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EMRs Are First Source For Population Health Management Functionality for Providers
KLAS: EMRs Are First Source For Population Health Management Functionality for Providers
Enterprise EMR vendors are the number-one source for population health management functionality, according to the latest KLAS report. The latest KLAS report “Population Health 2014 Perception: Who Are Providers Betting On?” found that despite a veritable flood of new best-of-breed entrants into the marketplace, providers are having an increasingly hard time finding a one-stop PHM solution.
For the report, KLAS spoke to 105 provider organizations across the country about their population health solutions and their future plans surrounding this segment. These providers mentioned a total of 69 vendors as currently playing a role or being considered for the future.
To learn more about the population health marketplace, check out the full “Population Health 2014 Perception: Who Are Providers Betting On?” report at www.KLASresearch.com/KLASreports.
KLAS: EMRs Are First Source For Population Health Management Functionality for Providers by Jasmine Pennic
Sustainable Population Health Management Program
Keys to Implementing a Sustainable Population Health Management Program
White paper from Siemens examines some of the critical success factors for a sustainable population health management program.
Population health management (PHM) has become and will continue to be a top priority for healthcare providers as the industry shifts from the current fee-for-service to new value-based purchasing models. Provisions of the Affordable Care Act (ACA) are driving the adoption of these models, which are designed to improve the quality of American healthcare, while large employers and other payers across the country are also establishing new value-based purchasing models. Delivery of high-value, cost-effective care requires a focus on—as well as a new approach to—population health management. By coordinating the care of a population across the continuum, healthcare providers can deliver improved quality at decreased costs, and share these benefits with their partners in models such as accountable care organizations (ACOs). Performance-based contracts enable providers to gain additional revenue if they meet quality standards. Similarly, by using PHM strategies to reduce hospital readmissions, healthcare providers can avoid costly penalties under the Centers for Medicare and Medicaid Services’ Hospital Readmissions Reduction Program.
With great potential to deliver a return on investment across multiple federal programs and quality-driven initiatives, PHM is a critical component in today’s healthcare transformation. In order to execute on this enormous and complex undertaking, , however, healthcare organizations must develop and implement PHM strategies that leverage healthcare information technology to successfully manage the unique health needs and risks factors of an increasingly diverse population.
This new shift requires strategies and tools for PHM to evolve toward more efficient and consistent management of an entire population in order to help providers achieve quality and cost objectives as well as keep patients engaged in their wellness. So what are the keys to implementing a sustainable population health management program?
This white paper examines some of the critical success factors for a sustainable population health management program and how the CareXcell™ solution can provide the IT infrastructure needed to address new value-based care requirements.
Download the white paper below to learn more.
Know when, why and how your current EHR platform may fall short of delivering a transformative community of care—and develop a new value-based care model that elevates population health and grows revenue across your organization.
This IDC Health Insights white paper, sponsored by Imprivata, presents key findings of interviews with three healthcare IT executives at Atlantic Health System, Carolinas Pathology Group, and Beaufort Memorial Hospital regarding the deployment of Imprivata Cortext, a secure communications platform. Consistent findings across the three healthcare organizations are as follows: ease of use leads to quick clinician adoption, there is broad application of secure communication across various hospital workflows, and instant communication can save time for care team members and can improve collaboration. Read this report to learn more about how these organizations streamlined clinical workflows such as patient admission notifications, specialist referrals, pathology consultations and code team activations.
Detecting and preventing errors that threaten patient safety is a closed-loop process that begins at the point of care, extends to independent laboratories, and then back to the caregiver. Download to learn more!
Healthcare providers face an urgent, internal battle every day: security and compliance versus productivity and service. For most healthcare organizations, the fight is an easy one: Providing quick, high-quality care wins every single time.
To prepare for value-based care models, Mercy Health System uses interoperable solutions to attest for Meaningful Use, implement 24 ACO clinical quality measures in three months, and achieve PCMH Level 2 Certification in eight sites. With a healthy EHR core, Mercy is prepared for future growth.
