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Breaking News: Meaningful Use is Not Covering Costs

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In one of my recent interviews with a healthcare IT consulting company, they revealed some breaking news for those of us in the EHR world. They told me point blank that:

Meaningful Use is Not Covering Costs

Ok, so that’s not really breaking news. Although, it seems that very few people want to actually articulate this point. It almost feels like heresy that someone would “complain” about the fact that the government is spending $36 billion on EHR incentives and that the money isn’t enough to cover the implementation of these EHR systems.

Actually, I should clarify that last point. The EHR incentive money is covering the costs to purchase the systems. It’s not covering the costs of implementing those EHR systems and then poking, prodding and otherwise cajoling end users to show meaningful use of that system (not to be confused with meaningfully using the system).

Let me also be clear that I’m not complaining about the EHR incentive money. I’ve done enough of that previously. What I’m just trying to acknowledge is something that everyone who deals with the EHR budget already realizes, but no one seems to want to say it. Organizations are spending more money on EHR and meaningful use than they’re getting from the government.

I think this is important for a couple reasons. First, many organizations didn’t budget any EHR money beyond what the EHR incentive money. You can certainly argue this was a mistake on their part, but that’s going to leave a bunch of organizations in a lurch. We’re already seeing the fall out of this as news reports keep coming out about hospitals systems in financial trouble due to the costs of their EHR system. Plus, in each of these cases, it seems their costs continue to balloon out of control with no end in sight. It makes me wonder if the compressed meaningful use timeline is partially to blame for a rushed implementation and poor EHR implementation and cost planning.

Second, there is still a swash of providers and organizations that haven’t yet implemented their EHR. If you can’t support the cost of EHR with government money, how does that bode for those who won’t be getting any EHR incentive money? One could make the argument that they’ll actually be in a better position since they won’t have to worry about meaningful use and can just focus on getting value out of their EHR. Hopefully that’s the case, but many of the meaningful use functions are now hardcoded into the EHR systems. Even if an organization isn’t planning on attesting to meaningful use, that doesn’t mean they won’t be forced by their EHR software to do a bunch of things they wouldn’t have done otherwise.

What are you seeing from your perspective? Is the EHR incentive money covering the costs of an EHR implementation? What are the impacts if it doesn’t?

April 21, 2014 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.

Realizing the Value of Health IT

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I’ve been focused on the value of healthcare IT for a long time. Obviously, I’ve been particularly focused on the value of EHR including a whole series of posts on the benefits of EHR (which I need to finish). I’m a huge fan of the value of EHR and healthcare IT, but I also am a realist. I realize that we aren’t getting all of the value out of healthcare IT that we could be getting. I also realize that poor health IT implementations can actually decrease value as opposed to increasing the value of health IT. Plus, I also see a huge disconnect between the value government sees in healthcare IT and what doctors find valuable.

If you don’t believe healthcare is missing out on the value healthcare IT could provide we don’t need to look any further than the fax machine. A recent Covisint-Porter Research study found that “76% of respondents stated that they are handling their inflow of information via Fax.” Mr H from HISTalk aptly described this: “Healthcare: the retirement home for 1980s technology.”

I’ve also seen illustrated dozens of times the way a poor implementation can actually cause more problems than it solves. The Sutter EHR implementation is one example to consider. No doubt there is a lot of internal politics involved in the challenges that Sutter is facing with their EHR, but soon I’ll be publishing on Hospital EMR and EHR some first hand experiences with that EHR implementation. It’s a sad thing to see when an EMR implementation is done the wrong way. However, the opposite is also true. I’ve seen hundreds of organizations that love their EHR and can’t imagine how they practiced medicine before EMR.

One thing I’ve never heard a practicing doctor say is that they want to show meaningful use to be able to realize the value of health IT. I’ve certainly heard doctors say they have to show meaningful use to get the government money. I’ve certainly heard doctors say they want to show meaningful use to avoid the EHR penalties. I haven’t heard any doctor say they want to show meaningful use because it provides value to their clinic.

