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!!

Why Clinicians Need a 2015 Certified EHR

Posted on January 11, 2018 I Written By

The following is a guest blog post by Lisa Eramo, a regular contributor to Kareo’s Go Practice Blog.

What does “2015 Certified EHR” mean to practicing clinicians? The once-flooded EHR market is now whittling down to those vendors equipped to respond to regulatory and industry changes. The Office of the National Coordinator (ONC) for Health Information Technology listed more than 4,000 EHRs with 2014 certification criteria, according to the most recent data from healthIT.gov. And to date, only about 200 EHRs have passed the rigorous 2015 certification criteria.

However, beyond the fact that 2015 is indeed the most recent certification criteria as issued by the HHS, why should medical practices care?  

When vendors certify their EHRs, physicians—and patients—are ultimately the beneficiaries, says Beth Onofri, EHR and industry advisor at Kareo, who led the 2015 Certification process for the Kareo Clinical EHR. Physicians benefit because the technology allows them to easily attest that they’ve met quality requirements specified in the Medicare Access and CHIP Reauthorization Act (MACRA). This includes Advancing Care Information (ACI)-related measures that help physicians boost their payments. ACI accounts for 25 percent of a physician’s performance score that dictates reimbursement under the Merit-based Incentive Payment System (MIPS). Patients benefit because they’re able to access and exchange their own health information more easily than ever before. It’s a win-win all around, says Onofri.

“The 2015 criteria require functionality supporting unprecedented patient engagement, care coordination, and information exchange, all of which bodes well for physicians striving to improve outcomes.”
—Beth Onofri, EHR and Industry Advisor at Kareo

Although using a certified EHR is important, implementing one that’s certified using only the 2015 criteria (not the 2014 criteria or a combination of the two) is a critical piece of the puzzle under MACRA, says Onofri. EHRs certified with the 2015 criteria help pave the way for physicians to receive a bonus in 2018. In addition, the 2015 criteria require functionality that supports unprecedented patient engagement, care coordination, and information exchange, all of which bodes well for physicians striving to improve outcomes.

Still, many physicians aren’t aware of how the 2015 certification criteria can help their practices, says Onofri.

Of the 60 different 2015 certification criteria, Onofri says these five are particularly helpful for practices seeking to improve the quality of the care they provide, ultimately fostering accurate payments under value-based payment reform:

1. View, download, and transmit health information to a third party

The 2015 criteria require a secure method of access (usually through a patient portal) as well as the ability to send information to an unsecured email address of the patient’s choice, says Onofri. The idea is that offering various access options improves overall patient engagement and outcomes.

She suggests creating a brochure that explains to patients how they can access and use the portal, including how to view, download, and transmit their health information. Another idea is to recruit a volunteer who can show patients how to use the portal while they wait in the waiting area. “There needs to be a strong advocate in each practice to make sure that these functionalities are implemented and used,” she adds. “Those practices with an advocate are the ones that will succeed.”

2. Secure messaging

This functionality allows physicians to send messages to—and receive messages from—patients in a secure manner, helping to improve engagement and communication. Practices must define how they’ll use secure messaging, including who will respond and what types of questions they’ll permit (e.g., fulfill appointment requests vs. answering clinical inquiries). “There are a small percentage of doctors who will want to answer their own messages, but there is a larger percentage of doctors who will want their staff to answer the emails and, if necessary, escalate to the provider,” says Onofri.

3. Patient health information capture

This functionality allows physicians to accept patient-generated health data into the EHR. For example, Onofri notes that the Kareo Clinical 2015 Edition EHR allows patients to record their health information at home to easily upload the information to their portal and transmit it securely to the physician for shared decision-making. The idea is that access to more comprehensive health data can help physicians prevent and manage disease—and it could be a game-changer in terms of population health management.

Start small when rolling out this functionality, she says. For instance, encourage patients with high blood pressure to upload their blood readings daily before engaging a second population (e.g., those with diabetes who upload their glucose levels).

4. Transitions of care

This functionality calls for interoperable documents that include key health data (e.g., name, date of birth, and medications) as well as standardized format for exchange. A transition of care summary provides critical information as patients transfer between different physicians at different health organizations or even distinct levels of care within the same organization.

