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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.

EHRMagic, EHR Certification, and the Great EHR Switch — #HITsm Chat Highlights

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Topic One: What lessons can be learned from the ONC’s decision to revoke #EHR Incentive Program certification of EHRMagic? #HealthIT

Topic Two: Does this action make EHR certification more meaningful or does it reduce confidence in certified products?

Topic Three: Who suffers the most from the ONC’s decision? The vendor or the physicians who purchased the product?

#HITsm T4: ”2013 is the year of the great #EHR switch.” With data migration and implementation hassles, is this truly a possibility?

May 4, 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.

Traditional Marketing, Drug Companies, and Behavioral Scientists – #HITsm Chat Highlights

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Topic One: @bjfogg behavior model has become well known in tech around engagement. How is this or other models applicable to patient care?

Topic Two: Outside #healthcare, “engagement” is largely about marketing. What can traditional marketing teach us about patients?

Topic Three: Engagement is closely tied to influence and by who you are trying to influence. What are biggest drivers of influence in hc?

Topic Four: Drug companies are masters of influence, how can we improve the influence of engagement?

Topic Five: @nationalehealth and @ONC_HIT work with top behavioral scientists. When does a nudge toward behavior change become a shove?

April 20, 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.

#HIMSS14 Speakers, Healthcare in 2013, and More — #HITsm Chat Highlights

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This weeks topics were suggested by Dan Munro, a contributor at Forbes.

Topic One: Head of ONC Farzad Mostashari calls and asks you what his top 2 priorities should be. What do you say? @Farzad_ONC

Topic Two: Biz Stone was HIMSS12 Keynote and Clinton will Keynote #HIMSS13. Who should Keynote HIMSS14?

Topic Three: Fill in the blank> Healthcare’s End-of-Year Headline for 2013 will be _______.

Topic Four: Among early stage healthcare startups – who’s your favorite? #mHealth

Topic Five: Should we skip over #ICD10? #healthIT

February 23, 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.

Keeping the “Health” in “Heathcare”

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‘Tis the season for family gatherings, holiday parties, and a plethora of professional networking events – all of which give me ample opportunity to perfect my “elevator speech”, introducing my business. It seems like each time I discuss what I do for a living, the question that follows is, “So, how do you feel about Obamacare?”

I understand that the Affordable Care Act, AKA Obamacare, is a significant slice of the polarizing pie our nation is currently attempting to consume and digest. And I appreciate that now, for the first time in my career, more people than not take an interest in what I have to say about being “a healthcare data consultant.” In years past, eyes would glaze over as I explained the enormous potential of predictive analytics in wellness and disease management programs, or the power of unstructured data mining for clinical notes data. Mentioning the health insurance plans I worked with brought inquiries into individual versus group rates, and complaints about the latest round of premium increases. It’s been refreshing to experience keen interest and pointed questions as I talk, rather than have each person gulp the last sip of wine and excuse themselves to run for more as soon as they figured out I have nothing to do with how much out-of-pocket expense they’re incurring after each doctor visit.

But as much as I enjoy the sudden interest in healthcare policy and data management, there isn’t enough wine in the world to make me debate the politics of healthcare reform with my 6’5″ uncles, my friends, or my social media connections. I am not a lawyer or political pundit. I am not qualified to comment on the merits of the ACA legislation. I am not an economist. I am not qualified to comment on the fiscal impact of Obamacare. I am a technologist. I am qualified to comment on the translation of ACA’s many provisions into the infrastructure and applications supporting our healthcare system. I am also a healthcare system consumer. I AM qualified to comment on what I believe this historic legislation means to my health, the health of my family, and the health of future generations.

This is what ACA healthcare reform and its many facets – Health Information Exchange (HIE), Electronic Health Records (EHR), Electronic Medical Records (EMR), Meaningful Use (MU) – mean to me: more, better, faster healthcare data capture and communication between all the stakeholders involved in my health and wellness:

- More health data: Meaningful Use-certified EMR applications require that particular medical service activities and clinical data elements are captured and stored discretely, electronically, and made available for retrieval upon patient demand.