To me this illustrates the wide divide between the value government wants to see from healthcare IT and the value healthcare IT can provide a healthcare organization. Currently the government is riding on the back of incentive money and penalties to motivate healthcare organizations. No doubt this has caused many healthcare organizations to adopt an EHR. However, the incentive money and penalties won’t last forever. Then what?

What’s sad for me is that EHR adoption was starting to gain some momentum pre-HITECH act. There was a definite shift towards EHR adoption as organizations realized they needed to head that direction. Then, once the HITECH act hit it threw every EHR organizations plans out the door and created an irrational hysteria around EHR. This has led to irrational selection of EHR vendors, rushed EHR implementations, and cemented in many Jabba the Hutt EHR vendors that the relatively free EHR market wouldn’t have adopted pre-HITECH. To be honest, I’m ready for a return to a more rational EHR market based on value created. That’s when we’ll truly start realizing the value of health IT.

Beyond EHR, we need more brave leaders in healthcare IT that aren’t afraid to move beyond the fax machine. Leaders who don’t need a business model to realize that we can do better than the fax machine and other 80′s technology. It shouldn’t take five committees, two research studies, a certification, and outside money for an organization to do what’s right for patients. In fact, doing so is the very best business model in the world.

What scares me is that we’re going to miss out on the value of healthcare IT because our healthcare leaders are too busy fighting the proverbial meaningful use, ICD-10, and ACO fires.

September 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.

Health IT & EHR State Summaries

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I’m always happy to look at data. Certainly data can lie, but it can also inform if you are looking at the right data and considering the biases of the data. I applaud ONC for being as transparent as possible with the EHR incentive program data. They have an entire Health IT Dashboard for analyzing the data. I think this is a great step towards accountability for how the EHR incentive money is being spent.

ONC recently announced a set of Health IT Quick Stats and even created a widget (embedded below) that lets you download a 3 page health IT and HITECH summary for your state. I think a few states are missing from the widget and why they grouped them by area I don’t know, but there’s some interesting data in the reports.

I downloaded my home state of Nevada to see how we’re doing with Health IT and HITECH. Here are a few thoughts I had when looking at EHR use in Nevada.

I was amazed that so many REC assisted providers were live with an EHR, but less than half of those had demonstrated meaningful use. We’ll see if that changes after this years attestations.

I do have to question some of the data since it shows the overall access to view lab results electronically as 0% for Nevada. Something is wrong with their data there. They did show office based EHR adoption in Nevada at 23% (39% nationally). I’m not sure how that national EHR adoption number meshes with the $60% I’ve heard thrown around. Different sources of data.

For hospital adoption of EHRs they show Nevada at 36% EHR adoption (35% nationally). It’s nice to see Nevada ahead of the national average in something.

I’ve always told people there were about 700,000 providers in America, so I was glad to see they listed 715,984 health care providers.

Lots more data in there, but those were a few of the things that stood out for me in the Nevada Health IT and EHR report. Take a look at your state and let us know what numbers stand out for your state in the comments.

June 18, 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.

Hospitals, Representative Ask For Extension of EMR “Safe Harbor”

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Right now, it’s legal for hospitals to give doctors EMRs under certain circumstances, despite the existence of the Stark law banning payments intended to induce referrals.  Specifically, hospitals won’t face anti-kickback enforcement if doctors pay 15 percent of the cost of EMRs donated by hospitals.

But the Stark law exception established by CMS, plus a “safe harbor” rule established by the HHS Office of the Inspector General, are both due to expire at the end of 2013. This will take place despite the fact that Medicare incentives for EMR adoption will continue through 2016, notes iHealthBeat.

Hoping to address this state of affairs, the Federation of American Hospitals has made the renewal of EMR exceptions to the Stark law its top recommendation in a proposed list of safe harbors, reports Modern Healthcare. More recently, Rep. Jim McDermott (D-Wash.) wrote a letter to the chief counsel to HHS’ OIG to extend those exceptions soon.