“It’s not uncommon for our providers to send the referral right as they are completing the note with the patient in the room,” says Onofri. “This obviously speeds the care coordination for patients in terms of seeing another doctor.” The only caveat is that practices must compile a list of direct email addresses for physicians to whom patients are frequently referred, she adds.

5. Application programming interfaces (APIs)

“This is one of those requirements that is the foundation of things to come,” says Onofri. “It’s the first step toward interoperability.” API functionality will eventually allow patients to aggregate data from multiple sources in a web or mobile application of their choice.

Physicians who take the time to explore each of these 2015 certification functionalities may be more likely to improve outcomes and reap financial rewards under MACRA, says Onofri. “The improved functionality is there—is your practice taking advantage of it?”

About Lisa Eramo
Lisa Eramo is a regular contributor to Kareo’s Go Practice Blog, as well as other healthcare publications, websites and blogs, including the AHIMA Journal. Her focus areas are medical coding, clinical documentation improvement and healthcare quality/efficiency.  Kareo is a proud sponsor of Healthcare Scene.

Key Articles in Health IT from 2017 (Part 2 of 2)

Posted on January 4, 2018 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The first part of this article set a general context for health IT in 2017 and started through the year with a review of interesting articles and studies. We’ll finish the review here.

A thoughtful article suggests a positive approach toward health care quality. The author stresses the value of organic change, although using data for accountability has value too.

An article extolling digital payments actually said more about the out-of-control complexity of the US reimbursement system. It may or not be coincidental that her article appeared one day after the CommonWell Health Alliance announced an API whose main purpose seems to be to facilitate payment and other data exchanges related to law and regulation.

A survey by KLAS asked health care providers what they want in connected apps. Most apps currently just display data from a health record.

A controlled study revived the concept of Health Information Exchanges as stand-alone institutions, examining the effects of emergency departments using one HIE in New York State.

In contrast to many leaders in the new Administration, Dr. Donald Rucker received positive comments upon acceding to the position of National Coordinator. More alarm was raised about the appointment of Scott Gottlieb as head of the FDA, but a later assessment gave him high marks for his first few months.

Before Dr. Gottlieb got there, the FDA was already loosening up. The 21st Century Cures Act instructed it to keep its hands off many health-related digital technologies. After kneecapping consumer access to genetic testing and then allowing it back into the ring in 2015, the FDA advanced consumer genetics another step this year with approval for 23andMe tests about risks for seven diseases. A close look at another DNA site’s privacy policy, meanwhile, warns that their use of data exploits loopholes in the laws and could end up hurting consumers. Another critique of the Genetic Information Nondiscrimination Act has been written by Dr. Deborah Peel of Patient Privacy Rights.

Little noticed was a bill authorizing the FDA to be more flexible in its regulation of digital apps. Shortly after, the FDA announced its principles for approving digital apps, stressing good software development practices over clinical trials.

No improvement has been seen in the regard clinicians have for electronic records. Subjective reports condemned the notorious number of clicks required. A study showed they spend as much time on computer work as they do seeing patients. Another study found the ratio to be even worse. Shoving the job onto scribes may introduce inaccuracies.

The time spent might actually pay off if the resulting data could generate new treatments, increase personalized care, and lower costs. But the analytics that are critical to these advances have stumbled in health care institutions, in large part because of the perennial barrier of interoperability. But analytics are showing scattered successes, being used to:

Deloitte published a guide to implementing health care analytics. And finally, a clarion signal that analytics in health care has arrived: WIRED covers it.

A government cybersecurity report warns that health technology will likely soon contribute to the stream of breaches in health care.

Dr. Joseph Kvedar identified fruitful areas for applying digital technology to clinical research.

The Government Accountability Office, terror of many US bureaucracies, cam out with a report criticizing the sloppiness of quality measures at the VA.

A report by leaders of the SMART platform listed barriers to interoperability and the use of analytics to change health care.

To improve the lower outcomes seen by marginalized communities, the NIH is recruiting people from those populations to trust the government with their health data. A policy analyst calls on digital health companies to diversify their staff as well. Google’s parent company, Alphabet, is also getting into the act.

Specific technologies

Digital apps are part of most modern health efforts, of course. A few articles focused on the apps themselves. One study found that digital apps can improve depression. Another found that an app can improve ADHD.

Lots of intriguing devices are being developed:

Remote monitoring and telehealth have also been in the news.

