Last week we attended the big healthcare IT confab HIMSS in that grand city of sin, Las Vegas. While many spoke of how HIMSS hit an all time record of over 37K attendees (an impressive number), HIMSS is still dwarfed by what is arguably the largest US-based healthcare trade show, RSNA, which had a 2011 attendance of just over 57K, (roughly 54% greater than HIMSS). Why such a radical difference you ask? As one colleague put it:
RSNA is where providers come to make money and HIMSS is where they go to lose money.
While that may be the case today, it is unlikely to be so in the future. The healthcare industry is undergoing a massive transformation that will likely take a decade to complete as we transition from a reimbursement model largely based on fee for service to one based on outcomes. Under this new model, providers will be taking on a greater portion of risk. In reward, these providers have an opportunity to receive a significantly higher net reimbursement. This transition is making for some interesting bedfellows as payers and providers join together to create new care delivery models such as Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs). These new models will be increasingly dependent on a robust HIT infrastructure to effectively measure quality, risk and performance, something that simply cannot be done effectively with the antiquated systems that are in place today in many healthcare organizations (HCOs).
George Halvorson is the CEO who initiated and oversaw the biggest (private sector) EMR implementation ever. What’s Kaiser Permanente doing to expand on that? How is the new technology changing their thinking about care? How fast does George think the rest of health care is changing (very) and can others catch Kaiser (he thinks it would help Kaiser if they tried)? And what about getting other non-Epic apps on that KP system? I spoke with George at HIMSS12 yesterday, and his views are well worth a listen.
Yesterday, one of the founders of Twitter, Biz Stone, gave the opening keynote at HIMSS.
This is probably going to be the best keynote at HIMSS, followed by a speech from Dr. Farzad Mostashari, which will also be excellent. It goes downhill after that: there will be a talk about politics and another talk from an “explorer.” I am sure those will be great talks, but when I go to HIMSS, I want to hear about health information technology. Want to know what @biz actually said? As usual, Twitter itself provides an instant summary.
HIMSS stands for Healthcare Information and Management Systems Society. The annual HIMSS conference is the largest Health IT gathering on the planet. Almost 40,000 people will show up to discuss healthcare information systems. Many of them will be individuals sent by their hospitals to try and find out what solutions they will need to purchase in order to meet meaningful use requirements. But many of the attendees are old school health IT experts, many of whom have spent entire careers trying to bring technology into a healthcare system that has resisted computerization tooth and nail. This year will likely break all kind of attendance records for HIMSS. Rightly so: The value of connecting thousands of health IT experts with tens of thousands who are seeking health IT experts has never been higher.
It is ironic that Biz Stone is keynoting this year’s talk, because Twitter has changed the health IT game so substantially. I say Twitter specifically, and not “social media” generally. I do not think Facebook or Google+ or your social media of choice has had nearly the impact that Twitter has had on healthcare communications.
HIMSS, and in many cases traditional health IT along with it, is experiencing something of a whirlwind. One force adding wind has been the fact that President Obama has funded EHR systems with meaningful use, and made it clear that the future of healthcare funding will take place at Accountable Care Organizations (ACO) that are paid to keep people healthy rather than to cover procedures when they are sick. It is hard to understate the importance of this. Meaningful Use and ACOs will do more to computerize medicine in five years than the previous 50 years without these incentive changes.Continue reading…
As those of us who work in health care prepare to analyze Stage 2 Meaningful Use rules – which are due any day now – it will be helpful to consider new data commissioned by the Optum Institute and conducted by Harris. The research finds that hospitals are progressing with adoption of electronic medical records (EMRs) but that the adoption is not creating the type of provider connectivity we need to support a more collaborative and aligned healthcare system.
To be sure, the survey of 301 U.S. hospital chief information officers has some very encouraging findings. In particular, the research finds that nearly nine out of 10 hospitals surveyed (87 percent) now have EMR systems in place – up significantly since 2011, when the Health Information and Management Systems Society (HIMSS) reported that only slightly more than half of CIOs had a fully operational electronic health record in at least one facility in their organization.
In addition, the survey finds that 70 percent of CIOs report their systems have attested to meaningful use 1 criteria (MU1) and three quarters anticipated being able to meet expected meaningful use 2 (MU2) criteria by 2014.
However, the survey also identifies six critical technology concerns facing hospital CIOs:
There has been a lot of buzz around two pieces of news –in one case, lack of news—in the past week. Last Thursday, HHS Secretary Kathleen Sebelius responded to heavy pressure from the American Medical Association and announced a delay to the ICD-10 implementation deadline, currently set for October 2013.
Meanwhile, the health IT universe continues to wait with baited breath for Sebelius and/or leadership at CMS or ONC to publish the proposed regulations for Stage 2 of the “meaningful use” EHR incentive program. The proposal was supposed to have been out before 35,000 or so health IT industry types descended on Las Vegas for HIMSS12, but it was not to be. As with any major federal rule-making, the White House’s Office of Management and Budget has to vet every word, so it is out of Sebelius’ hands for the moment.