Extending these safe harbor provisions at least through the life of the Meaningful Use program seems necessary and wise. After all, it’s hard enough to get smaller practices up on EMRs even with the promise of incentives. Letting hospitals pay for most of the cost of the system would meet the public policy objectives which prompted the creation of HITECH in the first place.

According to Modern Healthcare, the federal Office of Management and Budget is reviewing proposed rules regarding the Stark exception and the anti-kickback safe harbor. Let’s hope they’re finalized in time to solve the problem.

April 3, 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.

Keeping Up with Healthcare Regulations

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I know that meaningful use and the EHR incentive regulatory process has been an eye opening experience for many of us that weren’t as familiar with how the government put regulations in place. However, most hospitals are quite familiar with this process since they have been having to deal with it for a very long time.

Even with all this background and expertise, I’ve heard more and more organizations telling me that “they just can’t keep up with all of the healthcare regulations.”

Think about all of the regulations in just healthcare IT. It’s overwhelming and the healthcare IT regulations pale in comparison to many of the other regulations that hospitals must know about and follow. Plus, we’re just getting started with the fun of 5010 and ICD-10 is right around the corner.

With all of these regulations I was intrigued by a new offering from HCPro I saw during the AHIMA convention in Chicago this year. While HCPro has long been a publisher of healthcare content, they have a new product they are just launching called HCPro Comply. I think the best way to describe HCPro is a portal into every healthcare regulation imaginable. Certainly you could find all these regulations in other locations for free, but there was something beautiful about having them all available in one easily searchable place.

Plus, HCPro Comply does a lot of things to add value to the regulations they make available. For example, they chunk out sections of the regulations that really matter. I remember my shock when I heard that the Meaningful Use regulation was 692 pages. Then, as I looked at the regulation, I realized that there were really only a small number of pages in the middle that really mattered since the beginning was a bunch of overview. From what I understand, HCPro uses its clinical regulation experts to help you identify and bring out those sections of the regulation that matter most.

The other part of HCPro Comply that I found quite interesting was their “Ask An Expert” feature. While many hospitals likely have someone (or multiple people) in their organization that understand regulatory changes very well, there are always situations where it’s beneficial to get outside advice and analysis about a particularly challenging regulatory change. I’m quite familiar with meaningful use, but I’m often emailing a number of other experts to either make sure my interpretation is correct or to ask about nuances I haven’t quite figured out.

One thing that I think HCPro Comply should consider adding is allowing the experts from the various hospitals share their expertise with their colleagues. I can easily see a community of healthcare regulatory compliance experts interacting on their platform to discuss the latest regulatory changes. I’m sure that HCPro has many experts on their staff, but a network of the top hospital compliance experts would be an even more powerful offering.

Now that Obama won the Presidential campaign, ACA, HITECH and other healthcare reform are here to stay. I can see portals like HCPro Comply being a great asset in the ever changing healthcare regulatory environment.

November 7, 2012 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.

New Opportunities to Avoid ePrescribing Penalty for 2013 – Meaningful Use Monday

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According to the 2013 Medicare Final Rule released last week, there are new ways to avoid future payment adjustments under the MIPPA ePrescribing rule for those who have not already taken the necessary steps to avoid them: 1) The exemption request period has been reopened and 2) meaningful use will satisfy the ePrescribing requirements according to specific timetables.

1) CMS is offering a second chance to physicians who missed the June 30 deadline for requesting an exemption to the 2013 ePrescribing penalty (1.5%) under the original 4 categories. Between November 1, 2012 and January 31, 2013, physicians can go to the Quality Reporting Communication Support Page and request an exemption based on one of the following justifications:

  • Inability to electronically prescribe due to local, State, or Federal law or regulation (i.e., prescribe predominantly controlled substances)
  • Prescribed fewer than 100 prescriptions between January 1 and June 30, 2012
  • Insufficient high speed internet access (i.e., rural area)
  • Insufficient available pharmacies that accept electronic prescribing.

