This is a summary of the HIT Trends Report for December 2010 (The Year in Review). You can get the current issue or subscribe here.
Out of 325 stories we covered in 2010, and a few new ones, we picked about 30 that best tell the story of the past year.
Tracking HITECH in 2010: The Year’s Top Stories
- 1. The biggest story in HIT this year is the elegance of the federal ARRA HITECH strategy combining provider incentives and disincentives with state health information exchanges and regional extension centers for support. While this plan is off to a slow start, it seems to be working.
2. In July the federal rules for meaningful use were unveiled; a core set of 15 required elements and a menu set of 10 optional elements among which 5 are selected. Providers will attest to meeting these measures. In the next stage in 2013, all measures will be mandatory and providers must demonstrate real meaningful use for most patients.
3. There are now 5 companies designated as authorized to certify EHR technology. The federal government is keeping an updated list of products that have been certified. At the end of 2010 the count of different certified product versions was over 200.
4. NHIN Direct is a concept that grew out of a blog by Wes Rishel, at Gartner. It’s meant for simple communications between parties who know each other. Its focus is on meaningful use, specifically, summary care records, referrals, discharge summaries and others. It’s also being used as the foundation for the clinical messaging service recently announced by Surescripts.
5. The federal government also began work on comparative effectiveness research (CER), which it now refers to as “patient-centered outcomes research.” $435 million has been awarded by AHRQ across dozens of companies and projects focused on developing patient registries, clinical data networks, and other forms of electronic health data systems in order to generate data about treatment outcomes and options that can be compared by patients.
6. Todd Park, CTO at HHS, summed up the federal strategy as “incentives plus information equals transformation.” He connects the dots between the provider incentives in HITECH, provider payment reform in the Affordable Care Act, and Data Liberación, making federal data available for innovation.
Focus on E-prescribing in 2010: The Year’s Top Stories
- 1.E-prescribing has been growing dramatically, largely within EMR systems. Surescripts announced in the fall that 200,000 prescribers, 1/3 of office-based providers, were active on its network.
2. The DEA approved a security approach, effective in June, to allow electronic prescribing of controlled substances. It requires two-factor authentication for a prescriber to get a credential and e-prescribe. One factor is something you know, like a password. The other is something you have, like a token or a specific device, or something you are, like a biometric signature.
3.The HITECH incentives require EHRs, so virtually all the standalone e-prescribing solutions found new strategies or exits. CVS Caremark retiring its iScribe solution is a typical announcement of this trend. ZixCorp and eHealth Solutions also exited. Other e-script companies, such as DrFirst and RxNT have become light EHRs, while Prematics got acquired by NaviNet.
4.Using e-script data from ZixCorp for Massachusetts, researchers at Brigham & Women’s compared prescription orders with payer claims data to document adherence rates by drug class. Overall 72% of e-scripts for new medication were filled, which the researchers call, “primary adherence.”
4.And finally, in a study by the Center for the Study of Health System Change, utilization of e-prescribing functions is the real challenge. While 42% of physicians in the study report having e-prescribing capability, only 23% of these use electronic transmission, drug interactions and formulary checking regularly. That’s fewer than 10% of all prescribers.
Focus on EHR in 2010: The Year’s Top Stories
- 1. The CDC released its annual update for EHR adoption in US physician practices in December. 25% of physicians have a basic solution. And only 10% have one CDC considers fully functional. Utilization of available functions is a key issue.
2. KLAS reported that a few firms are emerging as winners in the EHR wars. Allscripts, NextGen and eClinicalWorks are considered most often in smaller practices. Epic is a leader in very large practices. Other companies of note include athenahealth, Greenway, e-MDs, McKesson and Sage. Epic and Cerner are reported to win 70% of the over 200 bed hospital deals, and MEDITECH leads in smaller deals, although only Epic customers say it’s worth it.
3. McKinsey & Co. reported that HITECH incentives of $17,500 per bed won’t cover the $80,000-$100,000 in costs for a hospital EHR project, but an ROI is possible.
4. Health Directions, a hospital consultant, outlined how hospitals can get an ROI from EHR projects through reaching out to community physicians with services and engaging with patients. CHiME, the association of hospital CIOs, with the American Hospital Association, compiled a detailed guide to EHR implementation with real-world practical advice. It considers the HITECH incentives, but goes beyond it, focusing on the enterprise.
