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Keep It Simple, Stupid!

Posted on February 28, 2014 I Written By

Kyle is CoFounder and CEO of Pristine, a VC backed company based in Austin, TX that builds software for Google Glass for healthcare, life sciences, and industrial environments. Pristine has over 30 healthcare customers. Kyle blogs regularly about business, entrepreneurship, technology, and healthcare at

There are an enormous number of startups trying to solve the medication adherence problem. Broadly speaking, these startups are trying to solve the problem through three avenues:

1) Hardware, i.e. smart pill bottles

2) Semi-intelligent software driven reminders

3) Patient education

The most effective solutions are likely to incorporate all three.

The hardware space has been the most interesting simply because of the variety of solutions cropping up. AdhereTech and CleverCap have developed unique pill bottles that control and monitor dispensing via proprietary smart pill bottles. They also incorporate software for notifications. Unfortunately, all smart pill bottle makers are bounded by FDA regulations because they physically control medications through a combination of hardware and software. FDA regulations will slow time rollout of these solutions to market and create enormous new expense.

I recently learned about PillPack, a startup that just raised $4M. They compete asymmetrically in the medication adherence by not making any hardware at all!

The problem with the pill bottle is that there are dozens of pills in a single container. Measuring and controlling output and consumption is intrinsically a difficult problem. PillPack solves these problems by simply averting the issue entirely. PillPack pre-packs pills by dose. This is particularly valuable because they pre-pack multiple kinds of medications that need to be taken at the same time.

PillPack doesn’t yet have any intelligent software that monitors when medications are taken. But with granular packaging, sensing and controlling the medications becomes dramatically easier than ever before. I suspect this will the marquee feature of PillPack 2.0. Once they add the ability to detect when a pack is opened, they can begin adding intelligent software alerts and reminders to patients and their families.

PillPack has a far more lucrative distribution strategy than companies who have to produce and distribute hardware. PillPack can scale their customer base incredibly quickly through B2C marketing. B2C marketing isn’t easy; Pillpack faces a significant challenge in terms of patient and provider education, but it’s one that’s definitely addressable. If PillPack’s service is as good as I think it is, they should develop incredibly happy customers, which will lead to recurring revenues and strong referrals.

The moment I saw Pillpack, I immediately recognized it as one of those “duh” business. We’re going to look back in 10 years and wonder why this wasn’t always around. Their solution solves so many of the pain points around taking medications on time and is coupled with a lucrative business model that feeds off of recurring revenues from long term customers.

The genius of their business is that they are tackling the medication adherence problem from a unique angle: packaging and distribution. They’ve bundled that solution into a simple and elegant package (pun intended) that helps patients avoid the pain of the modern US healthcare system: going to the pharmacy, fighting with the pharmacist, and manually tracking when to take how much of each medication.

Full disclosure: I have no relationship(s) with PillPack.

HIMSS: Insider Threats Still Biggest Health IT Security Worry

Posted on February 27, 2014 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

You can do whatever you like to lock down your data, but  it if they do they do it did buy a block of members of the earth is the work doesn’t go for all it takes is one insider who knows how to unlock it to create a serious security breach.

Results from the 2013 HIMSS Security Survey suggest that despite progress towards hardening security and use of analytics, healthcare organizations must still do more to mitigate the risk of insider threat, such as the inappropriate access of data via employees.

The HIMSS survey, which was supported by The Medical Group Management Association and underwritten by Experian Data Breach Resolution, surveyed 283 information technology and security professionals employed in US hospitals and physician practices. What the researchers found was that the greatest “that motivator” was that of healthcare workers potentially snooping into EMRs to find friends, neighbors, spouses or coworkers.

Given that healthcare IT leaders are particularly concerned about inappropriate use of health data by insiders, you won’t be surprised to hear that there’s been an increase use of several technologies related to access to patient data, including user access control and audit logs in each access to patient records.

