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What Happened with EMR and Health IT in 2013?

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As we wrap up 2013, I thought I’d take a look back at some of the major things that happened in 2013. They will be topics you’re very familiar with, but hopefully this will tie a nice bow on the top of 2013 as we look towards 2014.

ICD-10 Got Real – There are still many organizations that aren’t focusing on ICD-10 or that are underestimating it, but for the most part I’m seeing a lot of concern around ICD-10. I’ve started a whole series on ICD-10 and as I’ve been preparing posts the impact of ICD-10 is going to be huge. I think people are just starting to realize it and 7-8 months from now there’s going to be a lot of organizations that are going to go into panic mode. Some of the panic they could solve if they started working on ICD-10 today. Some of the panic will likely come from outside vendors who end up not delivering ICD-10 the way they should.

ACO’s Are Still a Mystery – Some of the ACO work from the government is coming into some focus, but that barely feels like an ACO to me. Of course, it’s all how you define an ACO. I mostly see defensive efforts by organizations trying to group and align themselves with other organizations for whatever reimbursement changes come down the pipe. However, I don’t think any of them really know what’s coming (and I don’t claim to know either).

Meaningful Use Stage 2 Hit Us – We got a meaningful use stage 2 extension and a meaningful use stage 3 delay, but we didn’t get what many were hoping would be a meaningful use stage 2 delay. That means organizations have little choice but to proceed with meaningful use stage 2. As I’ve seen more and more organizations get into MU stage 2, I’ve seen two main actions: workarounds and complaints.

I believe the inverse relationship between incentives and requirements is starting to become an issue. It will certainly blow up when the even more challenging meaningful use stage 3 requirements hit and the EHR incentives are gone.

Consolidation (Hospital and Physician Practice) – Everyone tells me private practice acquisition is cyclical and at some point we’ll see a return to independent doctors. However, I haven’t seen that cycle happen yet. All I see our hospitals acquiring practices like crazy. Not to mention hospitals joining together as well. I wonder if the prediction I heard of only 5-10 major health systems will play out.

HIPAA Omnibus Landed (and is mostly forgotten) – HIPAA Omnibus is in place whether a practice likes it or not. Most never realized it went into affect or have forgotten it already. Watch for 2014 to be the year that it starts biting organizations in the backside. Give us 4-5 stories about HIPAA Omnibus making a physician’s life miserable and then we’ll see more people getting HIPAA training, fixing their business associate agreements, and maybe even implementing encryption on their devices. Maybe I should have added this to my 2014 wish list I’ll post tomorrow.

Did I miss anything? Probably. So, let’s hear what I missed in the comments. Also, I made some similar comments with a hospital focus over on Hospital EMR and EHR.

December 31, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Physician Acquisition: Is It The Right Strategy For Your Health System?

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Today I was talking with a vendor of EHR conversion services. I’ll be writing a lot more about our conversation soon, but I wasn’t surprised by his comment that mane of the EHR conversions that they’re doing are due to physician practice acquisition. Whether it’s a large hospital system acquiring the practice or a group practice acquiring a practice, there’s often the desire to move that practice to the same EHR platform.

As I thought about the trend of acquired physician practices, I ran across a whitepaper by athenahealth which asked the question: Physician Acquisition: Is It The Right Strategy For Your Health System? The whitepaper highlights how varying interpretations of the Affordable Care Act (Obamacare), the launch of Accountable Care Organizations (ACO), bundled payment pilots, and the persistent pressure on commercial reimbursement rates makes planning for healthcare leaders a challenging task. However, what does seem clear is that doing the same thing you’ve always done won’t be a viable long term strategy.

All of these pressures are driving the physician acquisition strategy of most organizations. Does anyone see these pressures changing anytime soon? I don’t see any changes in this regard on the horizon.

