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Eyes Wide Shut – Making the Most of Meaningful Use, for Healthcare Providers, Insurers, and Patients

Posted on July 21, 2015 I Written By

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

When I ask a room of 100 health plan leaders, “how many of you know what HL7 is,” and only a third raise their hands, I realize there had been a “Meaningful Use” for my recent travels through the healthcare provider system and its maze of regulatory and payer mandates. I navigated change management hell in order to inform my future endeavors. I came out on the other side of an attestation nightmare with the knowledge to educate others who are embarking on extensions of that journey. This “Eyes Wide Shut” series has come full-circle.

For those who have followed this series, a quick update on the fate of the IDN highlighted throughout earlier posts: they have not yet successfully attested to all Meaningful Use Stage 2 measures across all the inpatient facilities and ambulatory practices. However, the continuing changes to attestation criteria (specifically, the engagement measures that caused so much consternation) may allow them to squeak in under the wire in fiscal year 2016 before penalties kick in. Although I’m no longer directly involved in the IDN’s pursuit of multi-EMR integration excellence, I am a “beneficiary” of those encounter data normalization efforts, as I am back to working with payer clients who are leveraging this clinically-integrated network. And I’m still having to adjust for inconsistencies in identity management rules, coding practices, and clinical workflow differences across each of the offices (and departments within offices), as I integrate their information with the insurer’s data ecosystem.

I began this series on my (woefully neglected) personal blog, almost 2 years ago: Eyes Wide Shut: Seeing the Dark Side of Health IT Mandates and Meaningful Use. Coming from the health insurance world, I had no idea of the magnitude of healthcare provider process impacts resulting from regulatory and payer demands (nee, mandates). I was insensitive to the plight of the independent general practitioner, and the size of the budget required to implement a certified EMR, let alone populate it with any patient history or integrate it with existing scheduling or billing processes. I didn’t realize that my request for chart data to support HEDIS measures would involve more work than simply clicking an indicator in an EMR configuration screen to suddenly send me my heart’s desire of data elements. I would never have believed that certified software would not be tested for conformance to code-level specifications (only visual output tests).

To all my clinician and provider office-worker friends: I am sorry for all the ways in which this ignorance may have contributed to the new reality forced on practitioners of medicine to also be data-entry clerks/contract lawyers/IT experts. Personally, I want my doctor to be my doctor. So, I’m dedicating the next leg of my career journey aligning all healthcare system actors to what should always have been our higher purpose: contributing positively to the health and well-being of the individuals and populations we serve.

When I initially began writing this post, I thought I’d be using it to end the series.

Instead, I’m just embarking on a new chapter: the post-provider world of healthcare actor convergence.

Will Meaningful Use Be Used by Payers?

Posted on May 15, 2014 I Written By

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

I was on a call recently with someone who started to state that it was inevitable that the payers would start requiring doctors be meaningful users of a certified EHR. I wouldn’t say that it’s 100% sure that payers won’t adopt meaningful use, but I think it’s far from a forgone conclusion that they’ll jump on the meaningful use bandwagon as well.

Before I get into some of the various rationale for why they will or won’t, I’d love to see what you think in the poll embedded beloww:

Those who think that payers will start requiring meaningful use if you want the highest reimbursement rate usually point to the fact that the payers have often followed whatever Medicare is doing. This is true and so it is possible that they’ll piggyback the meaningful use train.

Those who say they won’t do it will say that meaningful use doesn’t really align with what the payers want to accomplish. There are elements that interest them, but it goes too far in many areas.

I’d say that most payers will probably not hop on the meaningful use bandwagon. However, I’m sure that they’ll let Medicare take the lumps while they sit back and watch how doctors react to meaningful use. If a large portion of doctors opt out of meaningful use, then I can’t imagine payers hopping on that train and making all of those doctors angry. I see payers just sitting back and watching how MU plays out before making any firm decisions.

In the end, I think payers will adopt something that may include some elements of MU that align with their business interests. I’ll just be very surprised if they just take MU on in its current state.

What do you think?

What Is The Cost Of Fraud Prevention In Healthcare?

Posted on May 1, 2014 I Written By

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

Among other things, credit card companies prevent enormous volumes of fraud. In exchange for their services, credit card companies typically charge about 2.5% of merchant revenue. The cost of fraud prevention for most merchants is no more than 2.5% of revenues.

But healthcare is rarely paid for by credit card. The vast majority of payments are directly transferred from payers to providers.

So what is the cost of fraud prevention in healthcare?

If providers were angels and never frauded payers, then the entire claims system would have no reason to exist. In this utopian world, providers would simply bill payers accurately and payers would gladly pay knowing that the claims were honest.

But that’s unrealistic. Payers are extremely skeptical of providers. There is an enormous amount of friction between payers and providers to ensure that providers aren’t overpaid: the technology vendors at every layer of the stack (provider, clearing house, payer), the billers, coders, claims departments, prior authorization departments, insurance agents, AR departments, etc. All of these people, processes, and technologies exist to ensure that providers aren’t overpaid.