But you may be surprised to learn that of the 51 percent of respondents increase the security of the past year, 49 percent of these organizations are still spending just 3 percent  or less of their overall IT budget on securing patient data.

Other findings from the HIMSS survey include that healthcare organizations are using multiple means of controlling employee access to patient information;  67 percent use at least two mechanisms, such as user base and role-based controls, for controlling access the data.

#HIMSS14 Day 3 – Lack of Innovation

Posted on February 26, 2014 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

On the bus ride home from the HIMSS14 party at Universal Studios, I sat next to a hospital CIO. She summed up the conference perfectly, “I’m tired, but also energized to go forward and do great things.” There you have the HIMSS conference in a beautiful nutshell.

It’s always a really great experience to come to HIMSS and interact with amazing people. As long as intelligent, smart, fun, wonderful people keep coming to HIMSS, it will be worth it for me to attend.

While I love attending, this HIMSS I was pretty disappointed with the real lack of major innovation that I found at the event. As is usually the case, I had a few people ask me what I found that was really interesting and innovative at the event. This year I didn’t really have an answer. Much of the progress we’re seeing with healthcare IT has been around building to government regulations along with incremental progress.

Of course, I will offer the disclaimer that I was only able to meet and talk with ~40-50 companies (of the ~1300 vendors) and talk to a few hundred people over the main 3 days. So, maybe there was a lot of innovation out there and I just missed it. Maybe it was in one of those hundreds of HIMSS press releases I got and I somehow missed it. However, I heard a similar sentiment from other attendees.

It’s also worth commenting that I’m in touch with many of these companies now on a regular basis. Maybe when I come to HIMSS I’m just seeing the next generation of something I’ve often seen and heard was already coming and so it doesn’t feel like much of an innovation to me. However, with a broader view it is an incredible innovation that I’m taking for granted.

Innovation or not, I can assure you that there is a cloud of regulation that’s hanging over every piece of healthcare IT. It’s overwhelming to vendors, providers, hospital organizations, and quite frankly everyone in the industry. Healthcare has always been a highly regulated world, but I think this is much more regulation than health IT has ever experienced before.

While I was sad to not see major innovations, I do think we’re making incremental progress towards a better healthcare IT future. Exchanging healthcare data is feeling closer than its ever been before. The changing payment model is likely going to drive this to reality. We’re starting down a really exciting path to turning healthcare data into information (to steal from an old IBM line). It’s still going to take a number of years for both of these items to become a standard, but it’s starting to march down that path.

I still have major concerns for the physician #EHRbacklash. Many EHR vendors are still naive to this coming backlash and many aren’t doing what they need to do to avoid it. I also think ICD-10 is going to be a major train wreck for a large portion of healthcare.

As is usually the case in life, there are good and bad things. Life is about learning to deal with both in the best way possible. I’m still as optimistic as ever about the potential of EHR and Health IT. We’re not where we should be when it comes to really getting the value out of the technology, but I am confident we will get there. One of my favorite quotes from the movie Remember the Titans sums up my views well:

#HIMSS14 Day 2 – Future of EMR and EHR Market

Posted on February 25, 2014 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As is probably going to forever be the case, much of my experience at HIMSS gets to benefit from the beauty of social media. Today was no different as their was the #HITsm chat where we played #HITsm account bingo. Somehow I ended up on stage competing against my fellow EMR and EHR writer, Jennifer Dennard, for one of the prizes. Happily she won. I cheered for her over me too. All in all it was a fun time hearing about the various people in the HITsm social media community.

The evening of day 2 was also highlighted by the New Media Meetup event. This is our 5th year organizing the event and I believe we can call it a great success. A big thanks to Stericycle Communication Solutions for sponsoring the event, and for everyone that attended. For those I didn’t really get a chance to see and talk with, let’s make up for it tomorrow. Although, as I always tell people, the best part of the event is that there are hundreds of amazing people you can meet.