Natural language processing and voice interfaces are becoming a critical part of spreading health care:

Facial recognition is another potentially useful technology. It can replace passwords or devices to enable quick access to medical records.

Virtual reality and augmented reality seem to have some limited applications to health care. They are useful foremost in education, but also for pain management, physical therapy, and relaxation.

A number of articles hold out the tantalizing promise that interoperability headaches can be cured through blockchain, the newest hot application of cryptography. But one analysis warned that blockchain will be difficult and expensive to adopt.

3D printing can be used to produce models for training purposes as well as surgical tools and implants customized to the patient.

A number of other interesting companies in digital health can be found in a Fortune article.

We’ll end the year with a news item similar to one that began the article: serious good news about the ability of Accountable Care Organizations (ACOs) to save money. I would also like to mention three major articles of my own:

I hope this review of the year’s articles and studies in health IT has helped you recall key advances or challenges, and perhaps flagged some valuable topics for you to follow. 2018 will continue to be a year of adjustment to new reimbursement realities touched off by the tax bill, so health IT may once again languish somewhat.

Key Articles in Health IT from 2017 (Part 1 of 2)

Posted on January 2, 2018 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

This article provides a retrospective of 2017 in Health It–but a retrospective from an unusual perspective. I will highlight interesting articles I’ve read from the year as pointers to trends we should follow up on in the upcoming years.

Indubitably, 2017 is a unique year due to political events that threw the field of health care into wild uncertainty and speculation, exemplified most recently by the attempts to censor the use of precise and accurate language at the Centers for Disease Control (an act of political interference that could not be disguised even by those who tried to explain it away). Threats to replace the Affordable Care Act (another banned phrase) drove many institutions, which had formerly focused on improving communications or implementing risk sharing health care costs, to fall back into a lower level of Maslow’s hierarchy of needs, obsessing over whether insurance payments would cease and patients would stop coming. News about health IT was also drowned out by more general health topics such as drug pricing, the opiate crisis, and revenue pressures that close hospitals.

Key issues

But let’s start our retrospective on an upbeat note. A brief study summary from January 4 reported lower costs for some surgeries when hospitals participated in a modest bundled payment program sponsored by CMS. This suggests that fee-for-value could be required more widely by payers, even in the absence of sophisticated analytics and care coordination. Because only a small percentage of clinicians choose bold risk-sharing reimbursement models, this news is important.

Next, a note on security. Maybe we should reprioritize clinicians’ defenses against the electronic record breaches we’ve been hearing so much about. An analysis found that the most common reason for an unauthorized release of data was an attack by an insiders (43 percent). This contrasts with 26.8 percent from outside intruders. (The article doesn’t say how many records were compromised by each breach, though–if they had, the importance of outside intruders might have skyrocketed.) In any case, watch your audit logs and don’t trust your employees.

In a bracing and rare moment of candor, President Obama and Vice President Biden (remember them?) sharply criticized current EHRs for lack of interoperability. Other articles during the year showed that the political leaders were on target, as interoperability–an odd health care term for what other industries call “data exchange”–continues to be just as elusive as ever. Only 30% of hospitals were able to exchange data (although the situation has probably improved since the 2015 data used in the study). Advances in interoperability were called “theoretical” and the problem was placed into larger issues of poor communication. The Harvard Business Review weighed in too, chiding doctors for spending so much money on systems that don’t communicate.

The controversy sharpened as fraud charges were brought against a major EHR vendor for gaming the certification for Meaningful Use. A couple months later, strangely, the ONC weakened its certification process and announced it would rely more on the vendors to police themselves.

A long article provided some historical background on the reasons for incompatibility among EHRS.

Patients, as always, are left out of the loop: an ONC report finds improvements but many remaining barriers to attempts by patients to obtain the medical records that are theirs by law. And should the manufacturers of medical devices share the data they collect with patients? One would think it an elementary right of patients, but guidance released this year by the FDA was remarkably timid, pointing out the benefits of sharing but leaving it as merely a recommendation and offering big loopholes.

The continued failure to exchange data–which frustrates all attempts to improve treatments and cut costs–has led to the question: do EHR vendors and clinicians deliberately introduce technical measures for “information blocking”? Many leading health IT experts say no. But a study found that explicit information blocking measures are real.