Despite the widespread physician acquisitions that are happening, there are legal barriers (antitrust) that prevent a clinic from controlling all of healthcare in a community. What does this mean for an organization? How do they integrate with providers that they haven’t acquired? Plus, it’s naive to think that the acquired physicians are going to remain with your organization forever. We have seen the cycle before where acquired doctors leave the mothership and venture out on their own again. Organizations without a strong external strategy are going to be in a difficult position.

The whitepaper does make an interesting case for clinical integration versus full on practice acquisition. This is a great concept that every organization should consider. Can you clinically integrate with an organization that you don’t own? How would that clinical integration work? I think these integrations are still evolving, but the whitepaper had two case studies from organizations that were working on it.

What’s the right strategy for health systems when it comes to physician acquisition?

September 9, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Why PaaS is the Future of Healthcare

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The following is a guest post by Anil Kottoor, president and CEO of MedHOK.

The need for improved data management and quality reporting is increasing exponentially as various healthcare reform measures take effect. From hospitals and physicians participating in Accountable Care Organizations (ACOs) to Medicare Advantage and prescription drug plans looking to improve their Star ratings, it seems that no healthcare sector is exempt from this litany of change.

Take for instance ACO participants. While the newly formed care model promises to improve care coordination and cut costs, doing so requires that providers invest in patient population management platforms capable of collecting and sharing patient information across the continuum of care.

Similarly, Medicare Advantage and prescription drug plans are seeking out platforms capable of monitoring and tracking quality metrics. That is because under the Centers for Medicare and Medicaid Services (CMS’) continually evolving Five Star Rating System, the pressure is on to improve quality or miss out on incentives such as year-round enrollment under a newly created special election period.

Despite the system-wide need for these advanced technology tools, few organizations have the resources necessary to invest in the hardware and software required to manage and track patient information and quality metrics. Small- to medium-sized businesses in particular are finding that they simply do not have the space or technical expertise to house and manage additional servers in-house.

As a result, many providers are seeking alternative solutions to their data management needs.

Software-as-a-Service Model

Perhaps the most well-known alternative to purchasing costly hardware and software is the Software-as-a-Service (SaaS) model, which provides organizations with the software they need via intuitive web interfaces. By eliminating the need for upfront hardware investments and ongoing maintenance costs, cloud-based software eliminates the hefty cost barrier that many providers face with their IT infrastructure investments.

Further, unlike traditional software, SaaS-based solutions do not require the purchase of multiple licenses across the organization. Most subscriptions can be tailored to the organization’s user needs and customized as staff size fluctuates. In addition, because software is hosted by a vendor or service provider and made available over the Internet, users can access information anywhere with Internet access.

However, while the SaaS model has experienced a rise in popularity over the last several years, the reality is that it does not provide the holistic approach to care and quality management that healthcare organizations desire. That is because many organizations must subscribe to a number of SaaS-based solutions to meet their data management needs. As a result, information is stored in multiple silos across their various vendor networks.

Platform-as-a-Service Model

This has given rise to the Platform-as-a-Service (PaaS) model. In essence, PaaS provides users with both the SaaS-based solution and industry-specific application platform or operating system they need to manage data needs. For healthcare organizations that utilize various software solutions, this means that all of their solutions and the accompanying information can be found within the same user-friendly interface, thus removing the silos inherent in the SaaS model and streamlining information management and sharing.

In other words, PaaS provides all the benefits of SaaS with the added convenience of having all products within the same platform. Because these solutions are compatible with most existing software solutions, including electronic medical records (EMRs), they also eliminate the need to “rip and replace” systems that providers have grown comfortable using.

Unlike traditional IT infrastructures, PaaS solutions can be rapidly deployed to meet healthcare organizations’ comprehensive patient population management and data tracking needs. In fact, where traditional software solutions may take up to two years to implement, PaaS-based solutions can take as little as 90 days. Further, because PaaS providers manage both the software and the infrastructure, organizations can easily scale offerings to manage an increase – or decrease – in patient population.

