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Why the Market Can’t Solve the EHR Interoperability Problem

Apr 9, 2015• 2

By ROSS KOPPEL and STEVE SOUMERAI

Niam Yarhagi’s THCB piece, Congress Can’t Solve the EHR Interoperability Problem (March 21, 2015) raises excellent points with which I mainly agree. So why write a responding blog? Because I don’t agree with his solution.

To review: Dr. Yarhagi discusses a draft congressional bill that calls for the creation of a “Charter Organization” that “shall consist of one member from each of the standard development organizations accredited by the American National Standards Institute and representatives that include healthcare providers, EHR vendors, and health insurers.”

Four agreements: I agree with Dr. Yarhagi’s conclusion that the proposed charter organization will not succeed; I agree with his prediction that it won’t be able to develop useful interoperability measures (hint: these are the same vendors that have refused to cooperate for the past 30 years); I agree that the ONC or CMS will not decertify an EHR vendor that has over 50% of all American patients and providers; and I agree that there are some medical providers who intentionally refuse to share patient information (because they think it gives them a competitive advantage over their local rivals).

One disagreement: But I disagree strongly with Dr. Yarhagi’s faith in the market to ensure that healthcare information technology (HIT) vendors will be obliged to “develop sustainable revenue stream through reasonable exchange fees negotiated with the medical providers.” That is, he asserts that if there were a real market without federal subsidies and requirements that all healthcare providers buy the HIT, then providers and the HIT vendors would agree on reasonable fees for exchanging patient records.Continue reading…

How Technology is Driving the Next Wave of Telemedicine

Apr 9, 2015• 2

By RYAN BECKLAND

The growth in business cases for new models of healthcare delivery and integration of digital health technology is reaching the point of convergence — creating powerful synergies where there was once only data silos and skepticism.

We have not quite achieved this synergy yet, but opportunities emerging in 2015 will move the industry much closer to the long-awaited initiatives in connected, value-based care.

Individuals are constantly hyper-connected to a variety of technology networks and devices. Wearables will continue to enter the market, but their features and focus will go well beyond fitness. Even the devices entering the market now are more sophisticated than ever before. Some are now equipped with tools like muscle activity tracking, EEG, breath monitoring, and UV light measurement.

It will be fascinating to watch how consumer electronics, wearables, and clinical devices continue to merge and take new forms. Some particularly interesting examples will be in the categories of digital tattoos, implantable devices, and smart lenses.

As the adoption of wearables continues to grow, we will continue to see more value placed on accessing digital health data by healthcare and wellness organizations. This will be especially important as healthcare shifts towards value-based models of care. The need to gain access to the actionable data on connected devices will only grow as innovation creates more complex technologies in the market.

Electronic Medical Records May Cast Physicians in Unfavorable Light During Lawsuits

Apr 9, 2015• 1

By KEITH L. KLEIN, MD

While the electronic medical record (EMR) has advantages, it also has introduced liability risks. EMRs can lead to lawsuits or result in a weak defense by casting the physician in an unfavorable light.

EMRs can increase malpractice risk in documentation of clinical findings—copying and pasting previously entered information can perpetuate any prior mistakes or fail to document a changing clinical situation.1 In a study by The Doctors Company of 97 EMR-related closed claims from 2007 to 2014, 13 percent of cases involved prepopulating/copy-and-paste as a contributing factor.2 Copy-and-paste is a necessary evil to save time during documentation of daily notes, but whatever is pasted must also be edited to reflect the current situation. Too often the note makes reference to something that happened “yesterday.”

Checkboxes, particularly those that prepopulate, can be a physician’s nemesis. EMRs have been presented in court that show, through checkboxes, daily breast exams on comatose patients in the ICU, detailed daily neurological exams done by cardiologists, and a complete review of systems done by multiple treating physicians on comatose patients. Questioning in court as to how long it takes to do a review of systems and a physical examination, the patient load of the physician for that day, and how many hours the physician was at work cast doubt on the truthfulness of the testifying physician. A time analysis showed there was no way the physician could have accomplished all that was charted that day, leading to the loss of credibility of that physician in court.

The Coming Health Tech Disruption

Apr 8, 2015• 38

Mark Cuban has been actively commenting in Saurabh Jha’s THCB post about him. We thought this comment was worthy of being a standalone post (and he agreed)–Matthew Holt

By MARK CUBAN

The tech sector will leave people better off at a lower cost. Moore’s law will have its day. But we are 5 years off from minimal impact. 10 years off from Marginal Impact.