2) In the interest of harmonizing the various government programs that contain ePrescribing components, CMS now will provide two additional ways to avoid the 2013 MIPPA penalties:

  • Achieve meaningful use during 2013
  • Demonstrate intent to participate in the EHR Incentive Program and adopt Certified EHR Technology by January 31, 2013

This information will be retrieved by CMS from the information in its EHR Incentive Program’s Registration and Attestation System, rather than by having providers request an exemption as in #1 above.

November 5, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

HIE Waste

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In a post on LinkedIn, David Angove offered this comment on government HIE funding:

The biggest waste of the new program I’ve seen is the HIE (Health Information Exchange) part. It got much more money than the EHR/MU part (5-10 times) and much of it ended up in the pockets of universities who just absorbed it as personal funding. Just look to see how many HIEs are actually functional in the US now almost 4 years after the grants were awarded. Most of the working HIEs were done by private groups who got tired of waiting for the groups who got all the grant money to do something.

It should be clear that David’s comparing the money spent on HIE’s as compared with RECs (he refers to it as EHR/MU). If you take in the larger EHR incentive money that doctors will receive, then it blows the HIE portion of the funding away.

Instead of focusing on the comparable amounts, I think the question of whether the HIE money the government put out as part of ARRA and the HITECH Act has been generally a waste. I started to think through the successful HIE projects out there. David’s right that the most successful ones I know of (see Indiana’s HIE, Maine’s HIE, and Arizona’s HIE) would have happened regardless of whether the government money came. Does anyone know of government funded HIEs that are seeing success and wouldn’t have without the government money?

The hard part of this question is that we’re not likely to know exactly how well the HIE funding has gone until we see how many HIEs survive post government funding.

Related to this was how many hospital CIOs I’ve talked to that don’t believe that HIE is the future of health information exchange. As one hospital CIO told me, he didn’t think that the HIE was a viable model. Instead he suggested that point to point exchange of information is going to be the winner when it comes to exchanging health information. Considering the issues related to HIE, I have a hard time arguing against that thought.

October 30, 2012 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.

Important Dates in the Life of a Meaningful EHR User – Meaningful Use Monday

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Here’s a look at some of the important dates to know for those looking to attest for Meaningful Use:

October 3, 2012: Last date to start the 90-day reporting period to earn an $18,000 EHR incentive payment for 2012, and to be eligible for the maximum total of $44,000. (The potential total drops to $39,000 in 2013.) Physicians do not have to be registered by this date—they can register at any time before they attest.

January 1, 2013: First day of the 365-day, 2013 reporting period for any provider who earned his/her first incentive payment in 2011 or 2012.

February 28, 2013: Last date to register and to attest for the 2012 EHR incentive. (Happily, no one has to spend New Year’s Eve attesting!) But remember, the entire reporting period has to have occurred within 2012.

October 3, 2013: For EPs whose first EHR payment year will be 2013, last day to start the 90-day reporting period and earn a $15,000 2013 incentive.

2013: EPs who successfully demonstrate meaningful use in 2013 will not be subject to the 2015 payment adjustment.

October 1, 2014: For EPs whose first incentive year is 2014, this is the last date to submit a successful meaningful use attestation and avoid the 2015 payment adjustment.

October 8, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

National Patient Identifier, Allscripts Discontinues MyWay, EHR Incentive Payments Stopped, and Remotoscope — Around Healthcare Scene

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EMR and EHR

HIMSS Pushes for National Patient Identifier System

An estimated 14 percent of medical records contain incorrect patient information. Because of this, deadly errors can occur. In an effort to cut back on these errors, HIMSS is trying to implement a national patient identifier system. A single identifier isn’t going to solve problems, but it’s a step in the right direction.