Here were two comments attendees made to me about the event, “That conversation right there was more valuable to me than any of the sessions at HIMSS.” And then this one from someone who’s been to at least four of the meetups, “This is always my favorite event.” What a blessing for me to take part in such a tremendous HIMSS social media community.

Enough with my social media experience at HIMSS. Today I had a number of really interesting conversations. Some of them I’ll be saving for future posts. However, one thing stood out to me today in my discussions with a new EHR vendor called Viztek and the multiple EHR vendor, Allscripts.

When I decided to meet with Viztek, I was intrigued by the fact that they were just launching a new EHR software. I wanted to see who wave brave (or crazy depending on perspective) enough to launch a new EHR software at this point in the game. Are 300+ EHR vendors not enough? Plus, I thought the market was suppose to be contracting and not growing.

I was actually impressed by what I found at Viztek. No doubt, in the short time I had during HIMSS, I didn’t have time to dig in really deep to evaluate the breadth of the EHR they’ve created, it’s usability and feature set. Instead, with our short time I wanted to understand the why and EMR market conditions that prompted them to build and launch another EHR software.

What’s particularly interesting about Viztek is that they have a full PACS and RIS software system that they’ve already been selling for a long time. They saw offering an EHR software as a natural extension to this offering. Considering there’s still some growth available in the ambulatory market, and in specialties where they have deep PACS needs (like ortho) I could see an opportunity. One of the most compelling reasons for a practice to go with the fully integrated PACs and EHR software is that it leaves only one vendor to look to when there are issues. Don’t underestimate the value of this. I’m not sure of the pricing of their EHR, but I won’t be surprised if like many other vendors the EHR is just a way to get access to and solidify their main revenue stream (in this case PACS).

On the other end of the spectrum was my meeting with Allscripts. In my discussion, I almost got the feeling (although, they certainly didn’t state this specifically), that EHR has become almost a commodity. The idea being that everyone is going to have an EHR and that the EHR market is going to be a heterogeneous environment. I assure you that the later is true and will be for the forseeable future. So, it makes a lot of sense why much of the focus of our conversation was around Allscripts efforts with DBMotion to provide a platform that brings together all the data from the heterogeneous EHR systems.

I was really intrigued by each of these companies and how far apart they are in their approach to EHR. At the one side of the spectrum I see a new EHR that’s still trying to provide the right EHR software for the physician. On the other hand, you have a vendor that’s always been known as an EHR vendor (and quite frankly still is with so many EHR software under one roof) is now shifting much of their focus to population health and ACO technology.

I’ve previously written that the Golden Age of EHR adoption is over. We’re entering into a much bumpier and brutal period of EHR transition. We’ll see if doctors get some relief from ONC on Thursday. Word at HIMSS is that on Thursday they’ll be announcing something important in regards to meaningful use (likely during one of the ONC/CMS keynotes). At the CHIME event they said something to the effect of, “we’ve heard you and we’re going to help.” I’ll be on a plane home, but no doubt the details will be tweeted live.

There you have it. A few of my thoughts from day 2 of HIMSS. Tomorrow’s my last day at the event. I have too many things scheduled, but we’ll do what we can to discover interesting content and share more with you tomorrow.

Also, be sure to check out my #HIMSS14 Twitter Roundup – Take Two

#HIMSS14 Day 1 – Interoperability, HIE and Social Media

Posted on February 24, 2014 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Well, this is technically my second or third day, but this is the first official day of HIMSS. It’s a mad house like you can imagine and the vendor hall is as big as you’d expect. You need about 3 weeks to go through it. I actually decided to do a walking meeting with someone and we basically walked the whole exhibit floor twice. Luckily, the conversation was good and we dove into some interesting topics. I also told them about my future mobile strategy for Healthcare Scene. She liked it. Hopefully I can roll it out in the next few months.

