HIE

flying cadeuciiThere’s No Place Like Epic’s Home

Epic reveals plans for a fifth campus, which is slated to include half a million square feet of office space and pay homage to literary classics like “Charlie and the Chocolate Factory” and “The Wizard of Oz.”

A Setback for MyMedicalRecords

A US District Court rules against MyMedicalRecords in its patent case against Walgreens, Quest Diagnostics, and others. MyMedicalRecords, a company that many label a patent troll, contends its patents covered a method of providing online PHRs in a private, secure way. However, a judge ruled that “the concept of secure record access and management, in the context of personal health records or not, is an age-old idea,” and is therefore abstract.

Despite the setback, I doubt MyMedicalRecords will stop demanding organizations to pay up or risk facing a lawsuit. I predict they’ll make some tweaks to their business plan, such as focusing only on organizations with not-quite-so-deep pockets that are willing to settle without a fight.

What Has $564 million Bought Us?

Sens. Lamar Alexander (R-TN), Richard Burr (R-NC), and Mike Enzi (R-WY) ask the General Accounting Office to review the ONC-funded health information exchanges to determine what exactly the exchanges created with the government’s $564 million in grant money.

It’s a valid concern, given the significant number of providers and regions still lacking electronic exchange capabilities and the millions that have been spent.

Physicians Reject Stage 2 Attestation

Fifty-five percent of physicians say they won’t attest for Stage 2 MU in 2015, according to a SERMO survey of about 2,000 physicians. Respondents cite several reasons for not attesting including financial concerns, difficulty engaging older patients, and lack of software usability.

Given the lackluster Stage 2 attestation numbers so far, the findings are not particularly surprising. It will be interesting to see what CMS and ONC intend to do in the face of the overwhelming evidence that many providers simply don’t think it is worth the effort.

On To Stage 3

The Office of Management and Budget is currently reviewing the proposed Stage 3 MU rules and will likely publish them in February. CMS states that Stage 3 will include changes to the reporting period, timelines, and structure of the program, including a single definition of Meaningful Use. CMS also adds that “these changes will provide a flexible, yet clearer, framework to ensure future sustainability of the EHR program and reduce confusion from multiple stage requirements.”

Can’t wait to see what is included. And, I can’t help but be a little amused that it’s been six years since the passage of the HITECH legislation and we are just now getting a definition for “Meaningful Use.”

Show Me the Money

Allina Health and Health Catalyst sign a $100 million definitive agreement to combine technologies, clinical content, and front-line personnel.

Rush University Medical Center will implement Merge Healthcare’s cardiology PACS.

Healthcare operating system platform provider Par80 closes $10.5 million in Series A funding led by Atlas Ventures, Founder Collective, and CHV Capital.

Health analytics provider Apervita, formerly knowns as Pervasive Health, completes an $18 million Series A round of funding led by GE Ventures and Baird Capital.

Teledermatology provider PocketDerm raises $2.85 million from an undisclosed investor.

Caremerge, developers of a care coordination platform, raises $4 million in a second round of funding. Investors include Cambia Health Solutions, GE Ventures, Arsenal Health, and Ziegler-LinkAge Longevity Fund.

Continue reading “HIT Newser: A Setback for MyMedicalRecords”

flying cadeuciiBy MICHELLE RONAN NOTEBOOM

Accenture Tapped to Continue Work on HealthCare.gov

Accenture, the consulting firm that was hired a year ago to fix the troubled HealthCare.Gov insurance exchange, is awarded a five-year, $563 million to continue its work on the federal site. The government hired Accenture Federal Services to repair the online marketplace after dropping its original contractor, CGI Federal.

The long-term contract with Accenture also signals CMS’s acknowledgement that a task as large as HealthCare.Gov is best run with leadership from an experienced, private-sector vendor.

Connecticut HIE Dissolves After Wasting Millions

A former board member for The Health Information Technology Exchange of Connecticut blames management for the failure of the entity, which was tasked to create statewide HIE but dissolved by the legislature last summer. The HITE-CT “wasted” $4.3 million in federal grants over four years “without accomplishing anything,” according to Ellen Andrews, who served as the board’s consumer advocate.  State auditors also found deficiencies in state controls, legal problems, and a “need for improvement in management practices and procedures.” The state’s legislature is now developing a new exchange strategy.

Prediction: look for more HIEs to falter this year due to mismanagement and lack of sustainability.

Electronic Prescribing of Controlled Substances on the Rise

Electronic prescribing of controlled substances (EPCS) increased from 1,535 to 52,423 between July 2012 and December 2013, according to a study published in the American Journal of Managed Care. The percentage of pharmacies enabled for EPCS jumped from 13% to 30% during the same period.

The next task: figuring out how to get more than the current one percent of physicians to participate.

