s not all that’s holding people back. In my opinion, the climate of medical data fear HIPAA misunderstandings have created is playing a major part too.

While I understand why patients have to sign acknowledgements of privacy practices and be taught what HIPAA is intended to do, this doesn’t exactly foster a climate in which patients feel like they own their data. While doctor’s offices and hospitals may not have done this deliberately, the way they administer HIPAA compliance can make medical data seem portentous, scary and dangerous, more like a bomb set to go off than a tool patients can use to manage their care.

I guess what I’m suggesting is that if providers want to see patients engaged and managing their care, they should make sure patients feel comfortable asking for access to and using that data. While some may never feel at ease digging into their test results or correcting their medical history, I believe that there’s a sizable group of patients who would respond well to a reminder that there’s power in doing so.

The truth is that while most providers now give patients the option of logging on to a portal, they typically don’t make it easy. And heaven knows even the best-trained physician office staff rarely take the time to urge patients to log on and learn.

But if providers make the effort to balance stern HIPAA paperwork with encouraging words, patients are more likely to get inspired. Sometimes, all it takes is a little nudge to get people on board with new behavior. And there’s no excuse for letting foolish misinterpretations of HIPAA prevent that from happening.

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.