Although I cannot find any explicit numbers, it’s not unreasonable that the sheer administrative costs of the claim system is greater than 10% of all healthcare costs.

In addition to compliance costs, actual Medicare Fraud is estimated at about $50B, which is about 9% of all Medicare payments.

The takeaway of the story is that providers can’t seem to stop frauding Medicare. The irony is that physicians – who are generally respected by the public – are those whom the system works most diligently to ensure aren’t overpaid.

EMR and Health IT Development – Interview with Chetu

Posted on April 25, 2013 I Written By

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

Craig Schmidt - Chetu
Craig Schmidt is the Director of Global Sales for Healthcare & Pharmaceuticals at Chetu. Craig’s focus at Chetu is understanding the top healthcare industry challenges, creating relationships with HIT leaders and developing Information Technology solutions to address those challenges. Craig has, for over 15 years, held a variety of Sales and Sales Management positions with increasing responsibility in the Healthcare and Information Technology Industries.

Tell us more about Chetu and your work in the healthcare market.

It would not be an exaggeration to say that Chetu has experience in nearly every section of Healthcare IT. In our 13 years we have developed solutions for Providers, Payers, HIT Vendors and others. Just a few of the things with which we have helped customers include: complete EMR and Practice Management design and development, ePrescribing, Drug Database integration, Revenue Cycle Management (835/837 & 270/275 engines).

When does someone in healthcare look to Chetu versus doing the work in house?

The two main reasons are: they do not have the particular HIT experience in-house & they do not have enough “bandwidth” to develop in-house and do not want to hire and train permanent staff.

What’s the most challenging thing about developing applications in healthcare?

Healthcare in general and Healthcare IT are bound by many Federal, State and other rules and regulations, e.g., Meaningful Use, Affordable Care Act, HIPAA, etc. There are also a variety of standards for interoperability such as HL7, CCD/CCR.

Do you mostly do one off projects or long term contracts with your clients?

We strive to be the “Back End, Long-term” IT Partner for our clients. We offer complete solutions from application development and support to maintenance and management of applications and systems. In Healthcare we have many (over 60%) clients that have been working with Chetu for multiple years. Many of these have been with Chetu for over 5 years – which is very long-term in this market

What’s your view on SaaS vs. in house client server applications? Do you have a preferred technology stack? What do you see being used most in healthcare?

For the past several years organizations have been rapidly moving to the “Cloud.” And, there are obvious advantages for being cloud based. However, client server applications have advantages of speed and stability that can’t always be achieved with SaaS. We are now seeing a slight movement to applications that are hybrids – combining the best of both approaches.

In healthcare, there is no clear preferred technology stack. It is all over the place. We have worked in .NET, HTML5, Java, PHP, Native Mobile Apps (iOS, Android), Python, C++, Foxpro, VB, Mirth. Cobol, MUMPS and many more. Healthcare IT has traditionally seen a very fragmented approach. Chetu has the great advantage of being agnostic. We can and will work with nearly any platform or tool.

EMR usability (or lack thereof) has been a major topic of discussion. How do you manage this with your EHR clients?

We have had the opportunity to work with dozens of different EMRs; ambulatory and hospital based. Many of these EMRs are the product of individual physicians or physician groups that are unhappy with their current EMR and have not seen any existing EMRs that meet their usability needs. They have come to us with their ideas about developing an EMR from scratch. We have developed ENT, Ophthalmology, Plastic Surgery and other specialty focused EMRs stemming from this issue.

What are you seeing happening with mobile in healthcare?

There is a tremendous rush to mobile in Healthcare right now. Over the past several years our Healthcare mobile development has grown tenfold. There are many, many great mobile applications developed with patients, physicians, nurses, home health providers and others in mind. These apps have been and will continue to make providers, payers and patients lives easier and make delivering healthcare more efficient and productive.

You’ve worked with a lot of the various healthcare standards. How do they compare to the standards you work with in other industries?

There really is no parallel to the standards that guide healthcare in other industries. From my limited experience I would say that the Banking/Financial industry comes closest. But even then the amount and complexity of the standards are a fraction of what is found in Healthcare and Pharma.

Tell us about some of your work on the major hospital platforms like Siemens Soarian, Meditech and Epic. Is it a challenge working with these large companies?

These large companies have invested millions of dollars building and improving the very complex systems. So, they are rightfully concerned and selective about how and who is allowed to work in their systems. It can be a challenge, but not impossible to work with these companies. An added challenge comes from the hospitals themselves. There is the attitude that these systems are so unique that only company trained personnel have the capability to work in them.

Chetu, having worked in the Soarian, Meditech, Epic, Cerner, McKesson and other hospital platforms understands that the underlying technology in all of these systems are the same or very similar. Although each system may have unique capabilities – we recognize that the goal is the same for each. And, in getting past the UI or getting “under the hood” so to speak, we see mostly the same technologies at work.

What are the most innovative healthcare IT projects you see out there that you like working on?