Maximizing patient safety and improving the quality of care is the ultimate goal for healthcare providers. Doing so requires staying within regulatory compliance, while also advancing staff retention and meeting fiscal constraints. Barcode technologies provide a “virtual voice” to patients, applications and workflows. Barcoding accomplishes this by laying a solid foundation for enhancing patient identification, providing visibility into medical practices, and driving efficiencies throughout healthcare applications, and is an integral part of electronic medical record (EMR) adoption. Download to learn more!
Efficient communication and collaboration amongst physicians, nurses and other providers is critical to the coordination and delivery of patient care, especially given the increasingly mobile nature of today’s clinicians and the evolution of the accountable care organization (ACO) model. Download to learn more!
This case study focuses on the implementation of single sign-on at The John Hopkins Hospital which streamlined provider access to applications.
Optimizing revenue cycle performance has become even more critical for practices. Especially with today’s changing healthcare landscape of ICD-10, consumer-directed health plans, and declining reimbursements. Our new eBook “Seven Revenue-driving Best Practices of Successful Healthcare Organizations” will help you identify opportunities to take control of your revenue cycle and get paid every dollar you deserve.
Role of Claims Data in HealthIT
The Role of Claims Data in HealthIT: The Good, The Bad and The Ugly
As we move towards building a universal patient-centered data platform in health IT, several sources of data are useful. Data coming from transitions of care, clinical summary documents (C-CDAs) which can be shared between healthcare providers taking care of a patient, and claims data from insurance payers – these are all sources of data that can build the universal health record.
With all the focus in interoperability discussions around sharing data found in clinical Electronic Health Records (EHRs) and sharing them in some way between disparate systems, we have lost sight of the potentially important role of health plan data. It might serve well to consider the pluses and minuses of this data, in order to best understand where it might fit in.
Health plans have been keeping data based on insurance claims that they have paid for many years. Their historical archives will therefore pre-date the information found in clinical EHR systems in hospitals and doctors’ offices, since EHRs are a relatively recent arrival on the healthcare scene. Therefore, one advantage of health plan data is that it has longitudinal depth.
Another advantage of this type of data is that is collects information from all the different parties that have submitted bills for a given patient’s care – all the different doctors, hospitals, laboratories, imaging centers, pharmacies, etc. Thus, a second advantage is that health plan data is multi-sourced, irrespective of what each biller uses to send claims. Such data can, then, help
determine who is the care team taking care of a given patient, so that a patient-centeredhealth record can show the involved providers in a hub-and-spoke fashion.
The kind of information sent on a bill to a health plan is limited in scope, but still valuable. Clinical notes, vital signs, allergy lists, etc., are not things that appear on bills. What does appear, however, are procedure codes (CPT codes) and their associated diagnosis codes (ICD-9 codes). Prior to 2012, up to 4 different ICD-9 codes could be associated with each CPT code in a bill (the 4010 standard), but since then the new standard (the 5010 standard) allows up to 12 different diagnosis codes to be associated with each procedure code line.
There is considerable incentive for medical providers to use as many diagnosis codes as are appropriate on their bills. Medicare’s HMO offering, Medicare Advantage, will pay contracted private insurers a per-member-per-month premium that is adjusted on how “sick” their enrollees are. This is determined by HCC codes, which weight the level of acuity of a given patient based on their health conditions, and is determined by ICD9 codes found on their bills. Therefore, for those participating in Medicare Advantage plans, there is considerable incentive to be as complete as possible in capturing all the patient’s diagnoses in their billing every single year. Thus, another advantage to health plan data is that the Problem List for a patient, especially when it is incentivized in an environment of maximizing HCC coding, is robust (as well as multi-sourced).
Many important elements of a patient’s record are not captured in bills. There has been an attempt to capture certain clinical items used for Clinical Quality Measures – such as blood pressure ranges for diabetic patients, or other similar clinical data points – using claims. Medicare has introduced CPT-II and otherHCPCS codes which are zero-dollar codes intended to submit clinical information to Medicare and other payers, for use in certain pay-for-performance programs such as PQRS.
Such data could be helpful in building a clinical record, but the use of these codes in billing is spotty at best. After all, they are non-payable codes, and represent a coding burden to providers. In addition, there are other non-claims-based methods of submitting quality measures to PQRS and Meaningful Use, so the absolute need to use these is not compelling.
