Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

Creating Provider Loyalty – And Why Communication Matters

Posted on June 14, 2018 I Written By

The following is a guest blog post by Chelsea Kimbrough from Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms

Chelsea Kimbrough

A few months ago, I was on the hunt for the perfect healthcare provider – and my list of expectations was high. Thankfully, my extensive search paid off. I am happy to report I found an amazing physician who I fully plan on remaining loyal to for years to come! The main reason for this loyalty boils down to one common characteristic: communication. Across every step of my patient journey, I was engaged in a clear, convenient way.

Scheduling my appointment was easy. Like many patients, I enjoy the convenience of online scheduling. But as a first time patient, I opted to pick up the phone to make my appointment. The person who answered my call was friendly, focused, and efficient. I was not asked to repeat information and ended the call more quickly than I anticipated – and with more confidence that I’d made the right choice.

Before my appointment, I received a number of reminders. The first was sent via email a few days before my appointment. When I failed (read: forgot) to reply to it, I received another friendly reminder via text message. This time, I promptly confirmed my appointment. A few days before the appointment, I was invited to pre-check in online. I did this from the comfort of my home computer in just a few minutes. As a digital-minded patient, I was stoked that this was an available perk of my new doctor’s office.

When I arrived, I was thanked for already checking in. Unlike other locations where I needed to fill out additional paperwork upon arrival, I didn’t need to do this often repetitive task. This pleasant surprise allowed me to simply wait to be called back.

During my appointment, the doctor looked me in the eye, asked me genuine questions, and clearly explained anything I wanted to know more about. This level of dedicated attention made me feel genuinely cared for. What’s more, she ensured I understood what to expect after my appointment.

After my appointment, I received the communications I was advised to expect in a timely and unobtrusive manner. What’s more, I was invited to provide candid, anonymous feedback about my appointment. The survey was quick and unobtrusive, and left me feeling as if my opinion was valid and valued.

Each point of my patient journey was met with timely, convenient, and reliable engagement. As a patient, I felt confident and at ease. And as someone who works closely with healthcare communication services and solutions – both human and technology based – I was impressed. Few healthcare organizations provide patient experiences that meet patients’ traditional and digital expectations and reliably deliver on the expectations they set. Those that do, however, are sure to acquire patients like me who will stay loyal for the foreseeable future.

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality telephone answering, appointment scheduling, and automated communication services. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services. Connect with Stericycle Communication Solutions on social media: @StericycleComms

How to Introduce Microservices in a Legacy Healthcare Environment

Posted on May 31, 2018 I Written By

The following is a guest blog post by Nick Vennaro, Co-founder of Capto Consulting.

Healthcare as a whole is finding new ways to use technology to improve population health and patient experience. Population health is looking for a spectrum of precision in patient and provider data as well as clinical cost metrics and matching that data to patient communication, metrics and clinical outcomes. Patient experience requires streamlining information that is both timely and personalized, which is hard to accomplish with monolithic systems.

A monolithic system is usually one that has grown over many years and performs numerous functions that are not architecturally separated. These systems tend to be brittle and not easily changed.  The proliferation of mergers and acquisitions in healthcare further exacerbates the complexity of operating multiple monolithic systems within a healthcare network. It is not unheard of to operate 5, 8 or even 12 billing systems in parallel, because combining them would take so much more time, and it is more cost effective to let them operate individually.

An increasingly popular architectural style known as microservices are much better equipped to help healthcare organizations move forward rapidly than are the current monolithic, unstructured and difficult to maintain systems. While currently, no consensus exists on how to define microservices, it’s generally agreed that they are an architectural pattern that is composed of loosely coupled, autonomous, and independently deployable services that communicate using a lightweight mechanism such as HTTP/REST.

Now is the time for healthcare organizations to be investigating how best to introduce microservices in their legacy environments if they expect to realize a digital transformation. This is particularly important to enterprises that need to make frequent changes to their systems and where time-to-market is paramount.

The benefits and potential hurdles associated with adopting microservices are well documented. On the plus side, the modular and independent nature of microservices enables improvements in efficiency, scalability, speed and flexibility—all the features a nimble healthcare enterprise requires.  Detractors, however, frequently point to management and security challenges, especially when they pertain to customer-facing applications and services.   These challenges can be overcome with due diligence and planning.

Like virtually all technology decisions, it’s critical to balance risk with reward and, when it comes to microservices, embracing an evolutionary approach and process. After all, lessons can be learned from both success and failure, and the same is true for implementing microservices that can increase product and service quality, ensure systems are more resilient and secure, and drive revenue growth. This blog post will explain how business and technology leaders can smoothly and successfully introduce microservices in a legacy environment.