Failures in interoperability and patient engagement were cited in another paper.

And we can’t leave interoperability without acknowledging the hope provided by FHIR. A paper on the use of FHIR with the older Direct-based interoperability protocols was released.

We’ll make our way through the rest of year and look at some specific technologies in the next part of the article.

Public Health Agencies Struggle To Integrate With HIEs

Posted on September 21, 2017 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.

New research by ONC suggests that while public health agencies might benefit from connecting with HIEs, there are still some significant barriers many need to address before doing so.

Public health agencies at both the state and local level collect information from providers as part of conducting disease surveillance activities and maintaining data registries. Though some of these registries are common – notably those focusing on childhood immunizations, birth defects and cancer—the agencies’ technical infrastructure and data formats still vary. This makes sharing data between them difficult.

One alternative to cumbersome data matching between agencies is for the agencies to integrate with an HIE. According to the ONC report, public health researchers have begun to find that at least some of the time, the data they get from HIE organizations is richer than data from clinical systems. Not only that, when public health agencies integrate their information systems with HIEs, it can help them conduct many of their functions more effectively. However, it’s still unusual to find HIE-connected agencies as of yet.

In its new report, ONC outlines what it learned about what the agencies hoped to accomplish with HIE integration and how they moved ahead with integration. To find this out, ONC contracted with Clinovations Government + Health, which participated in discussions with eight entities and analyzing more detailed information on 10 others.

Virtually all respondents had two goals for HIE integration: 1) Minimizing the number of connections needed to link providers, HIEs and agencies and 2) Helping providers meet public health requirements for Medicare and Medicaid EHR incentive programs. A small subset also said that over the longer term, they wanted to create a sustainable platform for clinical and public health exchange which could support enhanced analytics and quality measurement.

Not surprisingly, though, they face considerable challenges in making HIE integration actually happen. In most cases, technology issues were possibly the toughest nut to crack, and almost certainly the most complex. To connect with an HIE, agencies may confront incompatible transport and messaging protocols, standards problems, data classification and coding issues, inconsistent data quality, and their often-inflexible legacy systems, to name just a few of the many problems ONC cites.

As if that weren’t enough, the agencies may not have the funding in place to take on the integration effort, and/or lack a stable funding stream; don’t have the kind of cross-functional leaders in place needed to integrate their systems with HIEs; grapple with complicated patient data privacy and security issues; and bump up against state laws limiting data sharing methods.

However, through its research, the ONC did gather some useful feedback on how the agencies were coping with the long list of HIE integration challenges they face. For example, to win over the support of policymakers, some agencies have emphasized that they’ll be able to use HIE data for higher-level analytics and quality measures. The respondents also noted that HIE integration got more internal support when they got buy-in from top leaders and second-tier leaders have project management, technical and policy skills.

Given these odds, it’s little wonder that the number of public health agencies successfully integrating with HIEs is still small. That being said, there’s good reason for them to keep pushing for integration, so their number is likely to grow over the next few years.

eClinicalWorks Settlement Hasn’t Led To Customer Defections, Yet

Posted on August 7, 2017 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.

Loyalty is a funny thing. You’d think that when a vendor let you down spectacularly, you wouldn’t do business with them anymore. But the truth is, when it comes to health IT it’s not that simple. In many cases, vendor-customer relationships are more like marriages than formal agreements. Even if things start to go south, customers have so much invested in their vendor relationship that backing out may not seem like a realistic possibility.

Yes, I’m pontificating here, but not without a point. What I’m responding to here is a recent KLAS survey which found that while many customers of the now-tarnished eClinicalWorks have lost confidence in the company, many are still on board for now.

As many readers will know, in May eCW settled a whistleblower suit against the company for $155 million. The suit, which was brought by the US Department of Justice, asserted that the vendor got certified for incentive payments by putting deceptive kludges in place.

After agreeing to pay a massive penalty to the feds and putting a “Coprrporate Integrity Agreement” in place, it’s little wonder that some customers don’t trust eCW anymore. But the reality of the situation is that they’re not exactly free to jump ship either.

The study, which was reported on in HIT Consultant, found that 66% of customers polled by KLAS said their perception of eCW had moderately or significantly worsened after the settlement. Meanwhile, 34% of current eCW customers plan to look elsewhere when they make their next health IT investment.