Right now we are seeing a rush to capitalize on the tremendous amount of data that EMRs are generating. Data analytics using this great resource is helping pharmaceutical companies, scientists and researchers, Accountable Care Organizations – nearly everyone on the healthcare continuum provide better and less expensive patient care. This is an area that is in its infancy but we see growing rapidly.

What types of data analytics projects have you done in healthcare? Do you do just the programming component or can you do every part of a data analytics project?

Chetu has been involved in numerous healthcare analytics projects. We have helped our customers with data warehousing, data mining, OLAP, business analysis, automated report generation, multi-dimensional information “cubes”, custom reporting solutions using tools like Informatica, DTS / SSIS, Datastage and SSRS, SSAS, Cognos, Microstrategy, Crystal, OBIEE.

We have developed solutions across the complete data analytics process. From data mining and ETL to data cube and data modeling and report generation we have the experience and the people that can handle nearly any healthcare analytics project.

Full Disclosure: Chetu is an advertiser on EMR and HIPAA.

Payer Driven mHealth and Mobile Apps as Pharma

Posted on September 18, 2012 I Written By

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

David Lee Scher, MD offered this fascinating insight into the Mobile App as Pharma discussion:

My assessment of this question is that saturation of the entire market will only occur if enough excellent apps which provide an impact are found to be of similar efficacy. This will need to be borne out of comparative studies (the performance of which I think will be driven by payers). There might very well be saturation of sectors of the industry, such as fitness, wellness, diabetes and other specific disease management tools, remote monitoring, and others. Expansion of the industry has, at this point far exceeded adoption in clinical practice. This provides an opportunity to fairly rapidly compare products, and not be dependent necessarily on a few which may not prove effective. There will continue to be a robust growth period, but, as in the pharma industry, the clear winners and workhorse apps will be likened to brand named drugs, and others will be considered either ‘me toos’ or generics. I don’t think this analogy is too off-base as apps will be entities that are prescribed. Sales of apps will be done virtually (as most pharma will be as well). Efforts by Johns Hopkins and others to demonstrate efficacy will go a long way in vetting the winners and losers on one level giving people guidance. just my personal perspective.

First, I agree that payers will likely drive the studies and then user of these apps.

Second, I look forward to places like Johns Hopkins testing the efficacy of apps. The big winners of these studies will be very big winners. Plus, the big winners from these studies are going to be very big winners. It’s actually the perfect study since whether you find that the app is effective or not, you have something to publish.

I look forward to this suite of mobile health apps that dramatically improve healthcare. I don’t think we’re that far from it.

ACOs (Accountable Care Organizations)

Posted on August 28, 2012 I Written By

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

ACO’s Built Around Primary Care Not Payers
It’s always quite interesting when a non-healthcare journalist covers healthcare. The above title comes from this article on In the article they offer the following interesting ACO stats (as of Sep 2011):

-51% of all ACOs are buist as joint ventures between doctors and hospitals
-20% of ACOs are physician led
-18% of ACOs are hospital led
-75% of hospitals surveyed were not planning on participating in ACOs
-13% of hospitals are already participating in ACOs

Then, the article offers this insight into the ACO battle between payers, physicians and hospitals:

The report also noted that hospital- and physician-led ACOs tend to focus more on primary care than acute care, but Horizon Blue Cross Blue Shield’s partnership with Optimus is set up to promote primary care based on patient-centered medical home models, according to spokesman Tom Vincz.

“Horizon ACO arrangements include incentive payments to support improved patient care coordination and fund other activities to further transform offices into patient-centered practices,” said Horizon in a statement from Vincz. “Entities that Horizon collaborates with are given other valuable resources, such as timely, population-based data, to help them deliver more effective and efficient care to their patients.”

Since I consider myself a physician advocate, it seems appropriate for me to add in a quote from a blog post Kerry A. Willis, MD did on KevinMD:

During the PHO debacle a few years ago, I reminded our physicians that the letters should represent the ownership and direction that these organizations should take as they developed. I frequently offered that they were really pHO’s with Big hospitals and Big organizations with little physician control over the direction and quality that was important to us.

I fear that the same is true with ACOs. If we are not vigilant in their formation and direction, then they will become AcOs with physicians being a small part of their governance but very accountable to their owners. They will be dependent on the revenue streams that spring from them. I see scenarios where physicians will profit but then be caught in a spider’s web of their own design where they will be told how to practice and what kind and amount of care they can provide. I guess you could claim that I don’t trust insurance companies and you would be wrong. I do trust them. I trust them to do what is best for the corporate profits and the nonprofit executives’ with bonus clauses at the end of a successful year.

I fear that when it comes to ACOs many physicians are sitting on the sideline. We saw what happened with EHR incentive money and meaningful use when more doctors weren’t involved in the process. There were requirements that didn’t make any clinical sense. I can see the same thing happening with ACOs if doctors don’t get involved.

It’s a rapidly changing ACO environment, and my hope is that many smart physicians will add their voice to the mix. Otherwise, the shift to hospital owned practices will continue and doctors won’t have much of a choice but to be beholden to a big company.