Finally, because the PaaS models allows software to be deployed as individual modules or comprehensive end-to-end solutions, providers can easily add or remove products as the customer’s needs change. This also eliminates the need for investment in long-term technology strategy that may be outdated before the phase ever goes live.

The Future of Healthcare

The reality is that healthcare reform is rapidly changing the business of healthcare as new regulations and requirements continually roll out. To remain competitive in today’s market, health plans must remain extremely agile, and be willing to upgrade their software and reporting solutions before requirements are fully defined. However, doing so often requires a hefty upfront investment and a great deal of risk for those organizations that do not have the internal resources to manage the evolution of the required technology.

PaaS removes both of these obstacles and provides organizations with the agility and flexibility needed to rapidly respond to regulatory and market changes. Further, by leaving all of the heavy lifting up to a software vendor who specializes in holistic healthcare data management on a single platform, providers can focus their time and efforts on what matters most – the patient, who at the end of the day is the true consumer of healthcare.

July 2, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Private HIE’s Will Make Nationwide HIE Possible

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We’ve been working for a long time on creating a nationwide HIE. I still remember when I first started blogging about EMR 7.5 years ago we were talking about implementing RHIO’s. I’m sure someone reading this blog can talk about what the exchange of health data was before RHIO’s. The irony is that we keep talking about creating this beautiful exchange of information, but it never really becomes a reality.

As I look at the landscape, there are very few HIEs that are showing a viable business model. The two leaders I think are probably the Indiana HIE and the Maine HIE. They seem to be the two making the most progress. I think there’s also something going on in Massachusetts, but it’s so complicated of a healthcare environment that I’m not sure how much is reality and hyperbole.

With those exceptions, I’m mostly seeing a lot of talk about some sort of community HIE and not very much action. However, I am seeing quite a few organizations starting to take the idea of a private HIE quite seriously. I’m not sure if this is driven by ACOs, by hospital consolidation, or some other force, but the move to implement a private HIE is happening in many health systems.

For a lot of reasons this makes sense. There is a business reason to create a private HIE and you own all the endpoints, so it’s easier to create consensus.

As I look across the landscape, I think these private HIEs could be what makes the nationwide HIE possible. Once a whole series of large private HIEs are in place, then it’s much easier to just connect the private HIEs than it is to try and connect each of the individual healthcare organizations.

Watch for the major hospital CIOs to meet at events like CHIME or HIMSS and discuss connecting their private HIEs. It will create some unlikely relationships, but it could be our greatest hope for a nationwide HIE.

June 14, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Integrating Telemedicine And EMRs

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Have you considered what an EMR would look and feel like if it integrated telemedicine? Rashid Bashshur, director of telemedicine at the University of Michigan Health System, has given the idea a lot of thought.

In an interview with InformationWeek Healthcare, Bashshur tells IW’s Ken Terry that it’s critical to integrate HIEs, ACOs, Meaningful Use and electronic health records.

Makes sense in theory. How would it work?

To begin with, Bashshur said, healthcare providers who have virtual encounters with patients via a telehealth set-up should create an electronic health record for that patient.  The record could then be ported over to the patient’s PHR.  The physician can also share the health record via an HIE with other providers.

When providers attempt mobile and home monitoring, it steps the complexity up a notch, as such activities generate a large flow of data. The key, in this situation, is to use the EMR to sensitively filter incoming data.

Unfortunately, few EMRs today can easily pinpoint the information providers need to process, so most organizations have nurse care managers sift through incoming monitoring data. That’s the case at University of Michigan Health System, where care managers sift data manually to determine whether patients seem to be seeing changes in their conditions.

Unfortunately, even attentive care managers can’t catch everything a properly-designed system can, Bashshur notes.  To integrate EMRs and telemedicine/remote monitoring, it will be important for EMRs to have sophisticated filters in place which can pinpoint trouble spots in a patient’s condition, using a standard protocol which is applied uniformly.

According to InformationWeek, vendor eClinicalWorks has promised a new feature which can pick out relevant data from a large data stream. But until eCW or another EMR vendor produces such a feature, it seems that remote monitoring will be labor-intensive and expensive.