It’s all about the monkey

A key requirement of microservices design is to focus service boundaries around application business boundaries. A keen awareness and understanding of service and business boundaries helps right-size services and keeps technology professionals focused on doing one thing and doing it very well.

Astro Teller, the “Captain of Google Moonshots” humorously advocates that companies “tackle the monkey first” meaning they should avoid allocating all of their resources on the easy stuff and instead start by addressing the hard problems. The monkey, when deploying microservices in a large, established environment, is understanding and decomposing the legacy systems.

Decompose the legacy environment by identifying seams

In his book, “Working Effectively with Legacy Code,” Michael Feathers presented the idea of a seam as a way to identify portions of code that can be modified without affecting the rest of the code base. This notion of seams can be extended as a method to divide a monolithic system into bounded contexts from which services can be quickly and seamlessly created.

Uncovering seams in applications and building bounded contexts is an important first step in breaking down the monolith. Here are two steps to identify seams:

  • Interview domain experts. This is a key step to learning where the seams are and identifying bounded contexts. Having domain experts that understand what the business should be doing not just what the system currently does is critically important.
  • Understand the organizational structure – Often, organizational structure will provide clues to where the seams can be found.

Once the boundaries are identified, along with the programming language and environment that support them, creating packages and sub-packages that contain these bounded contexts should closely follow. This approach will afford a careful analysis of package usage and dependencies, which are paramount to fully and quickly understanding and ensuring that testing and instrumenting code is being done properly.

Healthcare is a prime candidate for using microservices to find the seams and decompose the monolithic infrastructure. It allows modernization as well as merging technologies without a complete and disruptive overhaul of the monolith at one time. This will allow the healthcare organization more flexibility and ability to compete on many levels, it’s a relatively fast route to a more agile delivery of population health and patient experience.

About Nick Vennaro
Nick Vennaro is cofounder of Capto, a management consulting firm. Nick has more than 25 years of experience leading enterprise-scale technology and business management initiatives for Fortune 500 companies. Nick will be presenting May 31 at the Healthcare IT Expo on “Using Outcomes-based Contracts to Increase Performance and Innovation.”

Physician Burnout, a Healthcare Issue Unique to Our Healthcare Providers

Posted on May 25, 2018 I Written By

The following is a guest blog post by Justin Campbell, Vice President, Strategy, at Galen Healthcare Solutions.

I Can’t Get No Satisfaction…but I try, and I try, and I try, and I try – Rolling Stones

Justin CampbellIn a 2018 Medscape survey exploring the professional satisfaction of providers, 42 percent of 15,000 survey respondents reported feeling burnt out with their jobs, up from an overall rate of 40 percent in 2017. In recent years, physician burnout has become a serious industry issue, with national policy discussions ensuing on how to best combat the problem. Researchers have drawn correlations between physician burnout and higher medical error rates, lower overall quality of care, and increased clinical staff turnover. Year after year, the underlying drivers of dissatisfaction have remained consistent: overwhelming charting requirement, long work hours, and cumbersome EHRs.

As health IT leaders, one question we should be asking ourselves is how we can best apply our EHR expertise to help reduce physician burnout. To answer this question, let us look to the doctors we aim to help. When physicians are at the bedside, they analyze a patient’s condition and formulate a care plan accordingly. They look to diagnostic test results, review trended vitals, pain scores, and nursing assessments, and consult with specialists in a massive data gathering exercise all aimed at quantifying the problem and crafting a treatment plan.

Providers are telling us there is a problem, and they are consistently identifying the primary underlying causes. IT department leaders have a direct influence over many of the drivers of physician burnout, so it is time for us to dig into the details, measure the problem, and craft a treatment plan. How do we measure and manage physician burnout?

There’s Gold In Those EHR Audit Logs

The Office of the National Coordinator’s EHR Certification Requirements mandate that all certified EHRs be capable of generating an audit log detailing all user activity, stored in a database alongside user credentials and a date and time stamp. At first glance, these unassuming audit logs appear to provide little actionable insight, but buried in the data there is value. When audit logs are compiled across several months, data analysts will quickly see that they have a rich dataset that can be sliced and diced to expose the EHR navigation and module utilization trends of key physician populations.

Analyzing patterns within EHR audit logs will allow savvy data analysts to determine the average length of time providers spend working in the EHR. This information can be calculated at the individual level or aggregated across all providers.

