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Time To Treat Telemedicine as Just “Medicine”

Posted on October 25, 2016 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.

Over the last year or two, hospitals and clinics have shown a steadily growing interest in offering telemedicine services. Certainly, this is in part due to the fact that health plans are beginning to pay for telehealth consults, offering a new revenue stream that providers want to capture, but there’s more to consider here.

Until recently, much of the discussion around telehealth centered on how to get health insurance companies to pay for it. But now, as value-based purchasing becomes more the norm, providers will need to look at telemedicine as a key tool for managing patient health more effectively.

Evidence increasingly suggests that making providers available via telemedicine channels can help better manage chronic conditions and avert needless hospitalizations, both of which, under value-based payments, are more important than getting a few extra dollars for a consult.

Looked at another way, the days of telehealth being a boutique service for more-sophisticated consumers are ending. “It’s time to treat telemedicine as just ‘medicine,’” one physician consultant told me. “It’s no different than any other form of medicine.”

As reasons for treating telehealth as a core clinical service increase, barriers to sharing video and other telemedical records are falling, the consultant says. Telemedicine providers can already push the content of a video visit or other telehealth consult into an EMR using HL7, and soon information sharing should go both ways, he notes.

What’s more, breaking down another wall, major EMR vendors are offering providers the ability to conduct a telehealth visit using their platform. For example, Epic is offering telemedicine services to providers via its MyChart portal and Hyperspace platform, in collaboration with telehealth video provider Vidyo. Cerner, which operates some tele-ICUs, has gone even further, with senior exec John Glaser recently arguing that telehealth needs to be a central part of its population health strategy.

Admittedly, even if providers develop a high level of comfort delivering care through telehealth platforms, it’s probably too soon to rely on this medium as an agent of change. If nothing else, the industry must face up to the fact that telemedicine demand isn’t huge among their patients at present, though consumer plays like AmWell and DoctoronDemand are building awareness.

Also, while scheduling and conducting telemedicine consults need not be profoundly different than holding a face-to-face visit — other than offering both patient and doctor more flexibility — working in time to manage and document these cases can still pose a workflow challenge. Practical issues such as how, physically, a doctor documents a telehealth visit while staring at the screen must be resolved, issues of scheduling addressed and even questions of how to store and retrieve such visit records must be thought through.

However, I think it’s fair to say that we’re past wondering whether telemedicine should be part of the healthcare process, and whether it makes financial sense for hospitals and clinics to offer it. Now we just have to figure out where and when.

E-Patient Update: The Patient Data Engagement Leader

Posted on October 20, 2016 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.

As healthcare delivery models shift responsibility for patient health to the patients themselves, it’s becoming more important to give them tools to help them get and stay healthy. Increasingly, digital health tools are filling the bill.

For example, portals are moving from largely billing and scheduling apps to exchanging of patient data, holding two-way conversations between patient and doctor and even tracking key indicators like blood glucose levels. Wearables are slowly becoming capable of helping doctors improve diagnoses, and patterns revealed by big data should soon be used to create personalized treatment plants.

The ultimate goal of all this, of course, is to push as much data power as possible into the hands of consumers. After all, for patients to be engaged with their health, it helps to make them feel in control, and the more sophisticated information they get, the better choices they can make. Or at least that’s how the traditional script reads.

Now, as an e-patient, the above is certainly true for me. Every incremental improvement in the data I get me brings me closer to taking on otherwise overwhelming health challenges. That’s true, in part, because I’m comfortable reading charts, extrapolating conclusions from data points and visualizing ways to make use of the information. But if you want less tech-friendly patients to get on board, they’re going to need help.

The patient engagement leader

And where will that help come from? I’d argue that hospitals and clinics need to create a new position dedicated to helping engage patients, including though not limited to helping them make their health data their own. This position would cut across several disciplines, ranging from patient health education clinical medicine to data analytics.

The person owning this position would need to be current in patient engagement goals across the population and by disease/condition type, understand the preferred usage patterns established by the hospital, ACO, delivery network or clinic and understand trends in health behavior well enough to help steer patients in the right direction.

It also wouldn’t hurt if such a person had a healthy dose of marketing skills under their belt, as part of the patient engagement process is simply selling consumers on the idea that they can and should take more responsibility for their health outcomes. Speaking from personal experience, a good marketer can wheedle, nudge and empower people by turns, and this will be very necessary to boost your engagement.