May 17, 2013 I Written By

Katherine Rourke 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.

EHR Backlash, ACO, and Center of Care – #HITsm Chat Highlights

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Topic One: What’s your take on the emerging #EHRBacklash? A post-Meaningful Use fad, or a movement with actual potential?

 

Topic Two: Will patients ever take their place at the center of the care team? Do they know that they should care about it?

 

Topic Three: What does #ACO mean to you? Does anyone understand what will make them sustainable? Does human behavior even permit such things?

 

Topic Four: Open Forum. What topics are you tuned into right now? #healthIT

 

May 11, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

EHR Benefit – Eligibility for Pay-for-Performance

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It’s time for the next installment in my series of posts looking at the long list of EHR benefits.

Eligibility for Pay-for-Performance
I think that this is a really scary topic for most doctors. It’s not that a doctor is afraid of being reimbursed for the way they perform. The problem with pay for performance (ACO if you prefer) is that we have no idea what that’s really going to look like. The unknown is scary and a real problem. A change as dramatic from fee for service to pay for performance is an enormous shift and we still have very little idea how that shift is going to happen.

However, as one person told me, “That train (the shift to pay for performance) has already left the station.” In fact, I was talking with the former CEO of a major EMR vendor and he suggested that the shift is going to happen a lot faster than most of us realize. If we assume that this shift is going to happen, then doctors and healthcare better be prepared.

I believe having an EMR will be the only way a clinic can participate in pay for performance.

I make this assertion, because how else are payers going to measure your performance if they don’t have the data on how you’re performing? I’ve never thought of this before, but the EMR could become the performance measurement tool for doctors. Trying to flintstone your performance in a paper world is just not going to happen. The data collected in an EMR (and possibly other software) is going to drive the performance metrics which will drive the payments.

Think about what that means to a clinic. If you don’t have an EMR, you will miss out on the pay for performance payments.

I imagine many that read this will discount the shift that’s going to happen. That’s a fair position to take, but one that I think will come back to bite you. If the shift in payments doesn’t happen, then you won’t have to worry. However, if the shift to pay for performance has left the station, then you’re going to be at a tremendous disadvantage.

Healthcare data is going to drive a lot of things in the future of healthcare. Pay for performance is one of those things. Physicians who don’t have that data available in an EMR or other electronic format are going to face stiff challenges.

May 9, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

ACOs Make Healthcare Providers More Like Health Insurers

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I’m not sure why I haven’t seen more people talking about this idea. When you start to look at the ACO financial models, I think there are some real comparisons between what health insurance companies do with patient populations and what ACOs will have to do with patient populations.

Should ACOs be looking to insurance companies on how to manage patient populations?

Another interesting dynamic at play here is that many insurance companies are acquiring provider organizations. Is this because insurance companies want to leverage their expertise with patient populations to get at the ACO money that is getting ready to flow?

I admit that I’m not an expert on all the various methods of insurance companies. Maybe they were under a very different model than ACOs, but even then it seems like the principles could still apply. Even just starting with the way insurance companies use data to analyze patient populations. Shouldn’t that same data analysis be able to be applied to an ACO?

I’m sure just thinking about the idea makes most doctors wonder if they want to keep practicing medicine. No doctor I know wants to be in the insurance business. They want to care for patients. Anything that takes them away from that is a distraction.

What are your thoughts? Can an ACO learn from insurance companies?

April 16, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Can the Benefits of Hospitals Acquiring Practices Be Achieved By Other Means?

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I’ve regularly talked about the current healthcare environment of hospitals acquiring physician practices. This trend is occurring at a really rapid rate, but in an email exchange I had recently with Dave Chase from Avado I started asking myself if the benefits of a consolidated group of providers could be achieved by other means.