Source: Galen Healthcare Solutions

Knowing how long providers are spending on administrative tasks in the EHR is valuable information for a number of reasons. First and foremost, this information can be used as a benchmark to measure the impact of future software updates or optimization projects. Any significant changes to provider workflow should be retrospectively reviewed to understand how it impacts the average time providers spend in the EHR. First, do no harm.

Analyzing user activity logs at the individual level also helps identify highly efficient EHR users within each specialty. The EHR workflow patterns of these EHR champions can be modeled. Peers can be educated on how to adjust their own workflows to mirror specialty-specific champions, reducing their own daily EHR burden. These “quick win” workflow adjustments are changes that can be adopted by clinical staff immediately, before extensive EHR optimization efforts are undertaken.

Audit log analysis can also highlight which EHR modules providers spend the most time in. In most cases, updating user preferences and optimizing the information displayed on EHR screens can expedite chart navigation. Simplified documentation templates and macros training can expedite the documentation process. A library of evidence-based order sets and targeted clinical decision support algorithms can minimize time spent entering orders.

Analyzing utilization trends at the EHR module level exposes the workflow tasks that are consuming a disproportionate amount of provider time.

Don’t. Stop. There.

EHR audit log analysis can reveal how much time providers are spending in the EHR, and where specifically they are spending that time. It can identify physician champions, and highlight those that are struggling. Audit log analysis can be used to measure EHR-induced physician burnout and support system-wide optimization efforts aimed at improving satisfaction.

Beyond this, EHRs offer a wealth of additional datasets that can help highlight inefficiencies in clinical workflows. Traditional health IT data analytics typically aims to uncover problems in care quality or revenue cycle management, but analysis focused on EHR workflow improvement is just as noble an effort, and one providers have long been seeking.

Gain perspectives from HDO leaders who have successfully navigated EMR clinical optimization and refine your EMR strategy to transform it from a short-term clinical documentation data repository to a long-term asset by downloading our EMR Optimization Whitepaper.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement & data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.

About Galen Healthcare Solutions
Galen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and Gold sponsor of Health IT Expo. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us on TwitterFacebook and LinkedIn.

 

How Technology Helped My Family Receive a Better Healthcare Experience

Posted on May 10, 2018 I Written By

The following is a guest blog post by Brittany Quemby, Marketing Strategist for Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms

Brittany Quemby - Stericycle

When was the last time you had a truly outstanding patient experience? For my family, two healthcare facilities located hours apart recently teamed up to make our lives significantly more convenient. Without modern technology, however, our new reality may never have been possible. Let’s start from the beginning.

A few years ago, my family member suffered a heart attack that caused a traumatic brain injury. He was treated at a major facility about two hours away from his home for speech therapy, occupational therapy, neurological care, cardiologist support, and more. After a year of hard work, he was discharged from the hospital and was able to move back to his home town.

Unfortunately, his community hospital was not equipped to provide the specific care he required. So for the next two years, he and his wife, who is now his primary care giver, commuted to the city multiple times a week to ensure he received the care he needed.

Eventually, we all wondered the same thing: Isn’t there a better way?

After many meetings with the facility that treated my relative and our local hospital, we started discussing how digital health experiences and virtual care could augment my family’s patient and caregiver experience. We were determined to find a solution that provided care options and choice, and allowed them to continue receiving the necessary care without the exhaustion of “living on the road.”

A recent study by Accenture said it best: “Finding the best combination of traditional in-person services and making those same services available virtually can offer consumers the choice they want in deciding when and how they receive care and support.”

Fortunately, we learned that our local hospital was equipped to provide virtual care. However, many patients had not yet taken advantage of these technologies. After some coordinating between facilities, we were able to set up ongoing virtual appointments. These appointments enabled my family member to receive care in a much more convenient setting.

With virtual appointments, they can even:

  • Easily schedule virtual appointments
  • Participate in the appointments from the comfort of a boardroom at the hospital
  • Consult with the first hospital’s specialist and also an in-person care facilitator
  • Receive follow-up health reminders and education directly after the appointment

Now, almost half of his appointments have transitioned to virtual appointments. And my family is not the only one taking advantage of this care capability. Recent research explores the many reasons why healthcare consumers are making this virtual shift:

  • One of the top three reasons why consumers tried virtual health was convenience. 37% said it was more convenient than traditional, in-person health services
  • 76% of people would have a follow-up appointment (after seeing a doctor or healthcare professional)
  • 74% would get virtual follow-up care services in their home after being hospitalized
  • 73% would discuss a specific health concern virtually with a doctor or other healthcare people and
  • 72% would be open to getting virtual daily support to manage an ongoing health issue

Consumer willingness to demand choice and becoming more involved in their health is rising. Like my family, more patients are ready to collaborate with clinicians, embrace new technologies, and explore digital health experiences that can help manage our health and create more convenient and engaging patient experiences.