My day happened to start off with a lot of discussion on interoperability and HIE with MAeHC and then Orion Health. I think it’s really interesting to see the progress we’ve made when it comes to interoperability and HIE, but I also found it interesting that Micky Tripathi from MAeHC still described healthcare interoperability as being in its infancy. I largely agree with him and it’s really too bad. Although, it was also interesting to compare that to Orion Health talking about how they’ve proven that HIE can work. Plus, they also noted something I’ve written multiple times: Private HIEs are growing faster than the Public HIEs.

I’m still really torn on the business model for interoperability and HIEs. I don’t see a clear model in most situations. I even saw one tweet yesterday that talked about taxing on a per patient basis to pay for the HIE. I heard that in NY they’re actually literally working on a tax to fund it. However, I really think that calling it a per patient tax is a really bad way to describe the funding. I’ll certainly be covering more of my interoperability and HIE discussions in the future. Watch for those blog posts in the coming weeks.

I also did a lot of social media talk today. Together with Shahid Shah and Cari McLean we had a discussion about Social Media and Influence. It was great to see so many friendly faces in the audience. I feel lucky every chance I get to hear Shahid talk. He’s really good at reframing things in interesting ways. Plus, Cari has a unique perspective to offer from her perch on top of the HIMSS Social Media tower. I previously noted that social media has just become an integral part of HIMSS. What’s interesting is that most of the companies at HIMSS haven’t created it as an integral part of their company. Many are still learning, but it’s great to see them learn. I hope many will attend the Health IT Marketing and PR Conference where we dive in a lot deeper on these topics.

As I said to someone today, social media can provide value to every company, but not every company should do social media. Some companies aren’t ready to commit to doing social media the right way. Other companies aren’t ready to be that open and transparent. Social media is just one tool in the kit. Although, it’s a really powerful one if used properly. I’ve also been touched by the power of social media to help individuals. Social media has connected me to people that would have no doubt been back at their rooms or in the corner of the event wondering why they were there, but instead they’re out having a good time and connecting with other interesting people.

There you go. I talked about a number of other things today, but I’ll cover that over the weeks and months ahead. For now I’m calling my day today HIMSS HIE, Interoperability and Social Media day.

Be sure to also check out my #HIMSS14 Twitter Roundup and my post on Hospital EMR and EHR about the real cause of hospital readmissions. I think the later post will be a post I reference over and over as people continue to talk about solutions that reduce hospital readmissions.

Usable EMR, Post EMR World, and Impact of Meaningful Use

Posted on February 23, 2014 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This is an important nuance. Although, I’d argue that the biggest challenge to EMR usability is onerous billing requirements and prescriptive meaningful use requirements.

I’m really interested in the description of a post EMR world. It makes me ask myself the question, “What can we do with 100% EMR implementation?”

MU has spurred EHR adoption. No arguments there. Hard to argue against MU killing much of the EHR innovation and usability. We’ll see which exceptions emerge from the dust.

My #HIMSS14 Preview

Posted on February 21, 2014 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As most of you know, I’ll be heading on my annual pilgrimage to Health IT Mecca (otherwise known as HIMSS14). HIMSS 2014 is taking place in Orlando and I have another jam packed schedule with ~20 confirmed meetings and ~10 possible evening socials. Of course, this doesn’t count any of the sessions I plan to attend or time I’ve set aside to discover what’s in the enormous exhibit hall.

In case you don’t read EMR and EHR (shame on you, but this can be corrected), yesterday I posted Some Frank #HIMSS14 Advice (plus some cool preview pictures of the event). If you’re going to HIMSS, it’s well worth a read. I think it also illustrates how important the people at HIMSS are to me. Maybe that’s why I love Social Media at HIMSS14 so much. In fact, you’ll see in my preview below a great mix of social media and interesting companies.

Now for a preview of some of the things I’m looking forward to at HIMSS 2014 and a few things that caught my eye (Apologies in advance to those things I forgot to mention).