Another third of respondents said they felt stuck in their current eCW contract, though they would consider switching vendors when the contract expires or they have more resources to invest. Still, only 4% of KLAS respondents said they were leaving specifically because of the settlement.

Meanwhile, there’s apparently a subset of eCW customers who aren’t that worried about the settlement or its implications. One-third of respondents said that it had little impact on them, and some noted that eCW is probably just the first of many vendors whose meaningful use certification will be called into question.

The reality is that while eCW customers were a bit shaken by the settlement, it didn’t exactly come as a shock that the vendor was playing it close to the edge, with one-fifth noting that the settlement was “unsurprising.”

I would tend to side with the eCW customers who predict that this settlement is the tip of the iceberg, and that it’s likely to come out that other health IT vendors were gaming the certification process. The question is whether these settlements will merely inconvenience providers or lead to serious problems of their own. If the feds ever decide that providers should have known about faked certifications, the game will get a lot more complicated.

Inspector General Says CMS Made $729 Million In Questionable EHR Incentive Payments

Posted on June 16, 2017 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.

A new report from the HHS Office of Inspector General has concluded that over a three-year period, CMS made roughly $729.4 million in EHR incentive payments to providers who didn’t comply with program requirements.

To determine whether the incentive program was functioning appropriately, the OIG audited payments made between May 2011 to June 2014.

After sampling payment records for 100 eligible professionals, the agency found 14 EPs, who received payments totaling $291,022, who didn’t meet incentive criteria.  The auditors found that the 14 had either failed to meet bonus criteria or didn’t provide proof that they had.

Then, the OIG used the data to extrapolate how much CMS had spent on invalid payments, which is how it arrived at the $729 million estimate. In other words, given the margin of error across the sampled incentive payments, the OIG assumed that 12% of all incentive payments were in error. (The analysis also concluded that CMS mistakenly paid $2.3 million to EPs switching between Medicare and Medicaid programs.)

Not surprisingly, the OIG has recommended that CMS recover the $291,000 in payments made to the sampled providers. It also suggested that the agency review EP payments issued during the audit period to see what other errors were made. Of course, the ultimate goal is to get back the approximately $729.4 million the agency may have paid out in error.

In addition, the OIG  called on CMS to review a random sample of self-attested documentation from after the audit period, to determine whether additional inappropriate payments were made to EPs.

And to make sure the EPs don’t get payments under both Medicare and Medicaid incentive programs for the same program year, the report urged CMS to conduct edits of the National Level Depository system.

As part of this report, the OIG noted that allowing providers to self-report compliance data leaves the incentive payment program open to fraud, and recommended keeping a closer eye on these reports. CMS seems to have had at least some sympathy for this argument, as it apparently agreed partly or fully with all of the OIG’s suggested actions.

One side effect of the OIG report it brings back attention to the Meaningful Use program, which has been eclipsed by MACRA but still clings to life. Eligible providers can still report either Modified Stage 2 or Stage 3 in 2017, the main difference being you need a full year of data for Stage 2 but only 90 days for Stage 3.

But MACRA does change things, as its performance standards will test providers in new ways. This year, providers have a chance to get situated with either the MIPS or APM track, and those who jump in now are likely to benefit.

Meanwhile, the future of Meaningful Use remains fuzzy. To my knowledge, the agency has no immediate plans to restructure the current incentive program to audit provider reports in depth. In fact, given that providers are more concerned about MACRA these days, I doubt CMS will bother.

That being said, it’s fair to assume that incentive payouts will get a bit more attention going forward. So be prepared to defend your attestation if need be.

eCW (eClinicalWorks) Settles Whistleblower Lawsuit for $155 Million

Posted on May 31, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In many of my press panels and other discussions at the Healthcare IT Marketing and PR Conference, I’ve argued that there’s very little “Breaking News” when it comes to healthcare IT. Today is an example where this is not true. The news just broke that EHR vendor, eCW (eClinicalWorks), has settled a whistleblower lawsuit against them for $155 million.