Learn more about how Stericycle Communication Solutions is helping create the optimal patient experience through a combination of human and tech-enabled communication services. Check out our service overview here!

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality live agent services, scheduling solutions, and automated messaging solutions.  Stericycle Communication Solutions provides unified human & tech-enabled communication solutions for optimized patient experiences.  Connect with Stericycle Communication Solutions on social media: @StericycleComms

Why You Shouldn’t Take Calculated Risks with Security

Posted on May 9, 2018 I Written By

The following is a guest blog post by Erin Gilmer (@GilmerHealthLaw).

Calculated risks are often lauded in innovation.  However, with increasing security breaches in the tech industry, it is time to reassess the calculated risks companies take in healthcare.

Time and again, I have advised technology companies and medical practices to invest in security and yet I am often met with resistance, a culture of calculated risk prevails.  To these companies and practices, this risk may make sense to them in the short term. Resources are often limited and so they often believe that they needn’t spend the time and money in security.  However, the notion that a company or a practice can take this chance is ill advised.

As a recent study conducted by HIMSS (and reviewed by Ann Zieger here) warns, “significant security incidents are projected to continue to grow in number, complexity and impact.” Thus in taking the calculated risk not to invest in security, companies and practices are creating greater risk for in the long run, one that comes with severe consequences.

As we have seen outside of healthcare, even “simple” breaches of user names and passwords as happened to Under Armour’s MyFitnessPal app, become relatively important use cases as examples of the impact a security breach can have. While healthcare companies typically think of this in terms of HIPAA compliance and oversight by the Office for Civil Rights (OCR), the consequences reach far wider.  Beyond the fines or even jail time that the OCR can impose, what these current breaches show us is how easy it is for the public to lose trust in an entity.  For a technology company, this means losing valuation which could signal a death knell for a startup. For a practice, this may mean losing patients.  For any entity, it will likely result in substantial legal fees.

Why take the risk not to invest in security? A company may think they are saving time and money up front and the likelihood of a breach or security incident is low. But in the long run, the risk is too great – no company wants to end up with their name splashed across the headlines, spending more money on legal fees, scrambling to notify those whose information has been breached, and rebuilding lost trust.  The short term gain of saving resources is not worth this risk.

The best thing a company or practice can do to get started is to run a detailed risk assessment. This is already required under HIPAA but is not always made a priority.  As the HIMSS report also discussed, there is no one standard for risk assessment and often the OCR is flexible knowing entities may be different sizes and have different resource. While encryption standards and network security should remain a high priority with constant monitoring, there are a few standard aspects of risk assessment including:

  • Identifying information (in either physical or electronic format) that may be at risk including where it is and whether the entity created, received, and/or is storing it;
  • Categorizing the risk of each type of information in terms of high, medium, or low risk and the impact a breach would have on this information;
  • Identifying who has access to the information;
  • Developing backup systems in case information is lost, unavailable, or stolen; and
  • Assessing incidence response plans.

Additionally, it is important to ensure proper training of all staff members on HIPAA policies and procedures including roles and responsibilities, which should be detailed and kept up to date in the office.

This is merely a start and should not be the end of the security measures companies and practices take to ensure they do not become the next use case. When discussing a recent $3.5 million settlement, OCR Director Roger Severino recently emphasized that, “there is no substitute for an enterprise-wide risk analysis for a covered entity.” Further, he stressed that “Covered entities must take a thorough look at their internal policies and procedures to ensure they are protecting their patients’ health information in accordance with the law.”

Though this may seem rudimentary, healthcare companies and medical practices are still not following simple steps to address security and are taking the calculated risk not to – which will likely be at their own peril.

About Erin Gilmer
Erin Gilmer is a health law and policy attorney and patient advocate. She writes about a range of issues on different forums including technology, disability, social justice, law, and social determinants of health. She can be found on twitter @GilmerHealthLaw or on her blog at www.healthasahumanright.wordpress.com.

GDPR and Why U.S. Healthcare Providers Should Care

Posted on April 19, 2018 I Written By

The following is a guest blog post by Steven Marco, CISA, ITIL, HP SA and President of HIPAA One®.

Steven Marco - HIPAA expertThe European Union (EU) has drafted guidance to give citizens more control over their personal data, so what does this mean for U.S. based healthcare providers?