- Better health data: The majority of medical procedures, products, services, events, and outcomes are codified in order to meet regulatory standards. It may take longer for your provider to enter the information about a patient encounter into an EMR system than it did to scribble notes on a chart; however, because those detailed discrete data elements are now tied to compensation and incentives, there is a higher likelihood that more specific details will be captured individually per encounter, generating a more complete picture of a patient’s medical history than a manual review of their paper charts. No handwriting recognition required.

- Faster access to critical health data: With EHR applications and HIEs, providers can instantly access patient medical records from provider/facility sources and multiple insurance carriers. The difference between electronic transmission speeds and manual chart retrieval could be the difference between life and death.

How could a higher volume of increasingly accurate, integrated, and immediately available healthcare data result in adverse health outcomes?

To me, healthcare isn’t about politics. It is health care. It’s about me, caring for my health, and the health of my loved ones. I believe that technological advances can and will empower healthcare stakeholders of all ilks – provider, health insurance plan, pharmaceutical industry, patients – to increase the speed of condition diagnosis and treatment, and to assist in establishing and maintaining healthy habits for improved health over a lifetime.

This season, put the “health” back in “healthcare”.

December 11, 2012 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

Health IT Hazards, Selecting the Right EHR, and Withings Wireless Scale – Around Healthcare Scene

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Hospital EMR and EHR

Health IT Stands Out In Health Technology Hazards List

The Top 10 Health Technology Hazards list was recently released by ECRI. And this year, two of the hazards that made the list are health IT related – patient/data mismatches in EHRs and other HIT systems, and, interoperability failures with medical devices and health IT systems. Anne Zeiger predicts that more HIT issues will top this list in the future.

Patients Accessing Online Medical Records Use More Services

A new study revealed something interesting — patients who use online access to medical records are likely to use more clinical services than those who do not. The Journal of the American Medical Association drew this conclusion after studying members of Kaiser. Kaiser has had a patient portal in place since 2006, which made it an ideal candidate for this study.

EMR and EHR

10 Tips for Selecting the Right EHR

In the market for a new EHR? Or perhaps just implementing one? This post highlights 10 tips on selecting the right EHR for your practice, as presented by Insight Data Group. Some of the suggestions include making sure the EHR is easy to use and customized, and use the government’s money to pay for your EHR.

Meaningful Healthcare IT News

Social and Mobile Continue to Converge in Healthcare

An interesting infographic is shown and discussed in this post. It is called “How Health Consumers Engage Online,” and reveals some interesting facts about the digital and health world. According to it, more people in the United States own a smart phone than a tooth brush, and 23 percent of people use social media to follow the health experiences of a friend. This definitely presents some fascinating data that is worth reading.

Smart Phone Health Care

New Withings Wireless Internet Scale Hits the Market

A new scale was recently released, and it does more than just tell a person how much they weigh. It tracks numerous variables, including BMI, and can be synced to various mHealth apps. There is also an app that goes along with the scale as well. It is a bit pricey at over $100, but it definitely “tips the scales” when it comes to scales.

Smart Phone Enabled Thermometer Approved By FDA

The “Raiing” is the newest in smart phone technology. It’s a high-tech, yet easy-to-use, thermometer, designed for iOS devices. It is placed under the armpit, and can actually track a person’s temperature over time. If a temperature reaches a certain number, an alarm will go off on the connected smart phone. This can help give parent’s peace of mind, as a sick child sleeps.

December 2, 2012 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.

Will EMR Adoption Bankrupt Medicare?

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Much hullaballoo is made over the 47% increase in Medicare payments from 2006-2010, which some seem eager to attribute to the adoption of EMR. The outcry is understandable; a 47% increase is a big dang deal, and taxpayers should be concerned. But haven’t we all heard that statistics lie?

“Hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier, at least in part by changing the billing codes they assign to patients in emergency rooms,” cited the New York Times based on analysis of Medicare data from American Hospital Directory. Indeed, billing codes have changed from 2006-2010, in accordance with the HCPCS (Health Care Procedure Coding System) reform of CPT (Current Procedural Terminology) application and inclusion guidelines, cited here: HCPCS Reform from CMS. Healthcare industry growth and care advances drove an increase from 50 – 300 new CPT code annual applications between 1994-2004, leading to sweeping change in the review and adoption process starting in 2005 – including elimination of market data requirements for drugs.

Think about that for a second. If Pharma no longer has to submit 6 months of marketing data prior to applying for an official billing code, how many new CPT codes – and resultant billing opportunities – do you think have been generated by drugs alone since that HCPCS process change adoption in 2005? Which leads me to my next correlating fact: the most significant Medicare Part D prescription drug provisions did not start until 2006.

Let’s put two and two together: Medicare Part D prescription drug coverage (2006) + change in HCPCS billing code request process to speed drugs to market adoption (2005) = significant increase in Medicare reimbursements. To use the NYT analyst language, “in part”, administration of those drugs occurs in an emergency room. And who might be in the ER on a regular basis? I’ll give you a hint: “I’ve fallen, and I can’t get up!”

Perhaps the most profound contributor to this Medicare reimbursement increase is a recent dramatic rise in the Medicare-eligible population. Per the National Institute on Aging’s 65+ in the United States: 2005, the 65+ population is expected to double in size between 2005 and 2030 – by which point, 20% of the US will be of eligible age. The over-85 age group, as of 2005, was the fastest-growing population segment. Elderly people who are prone to chronic conditions as well as acute care events just might lead to higher Medicare reimbursements.

Of course, there are myriad contributing factors. Some industry analysts attribute the rise in Medicare claims cost to fraud, citing that the workflow efficiencies that the EMR technology provide allow for easy skimming. Activities such as “cloning”, or copying and pasting procedures from one patient to the next with minimal keystrokes within the EMR software, might contribute to false claim filing for procedures that were never performed. While the nefarious practice of Medicare fraud long predates EMR, the opportunity to scale one’s fraudulent operations to statistically relevant proportions increases significantly with automation. And as my mother always told me, it only takes one bad apple to spoil the bushel.

But how many bad apples would it take to spoil a multi-billion dollar bushel to the tune of a 47% cost increase? According to the NYT article, “The most aggressive billing — by just 1,700 of the more than 440,000 doctors in the country — cost Medicare as much as $100 million in 2010 alone,” and the increase in billing activity for each of those 1700 occurred post-EMR adoption. After all, “hospitals that received government incentives to adopt electronic records showed a 47 percent rise in Medicare payments…compared with a 32 percent rise in hospitals that have not received any government incentives.”

Wait, did that statistic just indicate a significant increase in Medicare reimbursements, across the board? So the differential between those providers who have received government incentives for EMR adoption, and those who have not, is 15%. The representative facilities and providers responded to the “aggressive billing” accusation by indicating that they had 1) more accurate billing mechanisms, 2) higher patient need for billable services. I’ll buy that. Sure, it’s likely that there is Medicare fraud happening, but that’s not new – it’s unfortunate that there will always be ways to game the system, whether manual or electronic. But is the increase in “fraud” pre and post-EMR adoption statistically relevant?

Considering the complex variables involved, I’ll chalk up the 15% increase to the combination of more specific billing practices, Medicare Part D drug provisions, an aging population and the health issues which accompany it, and not vilify the technology which facilitates further advances. Let the EMR adoption expansion continue!

November 27, 2012 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

Healthcare Twitter Roundup

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It’s that time again for a quick roundup of some interesting tweets happening out their in the wonderful twittersphere.

This series of responses made me laugh. Mostly because my response was totally facetious (and just like me in real life). I wouldn’t have said it if it were true. 33 Charts is an amazing blog. Especially if you love social media and healthcare.