The suit was filed by Brendan Delaney, a software technician formerly employed by the New York City Division of Health Care Access and Improvement, by his law firm Phillips & Cohen LLP against eClinicalWorks. eClinicalWworks and three of its founders (Chief Executive Officer Girish Navani, Chief Medical Officer Rajesh Dharampuriya, M.D., and Chief Operating Officer Mahesh Navani) are jointly liable for the payment of $154.92 million. Separately, Developer Jagan Vaithilingam will pay $50,000, and Project Managers Bryan Sequeira, and Robert Lynes will each pay $15,000. As a whistleblower, Delaney stands to receive $30 million of the settlement.

Here’s the summary of the complaints against eCW from the Justice Department’s press release about the settlement:

In its complaint-in-intervention, the government contends that ECW falsely obtained that certification for its EHR software when it concealed from its certifying entity that its software did not comply with the requirements for certification. For example, in order to pass certification testing without meeting the certification criteria for standardized drug codes, the company modified its software by “hardcoding” only the drug codes required for testing. In other words, rather than programming the capability to retrieve any drug code from a complete database, ECW simply typed the 16 codes necessary for certification testing directly into its software. ECW’s software also did not accurately record user actions in an audit log and in certain situations did not reliably record diagnostic imaging orders or perform drug interaction checks. In addition, ECW’s software failed to satisfy data portability requirements intended to permit healthcare providers to transfer patient data from ECW’s software to the software of other vendors. As a result of these and other deficiencies in its software, ECW caused the submission of false claims for federal incentive payments based on the use of ECW’s software.

Most people are writing about how eCW didn’t fully integrate the RxNorm codes, but instead hard coded the 16 codes that the certification process used. That’s embarrassing so it’s not a surprise that so many people are sharing that part of the story. However, I think the bigger part of the violation is probably around the data portability requirements. I bet a lot of EHR vendors are sweating right now as they look at the way they implemented those requirements. Not to mention the EHR audit logs which are poor in many EHR. Plus, the scariest claim is eClinicalWork’s inability to reliably record diagnostic imagine orders or perform drug interaction checks. Those are patient safety issues and exist in many EHR software.

If you want to dig into the weeds like I did, then you can see the government complaint against eClinicalWorks that was filed May 12, 2017 and the final settlement agreement with eClinicalWorks. Even more insightful was looking at the original complaint from Delaney against eClinicalWorks. Comparing the original whistleblower complaint to the government complaint against eClinicalWorks is very interesting. You’ll see that the government didn’t grab on to everything that was originally filed by Delaney. I imagine that’s a standard legal practice to file as many areas as possible and see what the government decides to use. It seems like Phillips & Cohen have represented a number of whistleblowers so I’m sure they were expert at this.

Girish Navani, CEO and Co-Founder or eClinicalWorks, offered this statement about the settlement:

“Today’s settlement recognizes that we have addressed the issues raised, and have taken significant measures to promote compliance and transparency. We are pleased to put this matter behind us and concentrate all of our efforts on our customers and continued innovations to enhance patient care delivery.”

Looking at the bigger picture, I’m certain that every EHR vendor is going through their EHR certification process and looking at all the statements they’ve made to make sure they’re not going to be in a similar situation. Not to mention the anti-kick back laws that were mentioned in the settlement. I’m sure there are other EHR vendors that are in violation of both of these items just as much as eCW.

Former ONC National Coordinator, Farrzad Mostashari seems to agree with me. Farzad tweeted, “Wow!! I hope this changes the attitude of the EHR vendor space more broadly.” Then, he later tweeted, “Let me be plain-spoken. eClinicalWorks is not the only EHR vendor who flouted certification /misled customers
Other vendors better clean up.”

Farzad then nailed it when he tweeted “There are a LOT of doctor’s office staff looking at their EHR today and wondering if there’s $30M worth of false promises hidden there”

I do wonder if Farzad Mostashari feels a little guilty of the role he played in this process since he oversaw such a porous EHR certification process. I’ve been against EHR certification for a long time because I thought it provided so little value to providers. The fact that it can be gamed by 16 codes being hard coded is a perfect example of why EHR Certification is a waste. Although, one could argue that without EHR certification, this suit would have never happened and maybe eClinicalWorks could still be selling the same product today.

I do find this quote from the US Attorney’s Office for the District of Vermont press release a little over the top (which I think is common on these things):

“Electronic health records have the potential to improve the care provided to Medicare and Medicaid beneficiaries, but only if the information is accurate and accessible,” said Special Agent in Charge Phillip Coyne of HHS-OIG. “Those who engage in fraud that undermines the goals of EHR or puts patients at risk can expect a thorough investigation and strong remedial measures such as those in the novel and innovative Corporate Integrity Agreement in this case.”