On May 25, 2018, the EU will roll out General Data Protection Regulation (GDPR), a new set of rules that is similar in nature to HIPAA compliance for EU countries. The effort to create GDPR started years ago in January 2012, when the European Commission began working on plans to create data protection reform across the EU so that European countries would have greater controls in place to manage information in the digital age. Additionally, GDPR aims to simplify the regulatory environment for businesses so both European citizens and businesses can benefit from a digital economy.

Being that GDPR has not yet taken effect, there are aspects to this new framework that are difficult to fully understand and define at this time yet we do know that U.S. companies DO NOT need to have business operations in one of the 28-member states of the EU to be impacted by GDPR. The new set of rules will require organizations around the world that hold data belonging to individuals who live in the EU to a high level of protection and must be able to account for where every bit of data is stored.

The good news is a large majority of U.S. based healthcare providers will be relatively safe in terms of complying with GDPR. If your organization is not actively marketing your services in the EU or practicing in the EU, a data breach where an EU citizen’s PHI is compromised would most likely be your most realistic brush with GDPR.

For instance, a walk-clinic in New York City seeing many international tourists has a much higher chance of being impacted than say a rural clinic treating mostly local residents. Providers in larger cities with more diverse patient groups will need to be extra vigilant regarding their breach notification standards and security posture.

Want to learn more about how your healthcare organization can prepare for GDPR? Read this HIPAA One blog post to learn how your practice can prepare now for a more international data sharing climate.

About Steven Marco
Steven Marco is the President of HIPAA One®, leading provider of HIPAA Risk Assessment software for practices of all sizes.  HIPAA One is a proud sponsor of EMR and HIPAA and the effort to make HIPAA compliance more accessible for all practices.  Are you HIPAA Compliant?  Take HIPAA One’s 5 minute HIPAA security and compliance quiz to see if your organization is risk or learn more at HIPAAOne.com.

Why Physician Practices Need a MIPS Expert on Staff

Posted on April 16, 2018 I Written By

The following is a guest blog post by Marina Verdara, Sr. Training Specialist for CMS Incentive Programs, Kareo.

Healthcare providers go to school to learn how to care for patients, and that’s what they do best. However, billing processes, performance-based payment adjustments, and payment incentives are typically not included in this education. Being responsible for today’s regulatory complexities and workload may not have been what providers envisioned for their career. And it’s taking a toll. Nearly half of physician practices spend more than $40,000 per full-time physician per year on complying with Medicare payment and incentive programs, according to an MGMA survey. These costs factor in loss of physician productivity and staff training needs, along with IT expenses.

Independent practices must find a way to streamline the CMS incentive program reporting process. One important way to do this is by designating a “MIPS expert” among your staff. This could be your lead clinician or another manager who has oversight of patient encounter documentation.  While 2017 reporting is done, now is the time to specify the MIPS expert so they can ensure compliance throughout all of 2018.  Don’t wait until 2018 is done to specify your MIPS expert.

MIPS Recap

In 2015, The Department of Health and Human Services (HHS) announced new goals for value-based payments in Medicare that changed your practice’s payment structure. The Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) introduced a system where providers receive payment based on the value and quality of services provided, not the volume. These changes repealed the Sustainable Growth Rate Formula, streamlined multiple quality reporting programs into MIPS, and provided incentive payments for participation in Advanced Alternative Payment Models (APMs).

HHS made these changes as the first steps to creating a Medicare for healthier people. Their goals are to create a Medicare system that will be here for generations to come while also providing open, flexible, and user-centered health information.

Navigating The System

This sounds like a great plan, right? But, how do you keep up with the frequent MIPS changes and alerts while maintaining a successful private practice?

You need a MIPS expert.

You wouldn’t leave your busy practice in the hands of a mechanic, and you shouldn’t leave your billing and incentive payments in the hands of someone who doesn’t understand MACRA and MIPS. You need an internal staff member who is your MIPS champion. This is the person who can partner with your EHR vendor to ensure that the eligible providers in your practice earn the highest incentive available, as well as avoid any negative penalties. In my role of training practices on implementing a streamlined CMS reporting system, I can tell you that practices with a designated MIPS expert are much more successful and efficient in their MIPS reporting process—and these are the practices that are earning the highest possible score.

Invest in the education and training of your internal MIPS expert so you can be confident that your practice is among the highest earners.

3 Reasons You Need a MIPS Expert at Your Practice

1. A MIPS expert will help maximize your payments. MIPS is all about streamlining your practice to become more efficient in how you diagnose and improve patient outcomes. When you do this well and report your data, you increase your chances of earning a positive payment adjustment.  