While this could be a middle management position, it would at least need to have the full support of the C-suite. After all, you can’t promote population-wide improvements in health by nibbling around the edges of the problem. Such measures need to be comprehensive and strategic to the mission of the healthcare organization as a whole, and the person behind the needs to have the authority to see them through.

Patients in control

If things go right, establishing this position would lead to the creation of a better-educated, more-confident patient population with a greater sense of self efficacy regarding their health. While specific goals would vary from one healthcare organization to the other, such an initiative would ideally lead to improvements in key metrics such as A1c levels population-wide, drops in hospital admission and readmission rates and simultaneously, lower spending on more intense modes of care.

Not only that, you could very well see patient satisfaction increase as well. After all, patients may not feel capable of making important health changes on their own, and if you help them do that it stands to reason that they’ll appreciate it.

Ultimately, engaging patients with their health calls for participation by everyone who touches the patient, from techs to the physician, nurses to the billing department. But if you put a patient engagement officer in place, it’s more likely that these efforts will have a focus.

What Do You Think Of Data Lakes?

Posted on October 4, 2016 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.

Being that I am not a high-end technologist, I’m not always up on the latest trends in database management – so the following may not be news to everyone who reads this. As for me, though, the notion of a “data lake” is a new one, and I think it a valuable idea which could hold a lot of promise for managing unruly healthcare data.

The following is a definition of the term appearing on a site called KDnuggets which focuses on data mining, analytics, big data and data science:

A data lake is a storage repository that holds a vast amount of raw data in its native format, including structured, semi-structured and unstructured data. The data structure and requirements are not defined until the data is needed.

According to article author Tamara Dull, while a data warehouse contains data which is structured and processed, expensive to store, relies on a fixed configuration and used by business professionals, a data link contains everything from raw to structured data, is designed for low-cost storage (made possible largely because it relies on open source software Hadoop which can be installed on cheaper commodity hardware), can be configured and reconfigured as needed and is typically used by data scientists. It’s no secret where she comes down as to which model is more exciting.

Perhaps the only downside she identifies as an issue with data lakes is that security may still be a concern, at least when compared to data warehouses. “Data warehouse technologies have been around for decades,” Dull notes. “Thus, the ability to secure data in a data warehouse is much more mature than securing data in a data lake.” But this issue is likely to receive in the near future, as the big data industry is focused tightly on security of late, and to her it’s not a question of if security will mature but when.

It doesn’t take much to envision how the data lake model might benefit healthcare organizations. After all, it may make sense to collect data for which we don’t yet have a well-developed idea of its use. Wearables data comes to mind, as does video from telemedicine consults, but there are probably many other examples you could supply.

On the other hand, one could always counter that there’s not much value in storing data for which you don’t have an immediate use, and which isn’t structured for handy analysis by business analysts on the fly. So even if data lake technology is less costly than data warehousing, it may or may not be worth the investment.

For what it’s worth, I’d come down on the side of the data-lake boosters. Given the growing volume of heterogenous data being generated by healthcare organizations, it’s worth asking whether deploying a healthcare data lake makes sense. With a data lake in place, healthcare leaders can at least catalog and store large volumes of un-normalized data, and that’s probably a good thing. After all, it seems inevitable that we will have to wring value out of such data at some point.

E-Patient Update:  Registration Can Add Value To Care 

Posted on August 15, 2016 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.

For those of you who end up seeking care in hospital emergency departments now and again, the following will probably be familiar. You’re spending the precious few minutes you get with the ED doc discussing your situation, having a test done or asking a nurse some rather personal questions, and a hapless man or woman shows up and inserts themselves into the moment. Why? Because they want to collect registration information.

While these clerks are typically pleasant enough, and their errand relatively brief, their interruption has consequences. In my case, their entry into the room has sometimes caused a nurse or doctor to lose their train of thought, or an explanation in progress was never finished. As if that weren’t irritating enough, the registration clerk – at least at my local community hospital – typically asks questions I’ve already answered previously, or asks me to sign forms I could easily have reviewed at an earlier stage in the process.

Not only that, there have been at least a couple of situations in which a nurse or doctor was so distracted by the clerk’s arrival that some reasonably important issues didn’t get handled. Don’t get me wrong, the skilled team at this facility recovered and addressed these issues before they could escalate, but there’s no guarantee that this will always happen, particularly if the patient isn’t used to keeping track of their care process.