At the core of the current trend is a little reimbursement loophole that many hospitals have been exploiting. I wrote about this loophole in a post on Hospital EMR and EHR called Reasons Hospitals Acquire Medical Practices. Considering this reimbursement loophole, I think there is a little that can be done to discourage hospitals that want to try and increase revenue through this loophole.

At some point Medicare is going to catch up with this and close the loophole. Once that happens, it’s worth considering the other benefits of being part of a large organization as opposed to being a solo practice. Plus, can those benefits be achieved through other means than fully acquiring a practice? This is particularly important as doctors that are currently working for hospitals choose to go back out on their own and for those organizations who haven’t already gotten on the practice acquiring bandwagon.

I think the most pressing reason that practices are interested in relationships with hospitals is based on the changing reimbursement models. It will be impossible to access the ACO money that’s coming without tight ties to a large number of organizations. One way to achieve this is for a healthcare organization to acquire all of the various healthcare organizations that will make up an ACO. I think that’s part of what we’re seeing now and I’ve discussed before how this might be the way hospitals avoid the cycle of doctors leaving. Although, we’re already seeing signs of doctors leaving for new medical models.

This seems like a pretty expensive proposition for hospitals to acquire practices just for the doctors to go back to private practice. Which makes me wonder if the benefits of an acquired practice can be achieved through software and relationships? As we’ve discussed before, interfaces in healthcare are quite hard to do. So, once you’ve been able to create that interface with a clinic or hospital, then you have some pretty solid lock in with that organization.

Although, I’m pretty sure that Dave Chase (which inspired this idea) would take this idea one step further. Imagine that most of the patients used one portal to interact with your local healthcare community. Could that portal facilitate your ACO efforts? Once the majority of patients are in that portal, will anyone in the community want to be somewhere else? There’s real lock in that can occur once patients are engaged with healthcare institutions. This occurs with the patients and with the healthcare organizations that are engaging with those patients.

I think it will be interesting to see if software can facilitate some of the same benefits to hospitals that they get from acquiring physician practices.

February 13, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Does Healthcare IT Need Stability?

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Last night during one of my favorite TV shows, Charlie Rose, he interviewed a guy about the economy. One of the discussion points that came out of this interview and that I’ve heard a lot in all the discussions about the economy is having some stability to the economy. Many argue that one of the biggest things holding our economy back is all the unknowns. When there are unknowns companies get paralyzed and hold back doing things they’d do if the economy felt stable.

I wonder if we’re experiencing the same thing in healthcare IT? Could we use some stability in healthcare IT?

Think about all the various unknowns that exist in healthcare IT. Let’s start with ICD-10. The pending ICD-10 implementation date is looming, but that date has been pushed back so many times it’s still unknown if it’s really going to happen this time. That’s the opposite of stability.

I’m sure that many also wonder if the same will be the case with EHR penalties. Will the EHR penalties go into effect? What exceptions will be made for the EHR penalties? I could easily see the EHR penalties being delayed, but then again what if they’re not?

Is it hard for anyone else to keep up with what’s happening with meaningful use? I do this every day and so I have a pretty good idea, but even I’m getting confused as it gets more complex. Imagine being a doctor who rarely looks at meaningful use. So, we’re in meaningful use stage 1, but meaningful use stage 2 is coming, unless you didn’t start meaningful use stage 1 and then meaningful use stage 2 won’t come until later. Oh, and they’re making changes to meaningful use stage 2. That’s right and they’re also coming out with meaningful use stage 3. However, don’t worry too much about meaningful use stage 3 because a lot of people are calling for it to be slowed down. So, does that mean that meaningful use will be delayed? Now how does the meaningful use stages match with the EHR certifications? Which version of my EHR software does which stage of meaningful use?

I think you get the picture.

Of course, I haven’t even mentioned things like ACO’s, HIE’s, 5010, HIPAA, RAC Audits, Medicare/Medicaid cuts, or healthcare reform (ACA) to name a few others.

It’s a messy healthcare IT environment right now. We could definitely use some stability in healthcare.

February 12, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.