Participating in MIPS earns you a payment adjustment according to evidence-based and practice-specific quality data. The better the quality of your data, the better your chances of earning a positive payment adjustment.  

Your MIPS expert will understand the details of the MIPS program. They should be familiar with the activities and measures that are most meaningful to your practice. Your MIPS expert can help your eligible clinicians select measures that best apply to the specialty to prove their performance and maximize their payments.

2. A MIPS expert will be your education partner. This staff member should stay educated and informed of the latest regulatory details. Here at Kareo, we notify eligible clinicians and the designated MIPS expert of ongoing education opportunities. These are offered on a set schedule and as needed with new changes to MACRA and MIPS.

3. A MIPS expert will mobilize your practice staff and clinicians. To successfully meet MIPS requirements, the entire practice needs to be engaged. The MIPS expert can partner up with your EHR vendor to ensure that eligible clinicians in your practice understand the MIPS requirements and know how to navigate through the system. In this process, your practice can identify areas where any given workflow should be modified to earn the highest possible score and receive maximum payment for the great care they deliver.

Resources for Your MIPS Expert

As we mentioned above, MIPS experts at independent practices must stay up to date on all MIPS alerts and resources available to you through the Quality Payment Program. They should take time to educate themselves, understand changes, and read all alerts provided by Medicare or by their EHR vendors.

Your MIPS expert should be able to find an education partner using one or both of these paths:   

  1. Your Regional Extension Center: Contact them to ask questions and get connected with a MIPS education partner.
  2. Your Electronic Health Record company: As an example, Kareo has MIPS training specialists who can partner with your MIPS expert to help maximize payments, stay up to date on the latest changes, and provide support. We have training sessions and ideas for implementation of new workflow processes.  

Don’t be intimidated by the complexity of MIPS. Take time to designate a MIPS expert on your staff and get them connected to their education partner today.

About Marina Verdara
Marina is a Sr. Training Specialist guiding Kareo customers to higher levels of success with their CMS Incentive Program reporting, including MIPS and Meaningful Use. Marina has over seven years of experience working directly with several hundred small practice clinicians on a variety of projects specializing on CMS Incentive programs such as Meaningful Use, PQRS, and MACRA. Kareo is a proud sponsor of Healthcare Scene.

Why I Didn’t Choose Your Healthcare Organization

Posted on April 12, 2018 I Written By

The following is a guest blog post by Chelsea Kimbrough from Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms

Chelsea Kimbrough

I recently had a bad healthcare experience. I received functional care, but I wasn’t cared for. As in, I’m fairly certain my doctor didn’t know my name when she walked into the room or when she left it. To her, I was another patient in a crowded schedule. To me, it was a rushed, impersonal experience that left me with absolutely no desire to trust my wellbeing in her hands.

As someone who is familiar with the healthcare space, I’m the first to admit that finding a new provider is hard work – and finding one that meets each of your communication expectations is even harder. But after that appointment, I was more than up for the challenge.

It’s important to note that I’m a proud millennial who is accustomed to the service and support provided in other industries. When I wanted to make a dinner reservation last night, I did it via a mobile app. When I needed a great blazer to wear to a conference, I requested one in my clothes subscription box. I am an all-access-at-all-hours type of person. So when it came time to schedule an appointment, I turned to the place where I, the consumer, felt I had the most power: the internet.

But first, I needed to find a new doctor. I leveraged a process that went something like this:

  1. I opened multiple review-focused sites.
  2. I searched for what I needed (i.e. ‘family practitioner within 10 miles of my zip code’).
  3. I filtered results to ensure my search only displayed doctors with the rating and characteristics I prefer.
  4. I began the tedious process of cross referencing their profiles on different sites.
  5. When I thought I found a keeper, I scoured their organization’s website for more information.
  6. And then, I dug into any information I could find online to learn more about the doctor.

This process eliminated doctors who had poor reviews, who lacked information available online, and who had questionable posts on social media. (Seriously, everything is available online these days – and digitally-savvy patients like me will find it.)

In the end, I narrowed my search to a handful of local, highly-rated doctors and organizations. But what I was searching for wasn’t just someone with a great online rating and an office close to my front door, I was looking for someone who:

  • Communicates information quickly via text message
  • Calls patients to communicate more important messages
  • Offers online scheduling that doesn’t require a formal login
  • Keeps average wait times down
  • Creates genuine connections with their patients

In short, I wanted to find an organization that provides exceptional in-person care, prompt telephone support, and convenient technology-based tools. Anyone who seemed lacking was unceremoniously crossed off my ‘potential new doctor’ list.  And I’m not the only one who goes to these lengths: in today’s digitally-empowered world, there are more healthcare consumers than ever flexing their online search superpowers before entrusting their care to any healthcare professional.