Also, given that alarm fatigue is already leading to patient care mistakes and near-misses, it seems odd that this hospital would squeeze yet another distraction into its ED routine. At least the alarms are intended to serve as clinical decision support and avoid needless errors. Collecting my street address a second time doesn’t rise to that level of importance.

Of course, hospitals need the information the clerk collects, for a variety of legal and operational reasons. I have no problem signing a form giving it permission to bill my insurer, affirming that I don’t need disability accommodations or agreeing to a facility’s “no smoking on campus” policy. And I certainly want any provider that treats me to have full and accurate insurance information, as I obviously don’t want to be billed for the care myself!  But is it really necessary to interrupt a vital care process to accomplish this?

As I see it, verifying registration information could be done much more effectively if it took place at a different point in the sequence of care – at the moment when physicians decide whether to discharge or admit that patient.  After all, if the patient is well enough to answer questions and sign forms while lying in an ED bed, they’re likely to remain so through the admissions process, and verify their financial and personal information once they’re settled (or even while they’re waiting to be transported to their bed). Meanwhile, if the patient is being discharged, they could just as easily provide signatures and personal data as they prepare to leave.

But the above would simply make registration less intrusive. What about adding real value to the process, for both the hospital and the patient? Instead of having a clerk gather this information, why not provide the patient with a tablet which presents the needed information, allowing patients to enter or edit their personal details at leisure.

Then, as they digitally sign off on registration, it would be a great time to ask the patient a few details which help the facility understand the patient’s need for support and care coordination. Why not find out, before the patient is discharged, whether they have a primary care doctor or relevant specialist, whether they can afford their medications, whether they can get to post-discharge visits and the like? This improves results for the patient and ties in with a value-based focus on continuity of care.

These days, it’s not enough just to eliminate pointless workflow disruptions. Let’s leverage the amazing consumer IT platforms we have to make things better!

ONC Announces Winners Of FHIR App Challenge

Posted on August 3, 2016 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.

The ONC has announced the first wave of winners of two app challenges, both of which called for competitors to use FHIR standards and open APIs.

As I’ve noted previously, I’m skeptical that market forces can solve our industry’s broad interoperability problems, even if they’re supported and channeled by a neutral intermediary like ONC. But there’s little doubt that FHIR has the potential to provide some of the benefits of interoperability, as we’ll see below.

Winners of Phase 1 of the agency’s Consumer Health Data Aggregator Challenge, each of whom will receive a $15,000 award, included the following:

  • Green Circle Health’s platform is designed to provide a comprehensive family health dashboard covering the Common Clinical Data Set, using FHIR to transfer patient information. This app will also integrate patient-generated health data from connected devices such as wearables and sensors.
  • The Prevvy Family Health Assistant by HealthCentrix offers tools for managing a family’s health and wellness, as well as targeted data exchange. Prevvy uses both FHIR and Direct messaging with EMRs certified for Meaningful Use Stage 2.
  • Medyear’s mobile app uses FHIR to merge patient records from multiple sources, making them accessible through a single interface. It displays real-time EMR updates via a social media-style feed, as well as functions intended to make it simple to message or call clinicians.
  • The Locket app by MetroStar Systems pulls patient data from different EMRs together onto a single mobile device. Other Locket capabilities include paper-free check in and appointment scheduling and reminders.

ONC also announced winners of the Provider User Experience Challenge, each of whom will also get a $15,000 award. This part of the contest was dedicated to promoting the use of FHIR as well, but participants were asked to show how they could enhance providers’ EMR experience, specifically by making clinical workflows more intuitive, specific to clinical specialty and actionable, by making data accessible to apps through APIs. Winners include the following:

  • The Herald platform by Herald Health uses FHIR to highlight patient information most needed by clinicians. By integrating FHIT, Herald will offer alerts based on real-time EMR data.
  • PHRASE (Population Health Risk Assessment Support Engine) Health is creating a clinical decision support platform designed to better manage emerging illnesses, integrating more external data sources into the process of identifying at-risk patients and enabling the two-way exchange of information between providers and public health entities.
  • A partnership between the University of Utah Health Care, Intermountain Healthcare and Duke Health System is providing clinical decision support for timely diagnosis and management of newborn bilirubin according to evidence-based practice. The partners will integrate the app across each member’s EMR.
  • WellSheet has created a web application using machine learning and natural language processing to prioritize important information during a patient visit. Its algorithm simplifies workflows incorporating multiple data sources, including those enabled by FHIR. It then presents information in a single screen.