In 20 years we will all look back and think 2015 was a barbaric year of discovery.

To give perspective. We pioneered the Streaming Industry TWENTY YEARS AGO. And now we are finally seeing streaming becoming mainstream as a technology but it still cant scale to handle mega live events.

HealthTech will continue to move forward quickly with lots of small wins. It will slow down when there is an inevitable recession in the next 20 years, then jump again afterwards.

In 30 years our kids/grandkids will ask if its true that there were drugstores where we all bought the same medications , no personalization at all, and there were warnings that the buyer may be the one unlucky schmuck that dies from what used to be called over the counter medication.

We will have to admit that while unfortunate it was true. Which is why “one dose fits all ” medications were outlawed in 2040 🙂

By then hopefully we will have a far better grasp on this math equation we call our bodies.

Of course it will be long before then that we make decisions based on optimizing health rather than trying to reduce risk.

The biggest challenge will be training health care professionals.

Medicine today seems to be in that 1980s phase that tech went through where no one got fired for hiring IBM. So IBM got lots of business because it was the safe choice rather than the best choice.

HIMSS 2015: Girish Navani

Apr 8, 2015• 1

By MICHELLE RONAN NOTEBOOM

Our intrepid tech columnist Michelle Noteboom caught up with eClinicalWorks CEO Girish Navani last week to talk with him about his company’s future, his patient engagement strategy and his plans for international expansion.

Michelle Noteboom: What’s the latest news from eClinicalWorks?

Girish Kumar: There’s a lot Michelle. I like to put it into some buckets so that I can define them. The core is our EHR and practice management space and the focus continues to be on usability and always making it’s more provider-friendly; the whole space around using touch and speech. We seem to be doing some innovative work in that arena to make EHR even more usable than just point and click. In that space we’re seeing continuous growth based on good customer satisfaction and retention.

That’s part one. Obviously the government mandates dictate a lot of other things. Meaningful Use 3 comes on the horizon. Interoperability is a big deal and I think we’ve done some good work with Epic and eCW integrations now for our mutual customers, which is making interoperability even better with faster deployment for our clients.

That’s the core. There are three other things. One is revenue cycle management, which averages 2.9%. We’ve gotten good momentum in that space, with both new customers and convergent customers.

Population health: we’re competing with stand-alone companies in that space reasonably well in both ACO product lines. We did well with other quality programs, so that’s an area that we’ll continue to invest.

SGR. RIP, Hopefully

Apr 8, 2015• 12

By STEVEN FINDLAY

The U.S. Senate has an opportunity next week to hammer the final nail in the coffin of the failed “sustainable growth rate” (SGR) formula for Medicare physician payment. At the same time, it can move the U.S. closer to a system that pays doctors for the quality of care they deliver, not the quantity.

Bear in mind that Medicare pays about a third of the tab each year for all physician services in the U.S.

For those who have not been following this issue (and I don’t blame you, it’s convoluted, even tortuous), here’s a quick recap:

The House in a rare bipartisan vote (392-37) voted on Thursday, March 26 to repeal the SGR formula, which has been in place since 1998. The formula, part of the Balanced Budget Act of 1997, was intended to constrain Medicare spending by pegging annual physician fee updates to a target based on the growth in overall physician spending and the gross domestic product.

The formula never worked. I’ll spare you the details on that. Suffice is to say that the disparities between the growth in physician costs and GDP over the period 2002-2013 were such that reducing physician fees each year by the amount the formula dictated were—well, let’s just say they were very politically distasteful. Continue reading…

The Digital Doctor – The Review

Apr 8, 2015• 20

By MATTHEW HOLT

Bob Wachter has been about as influential an academic doctor as there’s been in recent years. He more or less invented the concept of the hospitalist, he’s been a leader in patient safety, and even dressed up and sang as Elton John at the conference he runs! (He’s also pissed off lots of doctors by being a recent one year chair of the newly controversial and perhaps scandalous ABIM). But for the last 2 years he’s been touring the good and the great of health care and IT to try to figure out what the recent introduction of EMRs at scale has meant and will mean. The resulting book The Digital Doctor is one of this year’s “must reads” and yes we will have Bob as the keynote at this Fall’s Health 2.0 Conference.