ONC Shares Lessons Learned from State HIEs

An ONC report on state HIEs finds that many exchanges lack a critical mass of data and are struggling with data sharing. The case study also found that the technical approaches, services enabled, and use of policy and legislation varied across states; collaboration among HIE participants is critical for success; and states are leveraging a variety of policy and regulatory levers to advance interoperability and data exchange.

CMS Seeks ICD-10 Testers

CMS is seeking approximately 850 volunteers for ICD-10 end-to-end testing in April, according to a CMS bulletin. Volunteers have until January 9to submit applications to participate in the April 26-May 1, 2015 testing week.

Pediatrics Report Increased EHR Use

Seventy-nine percent of pediatricians reported using an EHR in 2012, compared to 58% in 2009, according to a study published in the journal Pediatrics.  Only eight percent of physicians say their EHRs include pediatric-specific functionality.

Modernizing Medicine Buys RCM Vendor Aesyntix

EMR developer Modernizing Medicine acquires Aesyntix, a provider of RCM, inventory management, and group purchasing services.

Presumably Modernizing Medicine was most interested in Aesyntix’s RCM component, which may create some concern among Modernizing Medicine’s current RCM partners, which include ADP/AdvancedMD, CareCloud, and Kareo.

Every day CIOs are inundated with buzzword-compliant products – BYOD, Cloud, Instant Messaging,  Software as a Service, and Social Networking.

In yesterday’s blog post, I suggested that we are about to enter the “post EHR” era in which the management of data gathered via EHRs will become more important than the clinical-facing functions within EHRs.

Today, I’ll add that we do need to a better job gathering data inside EHRs while at the same time reducing the burden on individual clinicians.

I suggest that BYOD, Cloud, Instant Messaging, Software as a Service and Social Networking can be combined to create “Social Documentation” for Healthcare.

In previous blogs, I’ve developed the core concepts of improving the structured and unstructured documentation we create in ambulatory and inpatient environments.

I define “social documentation” as team authored care plans, annotated event descriptions (ranging from acknowledging a test result to writing about the patient’s treatment progress), and process documentation (orders, alerts/reminders) sufficient to support care coordination, compliance/regulatory requirements, and billing.

Continue reading ““Social Documentation” for Healthcare”

November 16 marks the deadline for states to submit their plans for establishing a health insurance exchange—or HIX—either on their own or with some level of assistance from the federal government. For those states, a majority, according to Kaiser Family Foundation research, have yet to set up a HIX or develop concrete plans to do so. That’s an uncomfortably tight timeline in which to make some tough decisions.

According to the Supreme Court’s June ruling on the Affordable Care Act, states will no longer forfeit federal funding for Medicaid if they choose not to expand their Medicaid programs to all residents with incomes below 138 percent of the federal poverty level. Nevertheless, they must ensure coverage for an estimated 16 million currently uninsured people with an income between 100 percent and 400 percent of that poverty level. And by October 2013, each state needs to demonstrate that it has a HIX in place that can provide such cover: A user-friendly, one-stop shop for affordable healthcare, or affirmatively state that it intends to participate in the Federal exchange..

A HIX needs to have sufficient scale to support large and balanced risk pools. But there may not be sufficient numbers of uninsured state residents to make the HIX viable, particularly if a state is small, or has an extensive Medicaid program already in place. How will such states attract and sustain enrollment? How will they attract payers?

Continue reading “Ensuring the Long-Term Viability of Health Insurance Exchanges”

One major issue facing private and public Health Information Exchanges (HIE) is how to ensure patients privacy preferences are respected by obtaining their consent before data is shared.

Today I met with a multi-disciplinary team of attorneys, vendor experts, and IT leaders to discuss BIDMC’s approach to private HIE consent.

After two hours of discussion, here’s what we agreed upon:

Patients and families should be able to control the flow of their data among institutions.  The ability for the patient to chose what flows where for what purpose is “meaningful consent.”

To achieve “meaningful consent” we will ask all the patients of our 1800 BIDMC associated ambulatory clinicians to opt in for data sharing among the clinicians coordinating their care.

Patients may revoke this consent at any time.

Consent for patients under 18 years old and not emancipated will be sought from their parents.   Upon turning 18, the patients themselves will select their consent preferences.

Continue reading “Meaningful Consent”

What is a payer/insurer?

Typically, payer organizations collect premiums from employers and individuals, process claims, and engage in a variety of case management/disease management activities to encourage the appropriate use of medical resources.   If they collect more premiums than claims paid,  their medical loss ratio is less than 100% and they earn a profit.

In a world of accountable care organizations and healthcare reform, new reimbursement methods will include global payments to providers, which implies the risk of loss will shift from the payer to hospitals and clinicians.   Payers will no longer need their large claims processing staff, nor create complex actuarial models.   They’ll become very different organizations.