As I see it, the two contests don’t necessarily need to be run on separate tracks. After all, providers need aggregate data and consumers need prioritized, easy-to-navigate platforms. But either way, this effort seems to have been productive. I’m eager to see the winners of the next phase.

E-Patient Update:  When EMRs Didn’t Matter, But Should Have

Posted on July 27, 2016 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.

The other day I went to an urgent care clinic, suffering from a problem which needed attention promptly. This clinic is part of the local integrated health system’s network, where I’ve been seen for nearly 20 years. This system uses Epic everywhere in its network to coordinate care.

I admittedly arrived rather late and close to when the clinic was going to close. But I truly didn’t want to make a wasteful visit to the ED, so I pressed on and presented myself to the receptionist. And sadly, that’s where things got a bit hairy.

The receptionist said: “We’ve already got five patients to see so we can’t see anyone else.” Uncomfortable as I was, I fought back with what seemed like logic to me: “I need help and a hospital would be a waste. Could someone please check my medical records? The doctors will understand what I need and why it’s urgent.”

The receptionist got the nurse, who said “I’m sorry, but we aren’t seeing any more patients today.” I asked, “But what about the acuity of a given case, such as mine for example? Can’t you prioritize me? It’s all in my medical records and I know you’re online with Epic!”  She shook her head at me and walked away.

I sat in reception for a while, too irritated to walk out and too uncomfortable to let go of the issue. Man, it was no fun, and I called those folks some not-nice things in my mind – but more than anything else, wondered why they wouldn’t look at data on a well-documented patient like me for even a moment.

About 20 minutes before the place officially closed for the night, a nurse practitioner I know (let’s call him Ed) walked out into the waiting room and asked me what I needed. I explained in just a few words what I was after. Ed, who had reviewed my record, knew what I needed, knew why it was important and made it happen within five minutes. Officially, he wasn’t supposed to do that, but he felt comfortable helping because he was well-informed.

Truthfully, I realize this story is relatively trivial, but as I see it, it brings an important issue to the fore. And the issue is that even when seeing chronically-ill patients such as myself, whose comings and goings are well documented, providers can’t or won’t do much to exploit that data.

You hear a lot of talk about big data and analytics, and how they’ll change healthcare or even the world as we know it. But what about finding ways to better use “small data” produced by a single patient? It seems to me that clinicians don’t have the right tools to take advantage of a single patient’s history, or find it too difficult to do so. Either way, though, something must be done.

I know from personal experience that if clinicians don’t know my history, they can’t treat me efficiently and may drive up costs by letting me get sicker. And we need more Eds out there making the save. So let’s make the chart do a better job of mining patient’s data. Otherwise, having an EMR hardly matters.

VA May Drop VistA For Commercial EHR

Posted on July 12, 2016 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.

It’s beginning to look like the famed VistA EHR may be shelved by the Department of Veterans Affairs, probably to be replaced by a commercial EHR rollout. If so, it could spell the end of the VA’s involvement in the highly-rated open source platform, which has been in use for 40 years. It will be interesting to see how the commercial EHR companies that support Vista would be impacted by this decision.

The first rumblings were heard in March, when VA CIO LaVerne Council  suggested that the VA wasn’t committed to VistA. Now Council, who supervises the agency’s $4 billion IT budget, sounds a bit more resolved. “I have a lot of respect for VistA but it’s a 40-year-old product,” Council told Politico. “Looking at what technology can do today that it couldn’t do then — it can do a lot.”

Her comments were echoed by VA undersecretary for health David Shulkin, who last month told a Senate hearing that the agency is likely to replace VistA with commercial software.

Apparently, the agency will leave VistA in place through 2018. At that point, the agency expects to begin creating a cloud-based platform which may include VistA elements at its core, Politico reports. Council told the hearing that VA IT leaders expect to work with the ONC, as well as the Department of Defense, in building its new digital health platform.

Particularly given its history, which includes some serious fumbles, it’s hardly surprising that some Senate members were critical of the VA’s plans. For example, Sen. Patty Murray said that she was still disappointed with the agency’s 2013 decision back to call of plans for an EHR that integrated fully with the DoD. And Sen. Richard Blumenthal expressed frustration as well. “The decades of unsuccessful attempts to establish an electronic health record system that is compatible across the VA in DoD has caused hundreds of millions of taxpayer dollars to be wasted,” he told the committee.