Another topic I haven’t seen anyone else cover is the impact that this settlement will have on eCW’s customers that used eCW to attest to meaningful use. Technically it shows that eCW wasn’t appropriately certified, so that means that they weren’t using a certified EHR and therefore shouldn’t have been eligible for meaningful use incentives. I asked one friend about this and he suggested that CMS had previously said that it would not hold eligible providers and eligible hospitals responsible for EHRs that calculated the meaningful use measures the wrong way. So, we’ll probably see this same approach with eCW users that got EHR incentive money on what we now know was not appropriately certified.

I was also intrigued by the Corporate Integrity Agreement (CIA) that eClinicalWorks entered into with HHS-OIG. There are a lot of details and oversight that eCW will get from OIG, but it also required eClinicalWorks to “allow customers to obtain updated versions of their software free of charge and to give customers the option to have ECW transfer their data to another EHR software provider without penalties or service charges. [emphasis added]”

Free updates is pretty clear and ironic since not wanting to update all their clients is one possible hypothesis for why they didn’t really push the proper upgrades. Hopefully all eCW users will do it now or they might be facing their own violations for using outdated software that has known clinical issues. However, the kicker in the CIA detail above is that eClinicalWorks has to give customers the option to have eClinicalWorks transfer their data to another EHR without penalty or service charges. I wonder how many will take them up on this requirement and what the details will be. I still wish this was required of all EHR vendors, but that’s a story for another day.

How many EHR vendor marketing groups are putting together their eClinicalWorks Rescue Plan to take in the downtrodden eCW users? I’m not sure these will be as successful as other EHR switching marketing efforts like those we see when an EHR is being shut down.

I’m sorry to say that I think this is likely only the beginning of such lawsuits. In fact, it’s probably already woken up a lot of potential whistle blowers. Hopefully it’s woken up a lot of EHR vendors as well.

DNA Tests and Meaningful Use Humor – Fun Friday

Posted on April 14, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s Friday, so time for a little humor to start your weekend. First up is one that regular readers of this site will appreciate when it comes to the now tainted phrase: meaningful use:

This Dilbert comic seemed particularly relevant given that 23andMe just got FDA authorization for their consumer genetic health risk reports.

Have a great weekend!

The Impact of the 2016 Election on Healthcare IT

Posted on November 9, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today it’s pretty obvious that the Presidential is on everyone’s mind. While I don’t plan to discuss the details of the election and the specific results, it’s worth thinking about what Donald Trump in the white house will mean for healthcare IT.

Let’s start off with the easy one: Meaningful Use/MACRA. One doctor tweeted me that now that Trump is President, MACRA will be gone. I don’t think that’s further from the truth. In fact, I really can’t imagine any scenario where the EHR Incentive program (Meaningful Use, which still applies to hospitals and Medicaid) and the MACRA program would be gone. I think they’re here to stay and won’t be altered at all by this election.

The biggest reason for this belief is that Trump is going to have so many other things on the agenda. Not the least of which is ACA (Obamacare), which we’ll get to later in this post, but also a whole suite of other things that he’ll make a priority. Why would Trump want to take on a relatively bipartisan thing like healthcare IT, EHR and MACRA? I don’t think he’ll waste a second on the subject.

Plus, even if Trump wanted to go after the MACRA and EHR incentive legislation, I can’t imagine the Senate and House passing something to replace those programs either. Remember that Trump can propose all he wants, but the Senate and House have to pass it too and both of those groups seem to be firmly behind both efforts. Add this to the previous point and why would Trump go after health IT when it’s unlikely to pass and isn’t a strategic goal of his? Short Answer: He won’t.

My opinion: we’re unlikely to see any change to MACRA and other healthcare IT initiatives.

The trickier part to assess is the impact a Trump presidency will have on the Affordable Care Act (ACA or Obamacare). I live in Vegas and I wouldn’t even want to offer odds on what’s going to happen there. The rhetoric out there is to “repeal and replace Obamacare.” What’s not clear to me is if this concept is even practical and possible. There are so many issues with the idea of repealing Obamacare, that I can’t imagine it ever happening. I could see parts of it being repealed, but not the whole thing.