If you check out that link, you’ll see the unofficial HIMSS 14 5k, a HIMSS Dance Meetup, a HIMSS Tennis Meetup and the official Yoga and Wellness Challenge. I love that there’s at least some effort to be healthy and have some fun at HIMSS. Should be some fun events. I’ll be attending the ones that aren’t way too early for a west coast blogger like myself.

Stoltenberg Consulting
I found Stoltenberg Consulting’s idea to ask attendees “What If…” during HIMSS. They’ll be offering the option in their booth, but you can also get started on social media using the hashtag #WhatIf4HIT. I imagine Stoltenberg plans to take those questions and see how they can help solve the problems which makes the idea even better. There are always plenty of people at HIMSS asking What If, but not nearly enough people making those What Ifs a reality.

#SocialMedia and Influence Meetup
This meetup will include the spectacular Cari Mclean and Shahid Shah and I’ll be tagging along as well. This will be a real interactive discussion between all the participants. So, come to the event ready to ask questions, get answers, and share your experiences and viewpoints. I hope that this will be a sliver of a preview of the Healthcare IT Marketing and PR Conference I’m organizing in April.

5th Annual New Media Meetup at HIMSS
Unfortunately, this event has reached capacity (as it does every year). Imagine 200 of the best and brightest in healthcare IT social media in the same room. Everywhere you turn you see an amazing blogger or someone you follow on Twitter. It’s awesome. A big thanks to Stericycle Communication Solutions for sponsoring the event.

Santa Rosa Consulting
Besides always having a great booth at HIMSS, they also offer a full suite of consulting services around all the topics you would expect: ICD-10, meaningful use, BI and analytics, and HIE. Plus, Santa Rosa Consulting’s part of the larger company which owns the HIE company, Sandlot Solutions. They’re announcing a new Sandlot Connect Lite product that serves as an entry-level electronic notification service, providing the first level of information sharing between ambulatory and inpatient healthcare settings as patients are admitted and discharged. You can find them at Booth 5689 and 5783.

#HITsm Meetup
Always fun to meet many of the people you’ve shared tweets with in person at the #HITsm meetup. I hear this year they’re going to do more interacting and meeting and less single stream discussion. This makes me happy. Plus, I hear they have some giveaways this year as well.

Capsule Tech
Props to KNB for holding a Google Plus video hangout HIMSS pre-brief with Capsule Tech. Then, I have to take the props away for them having me hold an embargo until Monday. However, Capsule Tech did provide me some insight that I’d never heard about hospital readmissions. Plus, I found their HIMSS announcement an interesting evolution in their work. Too bad I can’t tell you more. However, I’m hoping to have a post about it up on Hospital EMR and EHR on Monday.

Healthcare Analytics
You won’t have to look for this. In fact, this is a warning that this is going to be the top buzz word at HIMSS14. I don’t think it’s even going to be close. If someone has more time than me, I’d love to know what percentage of HIMSS exhibitors have a Healthcare Analytics package. I bet it’s huge. What does healthcare analytics even mean? I guess that’s why everyone has a package. No one knows what it means and so everyone has something that does “analytics.” I do analytics too, in excel spreadsheets.

Encore Health Resources
Over on Hospital EMR and EHR, I did an interview with Dana Sellers about the new product their launching at HIMSS: Encore Pay for Performance (P4P) Managed Services. You can read the interview for all the details, but I find it really interesting that a consulting company wants to start taking on some of the risk associated with an organization’s P4P program. I’ll be interested to hear attendees response to this approach and how this plays out over time. We’re at the really early stages of P4P. Also, the Encore Pub Nights at HIMSS are always a nice break after a long day as well. Check those out if you haven’t before.

NextGen Giveaways
Everyone likes a nice giveaway (unless you’re press and they don’t like to give stuff to you). I was impressed by the suite of giveaways that NextGen will be doing at HIMSS. The “selfie contest” is a fun one that leverages social media. I love the prize patrol one as well, but I prefer carrying my backpack instead of another bag. Plus, they’re giving out 4 Grand Prize Vacations. I’d personally want the 5 nights in Rome, Italy, but I’m biased since I lived in Italy for 2 years.

