This is a summary of the HIT Trends report for August 2011. You can get the current issue or subscribe here.
Incentives driving the EMR market. According to a report by Sage Healthcare, most physicians (65%) buying EMRs are doing so because of federal incentives. The biggest obstacle is still cost with 32% of non-users saying it’s the number one issue. This is creating a mainstream market, even in solo practices, which report over 30% EMR adoption rates in a new survey by SK&A.
Incentives may also be driving hospital implementation of computerized physician order entry (CPOE). 80% of hospitals still lack CPOE capabilities as of last year. Meaningful use requires providers to order at least one medication for 30% of unique hospital patients. In a new KLAS report, CPOE projects have more than doubled, being led by Cerner and Epic.
It is a likely unintended consequence that the incentives are speeding the dominance of market leaders.
Federal innovation and standardization. Two innovations by CMS are announced this month. One described a new bundled payment initiative that encourages providers to negotiate a total payment for an inpatient stay, or 30-90 day post discharge services, or both. This is a real innovation with lots of flexibility to propose care bundles based on MS-DRGs. CMS will provide historical data. There is both upside and downside risk to participation. It appears the focus is on reducing the costs for readmission. This program will require lots of cost/risk tracking and care coordination which will be difficult for smaller organizations. CMS envisions a broad array of provider participation as well as “conveners of participating healthcare providers.”
CMS also launched a unified consumer portal that increases transparency into physician practices, hospitals, home health and Medicare health plans. Over time CMS will increase the quality data available through this portal. Users can select up to three providers or plans to compare directly. The site is easy to use.
ONC has made significant progress on the standards front in two areas. It is proposing standards for metadata for patient ID, data provenance and privacy. This work is an outgrowth of ONC’s response to a 12/2010 report by the President’s Council of Advisors on Science and Technology (PCAST). In April 2011 an ONC analysis recommended that standards for metadata could be wrapped around or attached to a patient summary care record, e.g., part of a header for an HL7 continuity of care document.
It is also proposing vocabulary standards focused on SNOMED, LOINC and RxNorm. This work has been focused on arriving at the minimum number of technical standards irrespective of the adoption issue. The three standards selected seem to be the most modern and comprehensive for the task. It will likely take a while to implement. The committee is recommending a transition plan, particularly to accommodate movement to SNOMED from CPT, HCPCS, ICD-9, ICD-10 and others.
Health insurers are impacting the HIT landscape. Aetna announced a new ability through NaviNet to get its clinical alerts based on ActiveHealth Care Considerations to physicians in Florida at the point of care. This is a breakthrough in getting these clinical alerts to physicians in the exam room when they are in the act of e-prescribing. About 2,000 physicians are currently using the e-prescribing service in Florida, recently acquired by NaviNet from Prematics.
Highmark announced a relationship with Allscripts and Accenture to support its growing partnership with West Allegheny to integrate community physicians through EMR services, extending its battle with UPMC in western PA. UPMC has recently refused to negotiate a new contract with Highmark. Highmark is the largest insurer and UPMC the largest provider in western PA. Both are non-profit organizations now seemingly locked into a competitive situation. The deadline for a new agreement is June 2012. It’s likely that emerging accountable care strategies and HIT capabilities contribute to the environment of the dispute.
A Commonwealth Fund study of eight payer supported ACOs reveals four basic shared risk models that need lots of HIT support to succeed. These are: (1) bonus payment at risk; (2) market share risk; (3) risk of baseline revenue loss; (4) financial risk for patient population. A major roadblock to effectively managing risk is lack of data about clinical and financial patient experience required for improving quality and lowering costs. New HIT solutions are emerging to address these issues, e.g., Health Access Solutions. It has recently signed an agreement with Anthem in Northern CA.
Health policy experts also caution providers in a JAMA article discussed in CMIO magazine pursuing ACOs that HIT is a key for them as well. Authors argue in the JAMA article that Kaiser comes closest to meeting these complex requirements because of its EHR and closed system. Additionally they suggest two other outcomes measures: functional status and patient experience.
While payers are increasing investments in technology, Accenture reports that much more is required to meaningfully engage with members. One in three members think plan communications helps them feel a connection. One in five thinks plans tailor the experience for them in any way. Accenture presents a wakeup call to get more serious about member experience.
And a Health Affairs study reports that U.S. physician practices spend 10 times as much as their Canadian counterparts in communicating administrative issues with health plans. Authors note the progress of CAQH on credentialing and other administrative inefficiencies. They caution that emerging accountable care issues are likely to increase the burden.
Art of HIT. The art this month is Black Mesa Landscape, by Georgia O‘Keefe (1930), a dramatic landscape in New Mexico. We’re in a period now where the HIT landscape appears to be changing based on the quality of light from the government, provider and payer segments.
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. The company works with healthcare, life sciences and technology companies on developing strategies, products and business models for complex multi-stakeholder healthcare environments. He publishes the HIT Trends report monthly and the CHaT Trends report quarterly. For more information, please see www.circlesquareinc.com.