The immersion research he conducted was fantastic. Bob interviewed just about anyone you’ve ever heard of and a few you wish you hadn’t (more on that later). And in fact he’s been running interviews on THCB and elsewhere sharing some of the stuff that didn’t get in the book. But I’m still wrestling a little with what I think about the book itself. And I think it’s because I largely agree with him and his angst.

There is lots of wonderful stuff in this book. The change in the role of radiology post PACS, how patients are using open notes, whether Vinod Khosla agrees with Vinod Khosla about algorithms replacing doctors–all this and much more are here. But the book is largely about the introduction of the current generation of EMRs into the everyday practice of ordinary clinicians. There are by and large three camps of opinions about what’s happened.

One is that the EMR is a pox visited on physicians that costs a fortune, has worsened quality, heightened medical errors, blown up successful processes, and ruined the lives of doctors–unless they were given scribes. The second is that because of the “rush to judgement” caused by the HITECH Act and Meaningful Use, we put in EMRs that were based on 1990s client-server technology but they were the only ones mature enough for the job. Most of this camp thinks that they were way better than paper, will slowly improve, and that doctors and patients will find that these technologies will soon integrate with easy to use iPhone-like apps as their APIs open up–and that if we hadn’t mandated EMRs when the great recession gave us the chance, nothing would have happened. The third camp agrees that EMRs are better than paper but felt that the way HITECH was rolled out kept a bunch of dinosaurs in business, and is preventing the health IT equivalent of Salesforce displacing Siebel (or Slack displacing email).Continue reading…

HIMSS 2015 THCB Sponsor Directory. Thank You Sponsors!

Apr 8, 2015

Booth: 2023 Map
Hall: South

athenahealth is a leading provider of cloud-based services for EHR, practice management and care coordination, named the Best in KLAS #1 Overall Software Vendor for 2013. With a cloud-based network of more than 50,000 providers, athenahealth helps caregivers thrive through change and stay focused on patient care.

Booth: 8115 Map
Hall: North

Corepoint Health solutions help hospitals and care providers create seamless health data interoperability in a scalable, cost-effective manner. The Corepoint Health team offers healthcare’s most flexible integration platform along with industry-leading customer support and services. Discover why Corepoint Integration Engine has been ranked number one for six consecutive years in the Best in KLAS® Awards: Sofware & Services report.

Booth: 3413 Map
Hall: South
Booth: 2084 Map
Show Floor Landmark: Interoperability Showcase

eClinicalWorks offers ambulatory clinical solutions consisting of EMR/PM software, patient portals and a community health records application. With more than 85,000 physicians and 545,000 users across all 50 states using its solutions, customers include physician practices, out-patient departments of hospitals, health centers, departments of health and convenient care clinics.

Livongo Health adds $20m, Tullman interview

Apr 7, 2015

By MATTHEW HOLT

Livongo Health is creating a tech-based service that aims to supersede the glucometer. Headed by former Allscripts CEO (and THCB interview regular) Glen Tullman, it raised another $20m from Kleiner Perkins, DFG & General Catalyst today. I grabbed 10 minutes to talk to Glen Tullman this morning. he had very interesting things to say not only about his business but Cerner, Epic & open systems too.
[youtube]https://youtu.be/4w-pHj91PKM[/youtube]

Epic Systems’ Open Platform Will Bring U.S. Health Care Delivery Into the 21st Century

Apr 7, 2015• 11

By STEPHEN M. KRUPA

Epic Systems, the market leader in electronic health record software (EHR), recently made a quiet but potentially transformative announcement that may finally shake the healthcare industry out of its technological doldrums.

Epic said it is prepared to support the creation of a more open interoperability platform for integration with other diversified healthcare applications. This will attract substantial investment to create software that operates, hopefully seamlessly, within the Epic EHR infrastructure. Expect Epic’s competitors to follow suit, eventually opening up the marketplace of installed EHRs to third-party software developers and the efficiencies of modern, post-EHR technology ecosystem.

Epic’s critics have often denounced the company for selling a mostly closed technology, dampening hopes for the creation of an ecosystem of best-of-breed applications that work together with the EHR to automate much of the care delivery infrastructure beyond patient intake and billing. The value of such an infrastructure is extremely compelling and so the company is under enormous pressure from its customers to become more open.