I also think it would be seen as very unfavorable for Trump to roll back things like the pre-existing condition exemption that allows those with pre-existing conditions to get insurance. There are probably a dozen other things like this that would likely be hard to take back without some major backlash and so I think they’ll have to preserve many of these things in whatever they do with Obamacare. Maybe that means a full repeal, but then rolling back in some of the popular pieces of the legislation so they can say they repealed it.

All of this said, I think that Trump will evaluate all options to undermine many of the things that were implemented by Obamacare including the insurance mandate and the insurance exchanges. Most people don’t realize that there’s so much more to Obamacare than just the mandate and exchanges. How he’ll undermine Obamacare and the impact it will have is anybody’s guess. I’m not sure anyone really knows and it’s certainly beyond my political punditry.

Long story short on Obamacare, I have no idea. I know that something’s going to happen because of the strict “Rip and Replace” rhetoric. I just think it’s really hard to predict which parts they’ll be able to rip out at this point and what they’ll replace it with going forward.

No doubt this will keep many in healthcare on edge. Unknowns are always a challenge. While I think the Trump Presidency will likely have a big impact on healthcare, I don’t see it having a big impact for good or bad on healthcare IT. I think the path to healthcare IT is happening and he won’t do anything to really stop it.

Side Note: Check out this interesting lessons learned post by Mr. H at Histalk which talks about the challenge of relying on data. As healthcare enters the world of data in a big way, it’s important to make sure we have a good understanding of what the data really tells us and what it doesn’t.

A Look At Nursing Home Readiness For HIE Participation

Posted on October 12, 2016 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.

A newly released study suggests that nursing homes have several steps to go through before they are ready to participate in health information exchanges. The study, which appeared in the AHIMA-backed Perspectives in Health Information Management, was designed to help researchers understand the challenges nursing homes faced in health information sharing, as well as what successes they had achieved to date.

As the study write up notes, the U.S. nursing home population is large — nearly 1.7 million residents spread across 15,600 nursing homes as of 2014. But unlike other settings that care for a high volume of patients, nursing homes haven’t been eligible for EMR incentive programs that might have helped them participate in HIEs.

Not surprisingly, this has left the homes at something of a disadvantage, with very few participating in networked health data sharing. And this is a problem in caring for residents adequately, as their care is complex, involving nurses, physicians, physicians’ offices, pharmacists and diagnostic testing services. So understanding what potential these homes have to connect is a worthwhile topic of study. That’s particularly the case given that little is known about HIE implementation and the value of shared patient records across multiple community-based settings, the study notes.

To conduct the study, researchers conducted interviews with 15 nursing home leaders representing 14 homes in the midwestern United States that participated in the Missouri Quality Improvement Initiative (MOQI) national demonstration project.  Studying MOQI participants helped researchers to achieve their goals, as one of the key technology goals of the CMS-backed project is to develop knowledge of HIE implementations across nursing homes and hospital boundaries and determine the value of such systems to users.

The researchers concluded that incorporating HIE technology into existing work processes would boost use and overall adoption. They also found that participation inside and outside of the facility, and providing employees with appropriate training and retraining, as well as getting others to use the HIE, would have a positive effect on health data sharing projects. Meanwhile, getting the HIE operational and putting policies for technology use were challenges on the table for these institutions.

Ultimately, the study concluded that nursing homes considering HIE adoption should look at three areas of concern before getting started.

  • One area was the home’s readiness to adopt technology. Without the right level of readiness to get started, any HIE project is likely to fail, and nursing home-based data exchanges are no exception. This would be particularly important to a project in a niche like this one, which never enjoyed the outside boost to the emergence of the technology culture which hospitals and doctors enjoyed under Meaningful Use.
  • Another area identified by researchers was the availability of technology resources. While the researchers didn’t specify whether they meant access to technology itself or the internal staff or consultants to execute the project, but both seem like important considerations in light of this study.
  • The final area researchers identified as critical for making a success of HIE adoption in nursing homes was the ability to match new clinical workflows to the work already getting done in the homes. This, of course, is important in any setting where leaders are considering major new technology initiatives.

Too often, discussions of health data sharing leave out major sectors of the healthcare economy like this one. It’s good to take a look at what full participation in health data sharing with nursing homes could mean for healthcare.