Now, the question is what commercial system the VA will select. While all the enterprise EHR vendors would seem to have a shot, it seems to me that Cerner is a likely bet. One major reason to anticipate such a move is that Cerner and its partners recently won the $4.3 billion contract to roll out a new health IT platform for the DoD.

Not only that, as I noted in a post earlier this year, the buzz around the deal suggested that Cerner won the DoD contract because it was seen as more open than Epic. I am taking no position on whether there’s any truth to this belief, nor how widespread such gossip may be. But if policymakers or politicians do see Cerner as more interoperability-friendly, that will certainly boost the odds that the VA will choose Cerner as partner.

Of course, any EHR selection process can take crazy turns, and when you grow in politics the process can even crazier. So obviously, no one knows what the VA will do. In fact, given their battles with the DoD maybe they’ll go with Epic just to be different. But if I were a Cerner marketer I’d like my odds.

Vendors Bring Heart And Lung Sounds To EHR

Posted on June 3, 2016 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.

In what they say is a first, a group of technology vendors has teamed up to add heart and lung sounds to an EMR. The current effort extends only to the drchrono EHR, but if this rollout works, it seems likely that other vendors will follow, as adding multimedia content to patient medical records is a very logical step.

Urgent care provider Direct Urgent Care, a Berkeley, CA-based urgent care provider with 30,000 patients, is rolling out the Eko Core Digital Stethoscope for use by physicians. The heart and lung sounds will be recorded by the digital stethoscope, then transmitted wirelessly to a phone- or tablet-based mobile app. The app, in turn, uploads the audio files to the drchrono HR.

Ordinarily, I’d see this as an early experiment in managing multimedia health data and leave it at that. But two things make it more interesting.

One is that the Eko Core sells for a relatively modest $299, which is not bad for an FDA-cleared device. (Eko also sells an attachment for $199 which digitizes and records sounds captured by traditional analog stethoscopes, as well as streaming those files to the Eko app.) The other is that the recorded sounds can be shared with remote specialists such as cardiologists and pulmonologists, which seems valuable on its face even if the data doesn’t get stored within an EMR.

Not only that, this rollout underscores a problem just been given too little attention. At present, what I’ve seen, few EMRs incorporated anything beyond text. Even radiology images, which have been digital for ages (and managed by sophisticated PACS platforms) typically aren’t accessible to the EMR interface. In fact, my understanding is that PACS data is another silo that needs to be broken down.

Meanwhile, medical practices and hospitals are increasingly generating data that doesn’t fit into the existing EMR template, from sources such as wearables, health apps and video consults. Neither EMR developers nor standards organizations seem to have kept up with the influx of emerging non-text data, so virtually none of it is being integrated into patient records yet.

In other words, not only is it interesting to note that an EMR vendor is incorporating audio into medical records, at a modest cost, it’s worth taking stock of what it can teach us about enriching digital patient records overall.

Eventually, after all, patients will be able to capture — with some degree of accuracy — multimedia content that includes not only audio, but also ultrasound recordings, EKG charts and more. Of course, these self-administered tests and will never replace a consult by a skilled clinician, but there certainly are situations in which this data will be relevant.

When you also bear in mind that the number of telemedicine consults being conducted is growing dramatically, and that these, too, offer insights that could become part of a patient’s chart, the need to go beyond text-based EMRs becomes even more evident.

So maybe the Eko/drchrono partnership will work out, and maybe it won’t. But what they’re doing matters nonetheless.

Joint Commission Now Allows Texting Of Orders

Posted on May 17, 2016 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.

For a long time, it was common for clinicians to share private patient information with each other via standard text messages, despite the fact that the information was in the clear, and could theoretically be intercepted and read (which this along with other factors makes SMS texts a HIPAA violation in most cases). To my knowledge, there have been no major cases based on theft of clinically-oriented texts, but it certainly could’ve happened.

Over the past few years, however, a number of vendors have sprung up to provide HIPAA-compliant text messaging.  And apparently, these vendors have evolved approaches which satisfy the stringent demands of The Joint Commission. The hospital accreditation group had previously prohibited hospitals from sanctioning the texting of orders for patient care, treatment or services, but has now given it the go-ahead under certain circumstances.