Thus, a major weakness of claims data is its incompleteness, particularly when it comes to reporting data important for Clinical Quality Measures.
The other weakness from health plan data is that patients often will switch health plans frequently over time. It is rare for an individual to keep the same health insurance their whole life. Therefore, in order to build a complete patient data record over time, data would need to be obtained from each different health plan that they were covered under, since no one plan would likely provide the whole story.
Health plan data may be accurate when it comes to identifying who has taken care of the patient, when certain procedures were done, when the patient was hospitalized, and when medications were dispensed. But diagnosis data can be inaccurate, largely based on source.
Community physicians in their offices are often directly involved in declaring the diagnoses on their claims. This is especially true for those involved in HCC environments. Diagnosis data from outpatient claims, therefore, are the most likely to be accurate.
In hospitals, billing is generally done by billing staff, and diagnoses are extracted from examining the record rather than by the physicians themselves. A degradation of diagnosis-coding accuracy is inherent in this arrangement. In addition, hospital bills are often bundled, or paid globally based on Diagnosis Related Groups (DRGs), so individual ICD9 codes are often not relevant.
Therefore, problem lists built from hospital-based claims can be quite inaccurate. As famously chronicled in 2009 by e-Patient Dave’s efforts to put his medical records on a PHR, he found widespread inaccuracies in his problem lists as recorded by the hospital’s system. Granted, such systems have improved in the past 5 years, but the point is that hospital diagnosis data can harbor many inaccuracies.
Related: The Riddle Adoption of Consumer PHRs
Perhaps the worst source of diagnosis data is from laboratory claims. Often, a diagnosis is placed on a lab order form simply to make sure the needed test is paid. The concurrence between the diagnosis submitted on a lab order and the diagnoses in a physician’s EHRs is less than 100%.
Using claims data
Insurance companies, in their efforts to keep their enrollees healthy and avoid unnecessary costs, spend considerable efforts identifying “gaps in care.” These can be from lapses in filling of maintenance medications, to suggesting medications that are appropriate for the conditions the patient seems to have but is not on (such as asthma controllers, or ACE/ARBs for diabetics). These kinds of alerts are sent to physicians daily, at considerable cost, often by fax. And entirely based on claims data. And often ignored by physicians as an “annoyance” that does not fit well within their already-overburdened workflows.
Clearly, insurance companies look to the data within their own data silos, and try to make the most of it. For all the good, bad and ugly of it, it remains actionable data.
Perhaps the best way to look at claims data, as a potential source for building universal patient records, is as a supplement to data from other sources. There are distinct advantages to insurance-based information, and there are distinct shortcomings as well.
Why would insurance companies share any of their data? Two reasons:
Claims-based data from health plans represent a source of data that can supplement a universal health record. It is part of the larger puzzle, and serves a useful role.
Dr. Robert Rowley is the Co-Founder and Chief Medical Officer of Flow Health, a next generation communication platform for care teams and patients, facilitating transitions of care, and aggregating patient-centered data from all the sources where it is found. From its inception through 2012, Dr. Rowley had been Practice Fusion’s Chief Medical Officer, having created the underlying technology in his own practice, and using that as the original foundation of the Practice Fusion web-based EHR.
Applying Automation to Healthcare
6 Big Benefits of Applying Automation to Healthcare
James Dias, Founder & CEO at Wellbe shares six big benefits that can be realized by applying automation to healthcare for overall cost reduction and efficiency.
Three out of four hospital and health systems CEOs cite overall cost reduction and efficiency as one of their top two financial priorities, HealthLeaders recently reported. With the healthcare industry continually looking to cut costs and waste and improve efficiency and throughput, automation of manual tasks can be an important part of a strategy for performance improvement.
Automation is defined as the use of control systems and information technologies to reduce the need for human work in the production of goods and services. The introduction of the assembly line at Ford Motor Company in 1913 is often cited as one of the first forms of automation. With this innovation Ford achieved a dramatic reduction in the time to produce a car from 12 hours down to 1.5 hours!