I’ll be interested to hear what other giveaways there are at HIMSS. In past years it seemed they weren’t giving as much away. Maybe I was just too busy in meetings. I did hear one vendor is giving out cool portable batteries to charge your cell phones. Those are nice if you don’t have one.

There you go. A few of the interesting things I’m looking forward to participating in and checking out at HIMSS. I’d love to hear what you find interesting and what you’re looking forward to see in the comments.

Full Disclosure: Santa Rosa Consulting and Stoltenberg Consulting both work with Healthcare IT Central posting jobs and sponsoring newsletters.

PQRS Incentives, Penalties and the Coming Value Based Payment Modifier

Posted on February 20, 2014 I Written By

The following is a guest post by Barry Haitoff, CEO of Medical Management Corporation of America.
Barry Haitoff
Much of the focus of healthcare has been on meaningful use and the EHR incentive money. Considering we just reached $19 billion of payouts, it’s definitely a topic worthy of attention. However, a topic which hasn’t gotten nearly as much attention, but is nearly or possibly more important than meaningful use is PQRS and the Value Based Payment Modifier.

Before I dig into some of the details and timelines for PQRS and the Value Based Payment Modifier, it’s really important to note that both of these programs are really just a preview of what’s happening with Medicare reimbursement. These programs are the core of the shift towards paying physicians differentially based on the quality and cost of the care they provide and away from the traditional fee for service model. We’ve seen similar value based payment arrangements with the advent of ACOs, CINs and other clinical networks establishing innovative payment models with payers. Understanding where these programs are going will give you a preview of what’s happening with healthcare reimbursement.

When it comes to PQRS, much like meaningful use, there is both a PQRS incentive and PQRS penalty (carrot and stick if you prefer). 2014 is the final year to receive the PQRS incentive money (0.5% of Medicare Part B claims) and participants must submit 12 months of 2013 CQM data by February 28, 2014 if reporting by claims data, March 21, 2014 if reporting by GPRO web interface, and March 31, 2014 if reporting by registry data. (Note: The 2013 MU reporting deadline was moved to March 31, 2014, but the PQRS deadlines have not changed.). However, more important is that providers who don’t report PQRS 2013 data will be penalized 1.5% in 2015. Those who don’t participate in PQRS in 2014 will be penalized 2% in 2016.

Value Based Payment Modifier
While most people have heard about PQRS and are hopefully participating to avoid the penalties, many people haven’t heard about the Value Based Payment Modifier that is built on the PQRS foundation. While you could look at the Value Based Payment Modifier final rule, this Value-Based Payment Modifier summary is a much better overview of the program.

Essentially, the Affordable Care Act (ACA) required that CMS implement a value based payment modifier that would apply to Medicare fee for service payments. This program will start with physicians in groups of 100 or more eligible professionals under the same TIN beginning January 1, 2015, and apply to all physicians and groups by January 1, 2017. CMS also recently announced that this applies to both par and non-par Medicare providers with 100 or more eligible professionals.

Here’s a look at how this new Value Modifier will work for groups of physicians with 100 or more eligible professionals and will likely be a preview of what’s to come for all Medicare physicians:
CMS Value Modifier

While the program starts with relatively small 1% adjustments, this quote from CMS also provides a clear indication of where they want to take this program:

We also anticipate that we would propose to increase the amount of payment at risk for the Value Modifier as we gain additional experience with the methodologies used to assess the quality of care, and the cost of care, furnished by physicians and groups of physicians.

What should you do to be prepared for this new Value Based Payment Modifier?
1. Participate in the PQRS program since it’s the foundation of what’s to come.
2. Keep an eye on changes to the PQRS and Value Based Modifier programs. They are changing regularly and it’s worth knowing what’s changing with these programs.
3. Work with your professional organization to provide feedback on these programs. No doubt they’re keeping an eye on them and providing feedback as part of the government rule making process. Make sure your voice is heard.