5. Consolidation in the EHR segment is taking some shape. Allscripts and Eclipsys combined inpatient and outpatient assets in line with future accountable care trends. GE acquired MedPlexus, a web-based EMR, pointing to the future importance of software as a service (SaaS) applications. Covisint acquired DocSite, adding a patient registry service to its physician portal being piloted by AMA. NextGen, Ingenix CareTracker, DrFirst’s Rcopia and other solutions are also using the platform.
Focus on HIE in 2010: The Year’s Top Stories
- 1. Consolidation has begun in the health information exchange segment also. Market leaders Axolotl and Medicity were acquired by UnitedHealth’s Ingenix and Aetna, respectively, the latter at $500 million. Ingenix also acquired Picis, focused on hospital high acuity, and A-Life, focused on natural language. IBM acquired Initiate, the leading HIE middleware vendor for master patient index.
2. Marlin & Associates helped explain the HIT consolidation as potentially resolving into a few super-firms who integrate infrastructure, applications and analytics for payers, providers and patients. They see an analog to financial services and Bloomberg or Thomson Reuters.
3. eHI surveyed 60 federally funded regional extension centers (RECs) and 234 HIEs and reported both groups off to a slow start. 14 RECs had signed agreements with physicians for services. Most are presenting a limited set of 3-8 recommended EMRs to physicians. 18 HIEs are sustainable without additional federal funding. Most common functions are connecting to EHRs, getting lab results and patient summaries.
4. Health systems are the most mature information exchanges because they have natural business relationships with community physicians. In fact, Premier announced it has 40 large health systems in a training program to create accountable care organizations.
5. Surescripts announced that it is opening up its physician, pharmacy and PBM network to carry clinical transactions other than pharmacy, starting with patient summaries. Any US physician can send patient clinical summaries to any other physician in the US. The service connects networks to outside physicians, mid-sized EHR solutions to its client physicians, and a portal for physicians without automation.
6. The Epic users group in Minnesota reported that it has a health record database representing 75% of the patients in the state. Most of the state’s large health organizations use Epic software.
Focus on Care Communications in 2010: The Year’s Top Stories
- 1. Insurance regulators agreed to include certain health IT expenses as medical expenses when calculating an insurer’s medical loss ratio under federal PPACA legislation. These include expenses related to communications of health record information among providers and their patients. This should make payer investments in wellness, care management and HIT easier.
3. The California Health Care Foundation released a report showing 15% adoption for personal health records in California, 11% in western states, and 7% for the US. Kaiser Permanente and Group Health are major drivers.
4. Kaiser’s EHR physician user interface is shown improve patient compliance with guidelines in two clinical studies. The tool monitors six chronic conditions and preventive measures. Patient notifications are sent via secure email. Kaiser also reports that members that use email do better than members that don’t. Ironically, another study reports that US physicians don’t use email.
5. Home health is emerging as an important area in care communications. The two segment leaders, Intel and GE, announced a joint venture combining their products and sales and marketing efforts.
6. Mobile communications is also important. WellDoc announced its mobile diabetes solution won FDA approval and a distribution deal through AT&T. Diversinet reported an Army deal to monitor returning vets with brain injuries.
A Few Final Words. Long term health and technology trends lay a foundation for the current dynamics in health IT. Federal legislation is the big driver right now. Through provider incentives it will drive adoption of certified EHR solutions from a rapidly consolidating market. Hospitals are supporting by helping affiliated practices automate. Insurers are supporting with P4P programs and new investments allowed by classifying clinical HIT as a medical expense. Larger hospitals and practices will automate first. But to get to Stage Three of meaningful use and clinical practice transformation, EHR technology isn’t enough. Innovation is required to create solutions that support more collaborative care among providers and between providers and patients in medical homes and Accountable Care Organizations. And provider compensation must be reoriented toward a new practice model.
Michael Lake has been a healthcare technology strategist for over 30 years. He is President of Circle Square Inc., a San Francisco-based strategy, business development and market research firm, focused exclusively on the healthcare information technology market. He publishes the HIT Trends Report monthly. For more information, please see www.michaellake.com.