Now automation surrounds us every day in our lives, including automated teller machines (ATMs), Redbox DVD rentals, self-checkout at the grocery store, cellphone-controlled thermostats, auto park assist in vehicles, and many more routine activities managed by technology. Despite its use for years in banking, retail and other industries, healthcare has lagged behind in its use of automation. The recent pressure from healthcare reform and increased competition is driving a heightened interest to reduce costs and eliminate waste in healthcare delivery. And that has brought the adoption of automation to the spotlight.
An aging population along with more people in the healthcare system will require more care, and staffing levels in healthcare will not be able to keep up. In the July/August 2009 issue of Health Affairs, Dr. Peter Buerhaus and coauthors found that despite the current easing of the nursing shortage due to the recession, the U.S. nursing shortage is projected to grow to 260,000 registered nurses by 2025. A shortage of this magnitude would be twice as large as any nursing shortage experienced in this country since the mid-1960s. The looming shortage of RNs demands efficiency and the elimination of redundant work and manual tasks.
John Dragovits, chief financial officer of Dallas-based Parkland Health & Hospital System, toldHealthLeaders in 2012: “If you look at an average hospital’s financial statement, 50%-60% of their expenses are salaries and benefits. By definition healthcare is an inflationary model, but it’s exacerbated by the fact that everyone wants to hire more people rather than think about how they can live with fewer people… The challenge in this industry has always been getting people excited and intrigued and rewarded for looking at things innovatively and using technology to do things quicker and cheaper.”
Once the industry transitions to population health, automation goes from a “nice to have” to a “must have.” There are not enough care providers to continuously monitor and check in with large patient populations for this new model of care. A report by the Institute for Health Technology Transformation says, “Automation makes population health management feasible, scalable and sustainable.”
Automation is often linked to a negative connotation in association with the loss of jobs in manufacturing industries. When automation and robotics were first introduced into the pharmacy, some feared it would be the end of pharmacists, with robots taking the place of human workers. However, ultimately it let them get rid of medication counting tasks that required little cognitive value, and instead let them focus on more clinically-relevant work for productive and rewarding work time.
Critics also point out that automation can’t replace doctors and nurses. And they are correct. However, automation can be blended in to their workflows to make a wide swath of care delivery processes much more efficient and to improve productivity. Patient engagement, for example, can get a big boost from automated check-ins and reminders.
Here are 6 big benefits that can be realized by applying automation to healthcare:
1. Labor Savings
2. Improved Quality and Consistency
3. Reduced Waste
4. Increased Predictability of Outcomes
5. Higher Throughput
6. Data-Driven Insights
When looking for good areas to apply automation in your healthcare environment, a standardized, repeatable process is the first thing to look for. Within hospital walls, a common procedure that is performed on a large population of patients on a routine basis, like joint replacements, is a prime area to apply automation tools. Ask yourself this question: Which program would you rather have?
Between programs A and B, automation is what makes the difference. So the next time you’re ready to tackle a new process and realize you need to hire 3 more FTEs to support it, first do a gut check and see if there’s a better way to do it through automation.
James Dias is the Founder & CEO at Wellbe where he leads innovations program to empower people and providers with new tools to improve health. He is also the co-inventor of the Patient Guidance System.
6 Big Benefits of Applying Automation to Healthcare by Jasmine Pennic
De-identification effective in maintaining patient privacy if done right
De-identification effective in maintaining patient privacy if done right
By Katie Dvorak
As hospitals and healthcare organizations adopt new ways to store and share data, privacy and security of the information is a top priority--and with that comes de-identification of data.
When it comes to HIPAA, there are two standards that allow for the sharing of data while maintaining privacy protections, according to privacy attorney Scot Ganow and Khaled El Emam, senior scientist at the Children's Hospital of Eastern Ontario Research Institute, both of whom spoke with HealthcareInfoSecurity.com.
The first HIPAA method for de-identifying data, according to Ganow, of Faruki Ireland & Cox, is to strip out the data and identifiable elements, though, he added that doing so doesn't offer a lot of value. The second, he said, is to de-identify data through the expert determination standard, which allows researchers to "retain a lot of the value of the info ... [while] at the same time carrying a very low risk of re-identification."