Dr. Nick, CMIO of Nuance Talks About Their Acquisition of Quantim and J.A. Thomas & Associates

In this interview, Dr. Nick discusses an important string of acquisitions by Nuance. This is an interesting move by Nuance and Dr. Nick does a good job of describing the vision of Nuance going forward with these acquisitions and their view of how healthcare documentation will happen in the future.

EMR Thoughts

Allscripts May Sell Out To Private Equity Buyer & Allscripts to Discontinue MyWay EHR

It has been a really busy week for Allscripts. First came the news that Allscripts was considering a sell to a Private Equity Buyer. This news is harder to read since it could mean a big sell or it could just be posturing. In what I think is even bigger news is that Allscripts is discontinuing their MyWay EHR. This is a big move on Allscripts part. It’s a necessary decision by Allscripts because they have too many EHR software to manage, but it’s going to leave a lot of doctors and a lot of VARs scrambling.

EMR, EHR and Healthcare IT News

HIMSS Opposes Call for Suspension of EHR Incentive Program

We’ll be writing some more pieces soon on the members of Congress that are calling for a halt on the HITECH Act and payment of EHR incentives. However, this was HIMSS’ response to the request to halt EHR incentive payments. It’s not a surprising response, but I do like the data that HIMSS provides to the conversation. Most people see this move as a political one, and not necessarily one that puts the HITECH EHR incentives at risk.

Hospital EMR and EHR

Smart Bed Technology Interview with Casey Pittock of BAM Labs 

Vice President of Sales and Marketing at Bam Labs was recently interviewed over at Hospital EMR and EHR. BAM Labs created the Smart Bed, a mat that is placed under a person’s mattress that can measure heart rate, breathing rate, and motion. Pittock discusses how it was created, the accuracy of it, and how providers can interact with the data.

Meaningful Health IT News

Attending Health 2.0? Donate Your Old Smartphone

If you have plans to attend Health 2.0 next week, be sure to bring along any old smartphones. Health eVillages will take the device and load onto it different medical materials and sent to doctors that are in third world countries. There are sites for Health eVillage in the countries of Haiti, China, Kenya, and Uganda, with plans to expand to more.

Wired EMR and EHR

The Naivete of mHealth

There are many mHealth creations coming out at a rapid pace. At first glance, these innovations seem incredible and life-changing. However, without supporting documents and proof of the effectiveness, the money and time that goes into implementing certain technologies might not be worth it. This post talks about a home monitor for CHF, and although it’s a great idea, unless a patient is really dedicated to following all the alerts, it may not be effective. Technology needs to be reliable and proven to work before it should be recommended for use.

Smart Phone Health Care

Remotoscope – Diagnose Ear Infections at Home Using Your iPhone

Many children get ear infections, and it’s no fun taking them to the doctor if the diagnosis of one is uncertain. Luckily, a new tool has been invented to help parents and physicians diagnose from home. The tool is a detachable clip that turns a smart phone into otoscope, and parents can take a picture of their child’s eardrum to send to their physician for further analysis.

October 7, 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.

A Fun (and Educational) Look at Privacy and Security – Meaningful Use Monday

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One of the most common sources of confusion about the meaningful use requirements is the Privacy and Security Risk Analysis measure. As I discussed in a past Meaningful Use Monday post, according to CMS, practices that are HIPAA compliant are likely in pretty good shape on this measure. For those physicians, what’s needed is documentation of the steps that were taken to review HIPAA compliance, the deficiencies identified, and what was done to remediate these exposures. (For more information, see the meaningful use chapter in ONC’s “Guide to Privacy and Security of Health Information.”)

This begs the question, “What exactly is HIPAA compliance?” I recently came upon the “Privacy and Security Training Game” that was created by ONC’s Chief Privacy Officer and couldn’t resist playing. While a lot of the information provided is quite basic for those with expertise in the privacy and security arena, as you progress through the game, the questions become more challenging. It’s definitely a fun way to introduce staff to the issues and increase awareness about the importance of safeguarding patient information.

Check out all of the past Meaningful Use Monday posts.

September 24, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.