CMS looks at this new value based modifier as a budget neutral program. That means that there are going to be winners and losers. By understanding how these programs work, you can better assess if you want to work to avoid the payment adjustments or if you’re ok taking them on.

Like it or not, PQRS is the start of the movement towards quality based reimbursement and likely a small preview of coming attractions. Of course, if the SGR Fix gets funded by congress, then PQRS, Meaningful Use and the Value Based Modifier will be sunset at the end of 2017 and rolled into a new Merit-Based Incentive Payment System (MIPS) that will start in 2018. More on MIPS in the future, but I think we can safely say that MIPS will be an amalgamation of all these incentive programs.

Medical Management Corporation of America, a leading provider of medical billing services, is a proud sponsor of EMR and HIPAA.

Meaningful Use Playbook 2014: Overcoming Adversity – Breakaway Thinking

Posted on February 19, 2014 I Written By

John Lynn is the Founder of the 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 and 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 following is a guest blog post by Carrie Yasemin Paykoc, Senior Instructional Designer at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
I apologize in advance, but I am still mourning the Super Bowl loss of the Denver Broncos. I can’t stop replaying each moment and thinking of alternative scenarios. What if Peyton Manning utilized a quick huddle instead of audibles and hand-signals? What if Denver’s defense had better protected Peyton? What if the Broncos had scored more than eight points?

Regardless of the what-ifs and wounds resulting from the loss, the team has to step up and prepare for the next season, if they want to finish at the top. In the healthcare world, providers must also change their playbook and approach, if they wish to capitalize on the next phase of Meaningful Use.

For the past year, providers have been scrambling to select, implement or optimize a new electronic health record system to meet federal requirements for Meaningful Use Stage 1. Adding to providers’ challenges is the evolving nature of the rules for achieving meaningful use incentives; federal agency Centers for Medicare and Medicaid Services (CMS) is constantly updating the Meaningful Use Playbook. Similar to football players at the end of the season, providers are tired and wounded. However, they must be aware of and prepare to take on the new requirements for 2014. Otherwise, they risk future penalties and foregoing funds. To help healthcare providers prepare for this new season, here is a summary of changes taking effect this year.

  • Three-month reporting period
    All providers are now required, regardless of their stage of meaningful use, to demonstrate meaningful use for a three-month EHR reporting period. Medicare providers may elect to report clinical quality measures (CQM) for the entire year or select an optional, three-month reporting period for CQMs that is identical to their meaningful use reporting.
  • Exclusions and vital sign objectives
    All eligible professionals, eligible hospitals and critical access hospitals are now responsible for adhering to the latest changes in Meaningful Use Stage 1. This includes new requirements for electing exclusions toward menu objectives, age limits for recording and charting changes to vital signs, and new exclusions toward reporting height, weight and blood pressure.
  • View, download and transmit all health information or admissions online
    To better align with the new capabilities of certified EHR technology, CMS is replacing Meaningful Use Stage 1 objectives for accessing information online with the capacity to view, download and transmit this information.
  • Reporting of clinical quality measures
    All providers, regardless of their stage of meaningful use, must report on clinical quality measures to CMS. Eligible hospitals must report 16 of the 29 CQMs and eligible providers must report 9 of the 64 CQMs.(Source)

For providers making the leap to Stage 2 of meaningful use, this is only the beginning. Not only must they abide to the changes mentioned above, but they also need to plan and execute a strategy for integrating diverse IT systems and engaging patients. Neither are simple tasks. However, just as I believe that Peyton can shake this last performance and finish strong next year, I believe in the resiliency of providers too. With the right leadership and planning, they will take patient care to the next level.