Emam, who also serves as the director of the multidisciplinary Electronic Health Information Laboratory at the Children's Hospital institute, also emphasized using the expert determination method, saying it allows for more flexibility.
He told HealthcareInfoSecurity.com that not every organization uses the standards, and in those cases, the data won't be protected.
In addition to HIPAA, the Federal Trade Commission also has de-identification standards, including that an organization takes reasonable steps to de-identify protected data and announces that re-identification of data will not occur.
However, some are not sure that de-identification goes far enough in protecting patients.
Some studies have shown the possible ease with which de-identified data can be linked with a patient, including one by Harvard University researchers who were able to identify and link anonymous participants in a public DNA study with their personal data.
And while HIPAA specifies how data should be de-identified, a report by the Bipartisan Policy Center maintains that too much variability exists in the execution of anonymization.
Emam, though, said that if the process is done right, it is very difficult to re-identify data. He stressed that problems occur when organizations do a "lousy job" with de-identification, and that makes it easy for someone to reverse.
To learn more:
Majority of Physicians Remain Happy with Career Choice
Majority of Physicians Remain Happy with Career Choice
Of the 1,311 physicians taking our 2014 Great American Physician Survey, Sponsored by Kareo, 8 in 10 said they still like being a physician. Furthermore, given the choice to change history and choose another path, 56 percent said thanks, but no thanks.
Here's more data on the ups and downs of being a physician from this year's survey.
States Could Soon Require Random Drug, Alcohol Tests for Docs
States Could Soon Require Random Drug, Alcohol Tests for Docs
By Ericka L. Adler
I recently spoke with a physician seeking guidance concerning a colleague in her office she believed might be impaired by drugs. She was alarmed at the risk this posed to patients, as well as her practice’s liability, and wanted to report the physician to her superiors.
In this particular case, we decided together there was insufficient factual knowledge of any wrongful activity to support my client taking action, without further evidence. As I have discussed before, presenting information to a third party without factual evidence, when such information can be damaging, will open a physician to liability for defamation.
Because physicians are typically afraid to report their suspicions, and can actually face liability for doing so, how should physician drug use in the workplace be addressed?
Given the subversive habits of drug users, how can practices catch physician drug-users before a patient is harmed, and do so in a manner that can help a provider receive assistance he may require?
The use of drugs and alcohol by physicians is a well-known public health risk. Statistics indicate that physicians are about as likely as the general public to abuse alcohol or illegal drugs, but five times more likely to misuse prescription drugs, according to the University of Florida’s Center for Addiction Research and Education. In a profession where clear thinking, decision-making, and a steady hand are all essential tools, physician drug use is a grave concern.
California is taking a stab at addressing the problem of physician drug use, and will present its residents with the issue of random physician drug testing on a ballot this November, known as “Proposition 46.” Apparently many in the medical industry don’t like Proposition 46, and The New York Times reports that the medical industry, including doctors, hospitals, and medical insurance companies, have already raised more than $35 million to defeat it.
The problem with Proposition 46, in particular, is that the motivation for the measure appears to be driven by lawyers. In fact, the proposed law would mainly impact the malpractice industry, increasing the ceiling for pain and suffering awards in medical negligence suits from $250,000 (set by the State legislature in 1975) to $1.1 million to reflect inflation.
It’s important to note that those who oppose Proposition 46 do not necessarily believe that drug testing of physicians is inappropriate, just that it should not be applied in the manner developed by California state trial lawyers. Instead, it should be focused on helping impaired physicians and protecting patients in a manner that physicians and others in the industry can support. This requires some thoughtfulness in developing an acceptable approach, which many believe Proposition 46 lacks.
There is no doubt that an issue of drug and alcohol abuse in the medical profession exists. The vote in California will be important in how it impacts other state laws around the country.
Seven Principles that Can Help Stressed Out Physicians
Seven Principles that Can Help Stressed Out Physicians
By Carol Stryker
Physicians are busy. They often have little time for friends and family, have no time for the community, and seldom feel as though they have covered all their bases. Their lives have way too much in common with a hamster in a wheel.