How different?

My prediction is that payers will become the health information exchange and analytics organizations that help hospitals and clinicians manage risk in a world of capitation.

I’ve said before that ACO=HIE+Analytics.

The payers are already making strategic acquisitions to build these new business models

Aetna acquired Medicity to gain expertise in healthcare information exchange.  Aetna had already acquired Active Health to gain access to its CareEngine analytics platform.

Continue reading “Will Payers be the Business Intelligence Services of the Future?”

2011 was a year of change and tumult. For a day by day look at the top stories of 2011, check out this impressive chart from the UK Guardian.

It was a year in which the economy sputtered worldwide, the Arab Spring toppled several regimes, and unprecedented acts of nature (severe weather, earthquakes) caused billions in worldwide damage.

What about the world of healthcare IT?

Federal

In 2011, Meaningful Use and Certification accelerated healthcare IT adoption and doubled implementation of EHRs throughout the country. Every aspect of the industry was stressed along the way

  • Vendors were challenged to add the features necessary for certification resulting in some “haste makes waste” lack of usability and workflow integration. GE admitted its faults and should be congratulated for its honesty, since many other vendors had the same problems but did not communicate them.
  • IT organizations created productivity miracles to meet meaningful use timeframes with limited staff and limited budgets. Many organizations will apply their meaningful use payments to general operations and not IT department budget increases, so the sacrifice of IT staff may remain unrecognized.
  • Providers had to radically change workflows to accommodate new business processes, resulting in staff turnover and short term frustration.

Continue reading “A Look Back at 2011″


Last week was the massive Salesforce.com user conference Dreamforce (massive in that there were more attendees at Dreamforce then this year’s HIMSS!). We’ve been reviewing more than a few articles and writings written by those who attended the event. In the few short years of its existence (~13yrs) Salesforce.com has become one of the leading Customer Relationship Management (CRM) vendors in the market and basically pushed the previous leader Siebel to the brink and into the arms of Oracle. Salesforce is arguably the leader in the Software as a Service (SaaS) market and thus someone to pay close attention to on all things “Cloud Computing.”

So what makes Salesforce.com so compelling and what are some parallels to the healthcare sector?

Similar Market Demographics: From the beginning Salesforce has always been structured as a SaaS and targeted the hard to reach and highly distributed sales forces of companies of all sizes. Actually, they first targeted the small to medium business (SMB) market and once successful there, went after Siebel in big enterprises. In healthcare, the vast majority of care is provided by small, 1-3 physician practices that are highly distributed across the country – perfect target for a hosted SaaS offering.

Continue reading “Who will be the Salesforce.com of Healthcare IT?”

According to the latest count, there are 255 Health Information Exchange (HIE) organizations across the country, which amounts to an average of 5 in each State. If you are a practicing physician and have an EHR, chances are someone already knocked on your door offering to connect your practice to the local HIE for a small fee. If you don’t have an EHR, you may have had offers to access an HIE web portal, or maybe an HIE supplied EHR Lite, allowing you to at the very least view clinical data from other sources. Perhaps for free. If you are the proud owner of one of the full-featured EHRs, you may wonder what an HIE can do for you that your EHR is not already doing, and whether that service is worth your hard earned money.

In theory, a top-shelf EHR should be able to connect your practice to multiple facilities and allow you to exchange information to the best of all participants’ abilities. Granted most EHRs are still working on some of the connections, particularly to local facilities, but all in all, an EHR should be able to eventually provide for all your connectivity needs as shown in Figure 1. Note that for some types of connections, your EHR vendor can use a clearinghouse or portal approach to simplify and reduce costs of connectivity. For example, you don’t need a separate interface for each pharmacy – you use Surescripts as the clearinghouse and let them worry about it. You also don’t need an individual connection to each patient’s home – you communicate with all of them through one portal. With the exception of Surescripts pharmacy connectivity and a small number of reference labs, each connection, or interface, is costing you a pretty penny, and the more local the connection, the longer it takes to build.

 

Continue reading “From EHR to HIE and Back”

The idea behind a network is that it grows stronger as more participants join it. A basic example is a cell phone provider that allows its members to make free calls to other members – the policy becomes more valuable as more people join the network.

Health Information Exchanges (HIEs) work on the same principle – networks connecting electronic health record (EHR) systems, pharmacies, Medicaid Management Information Systems, etc. The idea is sound, but the information shared is only as valuable as the number of participants and the quality of the data and resources.

Interconnectivity and interaction among providers can potentially do so much to raise the standard of patient care that it’s important we do all we can to facilitate participation in HIEs. With that said, we must recognize that it takes time to build quality and we want to make sure we’re getting it right. Continue reading “The Power of a Network: Health Information Exchanges”

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