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EHR Adoption: Step One to Successful Population Health Management – Breakaway Thinking

Posted on June 18, 2014 I Written By

The following is a guest blog post by Todd Stansfield from The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Todd Stansfield

The Managed Care movement dramatically transformed healthcare in the 1990s. For the first time, our industry discovered increased margins by conserving the services we provided. Now, Population Health Management (PHM) is on the brink of transforming healthcare yet again—and perhaps in a more dramatic fashion. The transformation is already underway, with industry-wide consolidations between hospital networks, physician practices, and even insurance companies; government reforms targeting cost and quality controls; and new breeds of health organizations, professionals, and technologies.

Today’s PHM movement presents the same cost benefit as healthcare’s traditional models with a greater focus on health outcomes. The philosophy behind PHM is that healthcare providers and organizations will save money and improve care by identifying and stratifying patients with high, medium, and low risk for developing chronic conditions. Once patients are assigned a level of risk, care plans are then developed and deployed to treat them appropriately. For high-risk patients, strategic interventions are provided that reduce hospital admissions, readmissions, and complications. For low-risk patients, preventative care is offered to maintain health and avoid costly conditions. The PHM model requires broad-scale data collection, analysis, and transmission between healthcare entities—the latter not yet possible with the lack of integration between electronic health record (EHR) systems. PHM also calls for redesigning processes, discovering gaps in care, and extending patient-provider interactions beyond clinical events to encourage healthy life behaviors.

In order to reach the level of data collection needed for successful PHM, healthcare organizations must first adopt their EHR. Doing so makes it possible to intercept data, analyze it, and transform it into useful clinical information delivered to the point of care. Without EHR adoption, the most foundational elements of PHM cannot be supported: We cannot efficiently discover gaps in our current care, identify and stratify at-risk patients treated by an organization, or improve our processes to lessen the new financial risks of value-based care. EHRs are so central to PHM that overlapping incentives for both initiatives were proposed in November 2011 by the Centers for Medicare & Medicaid Services (CMS). The technology is also a necessary tool for Accountable Care Organizations (ACOs), which are a form of PHM. The Agency for Healthcare Research and Quality (AHRQ) published an interview with Dr. Stephen Shortell, a Distinguished Professor of Health Policy and Management at the University of California, who outlined aspects of EHR adoption as being essential to the success of ACOs.[“The State of Accountable Care Organizations.”The Agency for Healthcare Research and Quality. http://www.innovations.ahrq.gov/]

Our research at The Breakaway Group (TBG) points to four crucial components needed to adopt an EHR for PHM. Strong leadership must inspire continual engagement from users to embrace the EHR as a tool for positive change. Targeted and effective education—creating system proficiency in role-based tasks—must also be established before and after the EHR go-live event. Performance must be gauged, measured, and analyzed to enhance EHR use and establish governance measures. And with the evolutionary nature of the EHR, all optimization efforts must be sustained and refreshed to meet new challenges, such as application upgrades and process changes.

Although the PHM movement is relatively new, there are numerous examples of the model’s success. ACOs enrolled in CMS’s Shared Savings and Pioneer ACO programs have generated $380 million in savings.[“Medicare’s delivery system reform initiatives achieve significant savings and quality improvements – off to a strong start.” US Department of Health and Human Services. www.hhs.gov.] One Pioneer ACO, Partners HealthCare, has established patient-centered medical homes that employ Care Managers specializing in customizing patient care plans.[“Patient-centered Medical Home: Role of the Care Manager.” Partners HealthCare. www.partners.org.] While Partners HealthCare is not employing true PHM in the sense of sharing information with other healthcare entities, it is large enough in size to perform broad-scale data collection that can help better manage health populations. This example demonstrates the potential effect of PHM on our industry when data becomes transferrable.

EHR adoption is an essential feat we are capable of achieving now. Doing so is the first step toward learning more about the populations we serve, how we’re not serving them, and how we can adjust our processes to succeed in a value-based model. Yet to manage populations effectively, more is required from us, including being willing to work together in our pursuit of a better, brighter healthcare system. If we can overcome these hurdles now, then we will arrive ready for when our industry is capable of embracing true care coordination.

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

Meaningful Use at HIMSS 2012 – Meaningful Use Monday

Posted on February 13, 2012 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.

Since I have HIMSS on the mind (as has probably been seen from my previous posts), I figured I’d talk about what we can expect from meaningful use at HIMSS 2012 in Las Vegas.