Still, there are some things physicians can do to experience improved work-life balance. Here are seven principles to keep in mind next time you feel like your sense of balance is spiraling out of control:
2. Accept the fact that there will never be enough time. The only people who never run out of time are lethargic and unimaginative, the antithesis of most physicians. Some tasks and interests have to be abandoned forever, while others will simply need to wait their turn.
3. Be intentional about the use of time, and be aware that it involves choices as well as decisions. Deciding to do something is deciding not to do something else. The decision is a choice, a corollary to the principle that two things cannot concurrently occupy the same space. The challenge is to distinguish between the urgent and the important, as well as the important and the less important. Without intention, priorities tend to be clear only in retrospect when different action is impossible.
4. Abandon guilt about what is not getting done. If you are making good use of your time and investing it in what is most important to you, there is no reason to feel guilty. You may wish you could do it all, but you must realize you bear no responsibility for an immutable law of nature.
5. Seek alternate resources. Nowhere is it written that you must do everything. If something essential is not getting done, find a way to delegate it.
6. Refuse to be bullied. This is particularly difficult because many physicians have so routinely been bullied during their training. When someone demands more research, more revenue, more whatever than is reasonably possible, push back and negotiate the demands. (I am not oblivious to the fact that this may involve finding another job or practice. You need to weigh the pros and cons.)
7. Do not engage in self-bullying. This kind of bullying may be the most common. Physicians have a tendency to be driven, and to be offended at the notion that they must make trade-offs. Unchecked, it leads to serious over-commitment, stress and, eventually, burnout.
Now that you have read the above, the key is applying these principles to your daily life. To help, I've provided an example below. Take a look, while it may not apply directly to you, it will get you thinking about some ways you may be able to improve your own work-life balance.
To help other physicians identify similar opportunities, I encourage you to share your thoughts in the comments section below.
Example: Dr. Jones is a mid-30s cardiologist with a wife and three small children. He loves soccer and biking. The family is anxious to retire its debt, build its dream home, and live the life they have been planning since the beginning of medical school. At present, Dr. Jones is feeling very stressed.
In order to generate the revenue that will generate the income he needs and feels he deserves, he needs to see about 40 patients a day. The senior partners in the practice refuse to hire a nonphysician provider for him until his numbers are up, and they give him the least experienced medical assistants. There is no way Dr. Jones can keep his schedule on track and do the business development he needs to do to increase his volumes.
His wife is very frustrated, and she lets him know it. She was moderately OK with being broke in school and even training, but she is ready for the struggle to be over. She is also tired of being a single parent and worried that the children do not have enough time with their father. Both money and time with the children are a concern for Dr. Jones, too. He also laments his lack of exercise.
He is constantly pedaling as fast as he can but no one is happy. Things do not seem to be getting better.
Based upon the seven principles above, what can he do?
Why healthcare info governance must be 'proactively managed'
Why healthcare info governance must be 'proactively managed'
By Katie Dvorak
While working on Wall Street, Laura Zubulake dealt with information convergence and governance, later becoming a key player in landmark opinions on preservation of electronically stored information. In an interview published this week in the Journal of the American Health Information Management Association, Zubulake spoke about her experiences and how they translate to healthcare.
The patient care industry shares many similarities with both the finance and banking industries, Zubulake told the Journal of AHIMA. Much of her work on Wall Street likely mirrored that of health information management professionals, Zubulake said, particularly when it comes to electronic health records.
"It is important for HIM professionals to become knowledgeable about all technology at their disposal, how to use it, communicate feedback, demand accuracy, and have patience," she told the Journal of AHIMA.
She also said that information for healthcare organizations is a strategic asset that greatly impacts their ability to advance goals and outcomes. It requires more than just the addition of CIOs, whom she said should not hold sole responsibility of information.
To that end, in AHIMA's fist study on information governance, it found 35 percent of the 1,000 respondents didn't know if their healthcare organization had any information governance efforts underway or did not recognize a need for it.
All levels of management need to endorse that information is as important as other assets, Zubulake said. It must be proactively managed, assembled and secured.
"It should be natural and intrinsic to employee's roles and responsibilities and the organization as a whole," Zubulake told the Journal. "Failure to instill this thinking exposes organizations to significant risks."