Unfortunately, the process isn’t perfect. Bad experiences happen, and when they do, patients like me may choose to look elsewhere for care. On the other hand, when we find a healthcare organization that does provide all of the above, we receive a more seamless, enjoyable experience. And when met with a better experience, we are less likely to choose a different provider, facility, or organization to provide future care.

Want to learn more about consumer-minded patients’ healthcare journeys? Check out our patient journey infographic here!

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality telephone answering, appointment scheduling, and automated communication services. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services. Connect with Stericycle Communication Solutions on social media: @StericycleComms

Should Apps with Personal Health Information Be Subject to HIPAA?

Posted on April 10, 2018 I Written By

The following is a guest blog post by Erin Gilmer (@GilmerHealthLaw).

With news of Grindr’s sharing of user’s HIV status and location data, many wonder how such sensitive information could be so easily disclosed and the answer is quite simply a lack of strong privacy and security standards for apps.  The question then becomes whether apps that store personal health information should be subject to HIPAA? Should apps like Grindr have to comply with the Privacy and Security Rules as doctors, insurance companies, and other covered entities already do?

A lot of people already think this information is protected by HIPAA as they do not realize that HIPAA only applies to “covered entities” (health care providers, health plans, and health care clearininghouses) and “business associates” (companies that contract with covered entities).  Grindr is neither of these. Nor are most apps that address health issues – everything from apps with mental health tools to diet and exercise trackers. These apps can store all manner of information ranging simply from a name and birthdate to sensitive information including diagnoses and treatments.

Grindr is particularly striking because under HIPAA, there are extra protections for information including AIDS/HIV status, mental health diagnoses, genetics, and substance abuse history.  Normally, this information is highly protected and rightly so given the potential for discrimination. The privacy laws surrounding this information were hard fought by patients and advocates who often experienced discrimination themselves.

However, there is another reason this is particularly important in Grindr’s case and that’s the issue of public health.  Just a few days before it was revealed that the HIV status of users had been exposed, Grindr announced that it would push notifications through the app to remind users to get tested.  This was lauded as a positive move and added to the culture created on this app of openness. Already users disclose their HIV status, which is a benefit for public health and reducing the spread of the disease. However, if users think that this information will be shared without explicit consent, they may be less likely to disclose their status. Thus, not having privacy and security standards for apps with sensitive personal health information, means these companies can easily share this information and break the users’ trust, at the expense of public health.

Trust is one of the same reasons HIPAA itself exists.  When implemented correctly, the Privacy and Security Rules lend themselves to creating an environment of safety where individuals can disclose information that they may not want others to know.  This then allows for discussion of mental health issues, sexually transmitted diseases, substance use issues, and other difficult topics. The consequences of which both impact the treatment plan for the individual and greater population health.

It would be sensible to apply a framework like HIPAA to apps to ensure the privacy and security of user data, but certainly some would challenge the idea.  Some may make the excuse that is often already used in healthcare, that HIPAA stifles innovation undue burden on their industry and technology in general.  While untrue, this rhetoric holds sway with government entities who may oversee these companies.

To that end, there is a question of who would regulate such a framework? Would it fall to the Office for Civil Rights (OCR) where HIPAA regulation is already overseen? The OCR itself is overburdened, taking months to assess even the smallest of HIPAA complaints.  Would the FDA regulate compliance as they look to regulate more mobile apps that are tied to medical devices?  Would the FCC have a roll?  The question of who would regulate apps would be a fight in itself.

And finally, would this really increase privacy and security? HIPAA has been in effect for over two decades and yet still many covered entities fail to implement proper privacy and security protocols.  This does not necessarily mean there shouldn’t be attempts to address these serious issues, but some might question whether the HIPAA framework would be the best model.  Perhaps a new model, with new standards and consequences for noncompliance should be considered.

Regardless, it is time to start really addressing privacy and security of personal health information in apps. Last year, both Aetna and CVS Caremark violated patient privacy sending mail to patients where their HIV status could be seen through the envelope window. At present it seems these cases are under review with the OCR. But the OCR has been tough on these disclosures. In fact, in May 2017, St. Luke’s Roosevelt Hospital Center Inc. paid the OCR $387,200 in a settlement for a breach of privacy information including the HIV status of a patient. So the question is, if as a society, we recognize the serious nature of such disclosures, should we not look to prevent them in all settings – whether the information comes from a healthcare entity or an app?