Meaningful Use Conversations Dominate
I think with all certainty all of us will be tired of hearing the word meaningful use after HIMSS. I might have to try and keep track of how many conversations I have where the words meaningful use aren’t used. Notice I’m counting the ones where it’s not used since I know that almost every conversation will include meaningful use.

I’m not sure that’s very healthy for the industry, but I think that’s the reality of where we’re at. While I’m sure I’ll ask plenty of questions about meaningful use as well, my favorite EHR vendors are probably going to be those that say: we meet meaningful use, we’ve abstracted meaningful use so its not an annoyance to doctors, and here’s what we’ve done to innovate our product outside of MU.

Meaningful Use Stage 2
Any day now I think that ONC/CMS is going to announce the final details for meaningful use stage 2. I imagine the regulatory process could push this so that ONC/CMS announce meaningful use stage 2 at HIMSS, but from what I’ve read I think they want to get it out before HIMSS. I hope they’re successful in making this happen.

Either way, I’ll be surprised if we don’t know about meaningful use stage 2 before/during HIMSS. So, if you want to be in the know, be prepared to talk about the final details of meaningful use stage 2. In the mean time, check out Lynn’s previous MU Monday post about meaningful use stage 2.

Federal IT Participation at HIMSS 12
Every healthcare related part of the federal government is going to be represented at HIMSS 12. HIMSS has been nice enough to provide a page listing all of HHS, CMS, ONC, AHRQ, CDC, HRSA, NIST, OCR, SSA, and VA sessions at HIMSS 2012. My only complaint with that page is that there are still a bunch of details missing on a number of the sessions. I imagine this is the government dragging their feet, but it sure makes it hard to plan.

While many of the government sessions can be dry and boring (partially attributed to what I call the government muzzle), it can be a really good place to hear the direction of the federal government when it comes to healthcare IT directly from their own mouth.

I also suggest that Farzad Mostashari’s keynote address won’t be nearly as interesting to someone familiar with healthcare IT as his ONC Townhall: Advancing Health IT into the Future session on Wed, 2/22 at 2:15 in San Polo 3503. I know I also want to work in a session on MU stage 2 and the future of EHR certification from the federal perspective as well.

“Meaningful” References
Is it just me, or do other people have a problem using the word meaningful now. At least it’s a challenge with many of my healthcare friends. Although, sometimes I throw it in there just for irony’s sake. Hopefully this post was meaningful to you.

Also, a big thanks to all those that filled out the EMR and HIPAA reader survey. I’ve loved all the feedback. Interestingly enough, one of the more common feedback items was that you liked the Meaningful Use Monday series. We’ll do what we can to keep it going.

The EHR Serenade by Enoch Choi at Doctors 2.0 and Health 2.0

Posted on September 25, 2011 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 must admit that I don’t know the background of this because I wasn’t able to make it to Doctors 2.0 and Health 2.0 this year, but I couldn’t help but laughing at the performance. Not sure why the YouTube video is black. Maybe it was just the audio of the presentation and they made a video out of it. Either way, I think this is an interesting message for doctors about EHR.

Here’s the description from the YouTube video:
“Give doctors a little respect. Make EHRs more usable. I serenade the last decade of developing and using EHR in full time urgent care practice at AHRQ”

And now for the EHR Serenade:

If someone knows of a video of this presentation at Health 2.0, let me know and I’ll update this post.

HITECH Act Gives HHS $2 Billion of Discretionary Funds

Posted on February 20, 2009 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.

The HITECH Act gives Health and Human Services (HHS) 90 days to develop a plan to allocate $2 Billion of discretionary funds. Talk about a nice infusion of funding for HHS. HHS does have a set of core areas of focus for the money (per an Allscripts presentation on HITECH).

The area of focus that interests me most is the “Regional Health IT Resource Centers.” Seriously, what is a regional health IT resource center? Can any of you imagine a doctor visiting a health IT resource center? I don’t understand how this will work at all.

I have a better idea. Why not take a cool million and give it to me? I’ll create a killer online platform for sharing of health care IT resources where people can share information nationally or within their region. Could be a killer application for sharing information quickly and could be available to every state in the country (and for that matter the world). Unless you think that training health care IT staff is better done without using IT.

Here’s a look at the full list of core areas of focus:

  • Standards requirements due before the end of this year
  • HIE Infastructure, National Health Information Network (NHIN)
  • Regional Health IT Resource Centers
  • Federal grants through AHRQ, HRSA, CMS
  • Grants to the states in 2010
  • Promote advanced EHR