Rumors spreading through the Sands Expo Center and the adjacent Venetian and Palazzo hotels have pegged Wednesday or Thursday for the release date, since national health IT coordinator Dr. Farzad Mostashari is leading a session on Stage 2 meaningful use with other ONC and CMS representatives Wednesday morning, then delivering a keynote address the following day.
In the wake of the ICD-10 bombshell last week, HIMSS itself and other IT-related groups are telling their membership and anyone else who will listen not to slack off when it comes to ICD-10 preparedness. HIMSS CEO Steve Lieber noted in his annual press conference Tuesday that the official HHS statement said the department would “initiate a process to postpone the date by which certain healthcare entities” must meet the requirements. That, to Lieber, suggests the possibility of a delay for physician practices or perhaps small hospitals, but not for larger organizations.Continue reading…
Innovative thinkers and influential healthcare leaders aren’t relying on the decisions coming out of HHS to determine their strategy. Despite the fact that many healthcare organizations were on target to transition from ICD-9 to ICD-10, Health and Human Services (HHS) announced it would initiate a process to postpone the date by which certain healthcare entities have to comply with ICD-10.
The details of the delay have not been revealed, but industry experts are speculating that a one-two year delay is in the works. With only 20 months remaining to the Oct. 1, 2013 deadline, this leaves many organizations in limbo. Do they continue down the path of ICD-10 adoption, revise plans based on speculation about a new timeline or completely put the initiative on hold?
The leaders in healthcare never limited their thinking to a coding mandate. They were aligning their ICD-10 efforts with quality of care initiatives- EMR adoption and improved clinical documentation. They won’t hesitate, they won’t miss a step, and they will focus on providing exceptional care through improved processes, many of which will prepare them for a successful transition to ICD-10 and ICD-11.
The following areas of focus will improve quality of care, reporting and accuracy of reimbursement.
– Lead with purpose- understand the long-term impact of a coding mandate and help providers understand the alignment of greater specificity in coding with quality reporting, improved clinical documentation and clinical decision support.
– Take this time to improve clinical documentation– develop processes and feedback to improve how physicians and other providers document care. This effort will reap financial benefits and directly impact quality of care and reporting.Continue reading…
Eric Topol was once a lowly (well not that lowly) cardiology professor at the University of Michigan, but he’s now without question the leading renaissance man in health care technology. Virtually every week sees him on some big stage disgnosing his own heart murmur with an iPhone app or showing off how his sleep brain waves and his genome interact or don’t.
His new book, The Creative Destruction of Medicine is a tour de force romp through basically every type of cool new medical technology. He covers the Cloud/Web/Wireless/Sensor phenomenon from both a social, transactional and diagnostic point of view–leaning heavily on his connection to the West Wireless Health Institute which he helped persuade Gary & Mary West to fund. He’s the creator of a new medical school program at Scripps focusing on the genomics and proteomics revolution, and the book covers in great detail the evolution of the human genome project and its impact on disease discovery (coming eventually) and matching patients to the right drug (available more or less now). Finally he was of course the head of Cardiology at the Cleveland Clinic where he not only was heavily involved in the testing of tPA (the drug that built Genetech) but also in unveiling the problems with Vioxx not limited to the drug itself but also concerning Merck’s behavior at the time. (Remember Dodgeball?)
With unsustainably high costs and tremendous gaps in quality and patient safety, the health care system is ripe with opportunities for improvement. For years, many have seen quality measurement as a means to drive needed change. Private and public payers, public health departments, and independent accreditation organizations have asked health care providers to report on quality measures, and quality measures have been publicly reported or tied to financial reimbursement or both.
Throughout the Affordable Care Act (ACA), quality measures are tied to reimbursements in multiple programs. It is critical that the Department of Health and Human Services (HHS) move forward with a strategy for measure harmonization that will accommodate local and national needs to evaluate outcomes and value. Additionally, a standard for calculation measures such as the use of a minimal data set for the universe of measures should be considered.
The field of quality measurement is at a critical juncture. The Affordable Care Act (ACA)—which mentions “quality measures,” “performance measures,” or “measures of quality,” 128 times—heightened an already growing emphasis on quality measurement. With so much focus on quality, the resource burden on health care providers of taking and reporting measures for multiple agencies and payers is significant.
Furthermore, the field itself is being transformed with the continued adoption of electronic health records (EHRs). Traditional measures are largely based on administrative or claims data. The increased use of EHRs create the opportunity to develop sophisticated electronic clinical quality measures (eQMs) leveraging clinical data, which when linked with clinical decision support tools and payment policy, have the potential to improve quality and decrease costs more dramatically than traditional ones. Innovative electronic measures on the horizon include “delta measures” calculating changes in patient health over time and care coordination measures for the electronic transfer of patient information (i.e., hospital discharge summary or consultant note successfully transmitted to the primary care physician). Additionally, traditional data abstraction methodologies for clinical data require labor intensive, chart review processes, which would be eliminated if data could be electronically extracted.