Omaha! Omaha! Omaha!
Carrie Yasemin Paykoc
Xerox is a sponsor of the Breakaway Thinking series of blog posts.

A Hospital Perspective on Meaningful Use from Encore Health Resources

Posted on February 18, 2014 I Written By

John Lynn is the Founder of the 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 and 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 following is a guest blog post by Karen Knecht in response to the question I posed in my “State of the Meaningful Use” call to action.

If MU were gone (ie. no more EHR incentive money or penalties), which parts of MU would you remove from your EHR immediately and which parts would you keep?

Karen Knecht
Karen Knecht
Chief Innovation Officer at Encore Health Resources

It’s an interesting question you’ve posed on MU, and I think you have generated some great discussion on this topic, such as last week’s response by Dr. Sherling from the perspective of an eligible provider.

My colleagues and I would like to provide an eligible hospital perspective.  The industry is now three-plus years down the path of implementing “certified EHRs.”  There was a need to kick-start the digitization of healthcare in this country and create a common infrastructure to drive change, and MU has done that.  For example, establishing standards for data capture is critical for unified reporting and analysis.  Would the industry establish and adopt these standards without a program like MU?

But working with many large healthcare organizations representing several hundred individual hospitals in their MU programs, there are clearly many lessons learned and opportunities to improve for the future, even if the MU program were to go away.

Overall, there are no MU objectives that we would discount as having no value.  However, there are some that have served their time and others that are ahead of their time.

For the parts to continue, we see a high level of value in the CPOE, Barcoded Medication Administration, Medication Reconciliation and Clinical Decision Support objectives, as they are making tangible contributions to patient care.  However, we would recommend timeline delay due to additional capital outlay as well as complexity of workflow.  This would give more time for deeper and broader adoption.

For the parts to no longer measure in the same way, we would start by simplifying and removing the objectives that are topped out: the ones that are already hardwired in most organizations such as Vital Signs, Demographics, and Smoking Status.  This is no different than the current process for removing quality measures from reporting requirements once they have been well adopted — and HITPC is in agreement about this.  In their meeting last week where they discussed proposed Stage 3 measures, they were saying much the same thing.  Even if you stop measuring these things explicitly, they will continue to be electronically documented.

Second, we could see removing objectives that are now standard for “certified” EHRs.  For example, the time and effort to document the Drug Formulary, Drug-Drug, and Drug-Allergy checking functionality, for the sole purpose of meeting the MU objective, is not well spent.  Another example is the lab results stored as discrete values, which are part and parcel of any lab system in existence.

Other objectives that are causing great concern among many hospitals are the ones dealing with providing and exchanging information electronically.  It would be helpful to reconsider the expectations for these objectives, since many are finding out that implementing a patient portal without a sound patient engagement strategy is not going to be enough to ensure that 5% of patients will actually access their records.  Hospitals should have a portal and secure messaging capability, but it doesn’t seem realistic to put thresholds on patient utilization.  As the old saying goes, “You can lead a horse to water, but you can’t make it drink.”

Additionally, the requirement for Direct exchange to transmit summary of care is cumbersome and actually a step backwards for those entities who are part of an HIE and are currently exchanging data among members.  For most others, it is really only practical to implement with a physician ambulatory partner.  The sad fact is that nursing homes, SNF’s, and other entities where hospitals commonly transfer patients are not included in the EHR incentive program and do not have the technology necessary to participate in a direct exchange in a meaningful way.

And finally, we think all aspects of electronic quality measures should be rethought.  We love the idea of calculating these measures electronically, but they need to be appropriately validated and re-addressed in the context of the poor data collection that is occurring.  Perhaps CMS should consider another voluntary incentive program for facilities that have fully implemented all their clinical documentation.  Given the change that is proposed to the physician quality reporting programs as a result of the SGR fix, perhaps a similar refinement of the IQR and VBP programs along with MU should be considered.

See other responses to this question here and please reach out to us if you’re interested in providing a response to the question.