With intense scrutiny of privacy and security in the media for all aspects of technology, increased regulation may be around the corner and the framework HIPAA creates may be worth applying to apps that contain personal health information.

About Erin Gilmer
Erin Gilmer is a health law and policy attorney and patient advocate. She writes about a range of issues on different forums including technology, disability, social justice, law, and social determinants of health. She can be found on twitter @GilmerHealthLaw or on her blog at www.healthasahumanright.wordpress.com.

#HIMSS18: Oh The Humanity

Posted on April 2, 2018 I Written By

The following is a guest blog post by Sean Erreger, LCSW or @StuckonSW as some of you may know him.

It was a privilege to attend the 2018 HIMSS global conference this year. Having blogged and tweeted about Health IT for a couple of years, it was great to finally live it. By taking a deep dive, attending presentations, demoing products, and networking; I came to a greater understanding of how Health IT tackles the problems I hope to solve. From a social work perspective, I continue to be fascinated with the idea that technology can facilitate change.  Getting lost in artificial intelligence, machine learning, natural language processing, and predictive analytics was easy. It was exciting to learn the landscape of solutions, amount of automation, and workflow management possible. As a care manager, I believe these tools can be incredibly impactful.

However, despite all the technology and solutions, came the reminder that Health IT is a human process. There were two presentations that argued that we can’t divorce the humanity from health information technology process.  First was on the value of behavioral science and secondly a presentation on provider burnout and physician suicide.

The Value Of Behavioral Science

This was a panel presentation and discussion moderated by Dr. Amy Bucher of Mad*Pow including Dr. Heather Cole-Lewis of Johnson and Johnson, Dr. David Ahern of the FCC, and Dr. John Torous of Harvard Medical school. All experts were a part of projects related to Personal Connected Health Alliance. They asked attendees to consider the following challenges and how behavior science play a role…

Questions like how do we measure outcome and defining what “engagement” look like are key to how we build Health IT.  Yes, things like apps and wearables are cool but how do we measure their success. This can often be a challenge. It often feels like health IT is trying to outdo each other about who is coming up with the coolest piece of technology. However, when we get down to the nuts and bolts and start to measure engagement in technology, we might not like the results…

This presentation reminded me that technology is not often enough. Valuing the importance of “meeting people where they are”, may not include technology at all. We have to challenge ourselves to look ethically at the evidence and ensure that digital health is something a patient may or may not want.

Technology as a Solution to Physician Burnout and Suicide

It was reassuring to know even before I got to HIMSS that suicide prevention was going to be part of the conversation. Janae Sharpe and Melissa McCool presented on physician suicide and tools to potentially prevent it. This presents another human aspect of Health IT, the clinicians that use them. The facts about physician suicide are hard to ignore…

As someone who has done presentations about burnout and secondary trauma, I am acutely aware of how stressful clinical care can be.  It is unclear whether technology is a cause but it is certainly a factor, even in physician suicide. The research on this complex, but to blame the paperwork demands for burnout and physician suicide is tricky. To attribute a cause to things is always a challenge but my take away is that the Health IT community might be part of the problem but the presenters made a compelling case that it should be part of the solution. That not only reducing clicks and improving workflow is needed but providing support is critical.

They talked about the need to measure “burnout” and see how the Health IT community can design technology to support those at risk.  They have created a scale called the Sharp Index to try to measure physician burnout and also build technology to provide support. This seems to be striving for that right mix between measurement in the hopes of making space for human processes in a complex technology space.

Cooking The Mix Between Tech and Human Care

These presentations leave Health IT with many questions. Apps to provide a means of clinical care exist but are they working? How can we tell we are getting digital health right? How can we tell if technology is making a difference in patients’ lives? How do we define “success” of an app? Is technology having a negative impact on clinical care and clinicians themselves? If so, how do we measure that?

These questions force us to take an intentional look at how we measure outcomes but more importantly how we define them. Both presentations stressed the multi-disciplinary nature of health information technology development.  That no matter what the technology, you need to ask what problem does it solve and for who? As we consider building out AI and other automation we need to keep the humanity in healthcare.  So we can better care for ourselves as providers and ask what patients need in a human centered manner.

For a deeper dive into each presentation, I have created twitter recaps of both the Behavioral Science Panel and the presentation on Physician Suicide.

About Sean Erreger
Sean is Licensed Clinical Social Worker in New York. He is interested in technology and how it is facilitating change in a variety of areas. Within Health IT is interested in how it can include mental health, substance abuse, and information about social determinants. He can be found at his blog www.stuckonsocialwork.com.