This represents an about-face from 2011, when the group had deemed the texting of orders “not acceptable.” At the time, the Joint Commission said, technology available didn’t provide the safety and security necessary to adequately support the use of texted orders. But now that several HIPAA-compliant text-messaging apps are available, the game has changed, according to the accrediting body.

Prescribers may now text such orders to hospitals and other healthcare settings if they meet the Commissioin’s Medication Management Standard MM.04.01.01. In addition, the app prescribers use to text the orders must provide for a secure sign-on process, encrypted messaging, delivery and read receipts, date and time stamp, customized message retention time frames and a specified contact list for individuals authorized to receive and record orders.

I see this is a welcome development. After all, it’s better to guide and control key aspects of a process rather than letting it continue on underneath the surface. Also, the reality is that healthcare entities need to keep adapting to and building upon the way providers actually communicate. Failing to do so can only add layers to a system already fraught with inefficiencies.

That being said, treating provider-to-provider texts as official communications generates some technical issues that haven’t been addressed yet so far as I know.

Most particularly, if clinicians are going to be texting orders — as well as sharing PHI via text — with the full knowledge and consent of hospitals and other healthcare organizations — it’s time to look at what it takes manage that information more efficiently. When used this way, texts go from informal communication to extensions of the medical record, and organizations should address that reality.

At the very least, healthcare players need to develop policies for saving and managing texts, and more importantly, for mining the data found within these texts. And that brings up many questions. For example, should texts be stored as a searchable file? Should they be appended to the medical records of the patients referenced, and if so, how should that be accomplished technically? How should texted information be integrated into a healthcare organization’s data mining efforts?

I don’t have the answers to all of these questions, but I’d argue that if texts are now vehicles for day-to-day clinical communication, we need to establish some best practices for text management. It just makes sense.

Time To Leverage EHR Data Analytics

Posted on May 5, 2016 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.

For many healthcare organizations, implementing an EHR has been one of the largest IT projects they’ve ever undertaken. And during that implementation, most have decided to focus on meeting Meaningful Use requirements, while keeping their projects on time and on budget.

But it’s not good to stay in emergency mode forever. So at least for providers that have finished the bulk of their initial implementation, it may be time to pay attention to issues that were left behind in the rush to complete the EHR rollout.

According to a recent report by PricewaterhouseCoopers’ Advanced Risk & Compliance Analytics practice, it’s time for healthcare organizations to focus on a new set of EHR data analytics approaches. PwC argues that there is significant opportunity to boost the value of EHR implementations by using advanced analytics for pre-live testing and post-live monitoring. Steps it suggests include the following:

  • Go beyond sample testing: While typical EHR implementation testing strategies look at the underlying systems build and all records, that may not be enough, as build efforts may remain incomplete. Also, end-user workflow specific testing may be occurring simultaneously. Consider using new data mining, visualization analytics tools to conduct more thorough tests and spot trends.
  • Conduct real-time surveillance: Use data analytics programs to review upstream and downstream EHR workflows to find gaps, inefficiencies and other issues. This allows providers to design analytic programs using existing technology architecture.
  • Find RCM inefficiencies: Rather than relying on static EHR revenue cycle reports, which make it hard to identify root causes of trends and concerns, conduct interactive assessment of RCM issues. By creating dashboards with drill-down capabilities, providers can increase collections by scoring patients invoices, prioritizing patient invoices with the highest scores and calculating the bottom-line impact of missing payments.
  • Build a continuously-monitored compliance program: Use a risk-based approach to data sampling and drill-down testing. Analytics tools can allow providers to review multiple data sources under one dashboard identify high-risk patterns in critical areas such as billing.

It’s worth noting, at this point, that while these goals seem worthy, only a small percentage of providers have the resources to create and manage such programs. Sure, vendors will probably tell you that they can pop a solution in place that will get all the work done, but that’s seldom the case in reality. Not only that, a surprising number of providers are still unhappy with their existing EHR, and are now living in replacing those systems despite the cost. So we’re hardly at the “stop and take a breath” stage in most cases.

That being said, it’s certainly time for providers to get out of whatever defensive crouch they’ve been in and get proactive. For example, it certainly would be great to leverage EHRs as tools for revenue cycle enhancement, rather than the absolute revenue drain they’ve been in the past. PwC’s suggestions certainly offer a useful look on where to go from here. That is, if providers’ efforts don’t get hijacked by MACRA.