Since we’re talking social media and healthcare, this tweet seemed appropriate. I love when people say that they don’t like Twitter because they don’t care what someone ate today. My do people that say such things not understand the real power of social media. I sum it up by saying that Twitter is amazing at connecting people.

Fine, if @ahier and @janicemccallum say I must read it I will. Although, I’ll actually book mark and and post about it later.

I’m a sucker for charts. These are quite interesting. At least if you care about the costs of healthcare and where the money is spent.

I’m not sure if I’m ready to usher in the digital pen and paper technology as the path to meaningful use. Although, many of you will likely remember how much I enjoyed Shareable Ink when I first saw it.

I’m not sure about the article, but I love the commentary on blogging. I love the comments on the blog. They definitely do a great job of balancing out and mistakes in my posts. Not that I’ve ever created a “biased post.” Not me;-)

May 1, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.

Some Perspective, ACO’s, Costco EMR, and April Fool’s Day

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Nothing like enjoying the end of the weekend by going over some tweets from interesting people in the healthcare IT and EMR world.

The first one hit me the strongest since I think I sometimes get so wrapped up in the details of EMR and healthcare IT that I forget to stop and remember really why we’re doing all of this. Thanks Diane for reminding us.

After John Chilmark from Chilmark Research skipped doing his taxes (thankfully mine are done) to read about ACO’s he provided this perspective:

John also offered this tweet to a Kaiser resource on ACO’s:

ACO’s are a hot topic and I have a guest post coming which will hopefully shed even more light on what’s happening in Washington around ACO’s and the new legislation.

@TheGr8Chaulupa (best twitter name) and @j_schilz reminds us of the crazy channels vendors are using to sell EHR software. Although, Costco’s only a couple years after Walmart and Sam’s Club EMR was offered (4-5 posts I did on it):

Finally, my announcement of a new EMR and HIPAA EMR was an April Fool’s joke in case you didn’t realize it when you read it. Hopefully everyone that read it enjoyed it as much as I enjoyed writing it (with Katherine Rourke’s help).

April 3, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.

What could replace E&M coding to improve healthcare (and EMR)?

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A comment on my somewhat controversial thought post about imagining an EMR without billing reminded me that I wanted to ask the question of my readers about what could replace E&M coding. Seriously, I can’t think of anyone I know that actually likes E&M coding. I know some people that are good at it and so they like that they have a skill in that area. However, I don’t remember anyone being a proponent of E&M coding because it provides better patient care or makes life easier for doctors. Am I just missing these reports? So, this leads to the important question…

What could replace E&M coding that would improve healthcare and still handle billing?

Plus, after you read the comment below, you’ll understand why improving billing could also improve many of the billing machines EMR software that’s out there as well. Let’s hear your thoughts.

Here’s the comment that prompted this thought:

The broader problem is that the billing aspects have many more insidiously negative effects than simply sending a charge transaction across an interface.

They actually degrade the quality of the documentation by requiring certain elements to support specific levels of billing. The whole issue of needing to have a certain number of elements done and documented to bill a particular E&M code is one example. A particular visit may have extremely complex history/assessment/decision-making but to get “credit” one also has to document a certain number of irrelevant review of systems items.

It is no surprise that the places that have used EHRs most effectively such as Kaiser and the VA are incentivized to give care that will produce better outcomes. They are less beholden to bureaucratic insurer-driven documentation demands that do not aid in patient care or communication.

Eliminating all of these items (and similar demands for information to fulfill PQRI and other measures that are irrelevant to a particular patient or that fragment thought processes) would improve workflow and efficiency in any system, paper or electronic. It would certainly make it easier to develop an EMR that would support patient care needs.

But just having distinct EMR and billing software isn’t going to do the trick in our current dysfunctional health care system. It is only if an EMR can be designed (and insurer/payor/regulatory demands can be synchronized) so that the health care system looks like a single payer system to the EHR user and clinicians can go about the business of treating patients.

It’s a little bit pie in the sky thinking, but sometimes that’s beneficial.

January 21, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.