$75K Mass HIway implementation grants build health information exchange capacity

More than 80 Massachusetts healthcare organizations will receive a Mass HIway Implementation Grant, courtesy of the Last Mile Program, a spinoff of the Mass HIway statewide health information exchange. The grants, Last Mile leaders hope, will increase adoption of the program and foster HIE innovation.

Established in October 2012, the Massachusetts Health Information Highway (Mass HIway) is a collaboration between the state’s Health and Human Services agency and Massachusetts eHealth Institute (MeHI) to stand up the state’s health information exchange. Doctors, researchers, pharmacists, nurses, payers and other healthcare professionals can exchange clinical information on the HIway via directly-enabled EHR systems, a local area network device or secure webmail service.

The roughly 30 grants, worth up to $75,000 each, will cover the cost of paper-based exchanges and then connect them to the Mass HIway. About $2 million in total has been budgeted for the grants; the HIE will announce the recipients later this month.

Meanwhile, MeHI is soliciting proposals for another grant initiative, the Mass HIway Interface Grant Program. Health IT vendors with four or more product implementations in Massachusetts are eligible to apply, although the primary target audience includes vendors whose products support small practices or providers not covered by meaningful use incentives.

The interface grants will support vendors’ efforts to connect their EHRs, clinical information systems and other health data systems solutions to the Mass HIway or to implement an existing interface in the state.

Vendors have until June 16 to submit applications for the interface grants; the agency plans to announce recipients around June 28.

The right platform could fuel healthcare app development

These days, integrated enterprise EHR systems rule the health IT realm. But the idea of putting in place a sort of API-based platform to run more lightweight applications for specific functions may be gaining ground.

At the MIT CIO Symposium yesterday, Beth Israel Deaconess Medical Center CIO John Halamka discussed how the healthcare system may be close to moving to modular systems or app-based health IT ecosystems, much like how app development fuels the smartphone industry. He said some aspects of stage 2 meaningful use may drive organizations toward this approach, but the formation of accountable care organizations will be the real motivating factor.

“It’s a whole different approach when you’re paid on outcomes,” Halamka said.

Beth Israel is already heading down this road toward app development. Halamka talked about how the health system has started developing its own platform geared toward helping non-clinician caregivers keep loved ones healthy. Why is the health system investing its own resources in the project? Because vendors simply don’t offer this kind of functionality. Halamka also pointed out that EHR vendors have been slow to offer integrated care management systems. These are things ACOs need to handle financial risk and keep patients well.

The idea of replacing integrated enterprise EHR systems with lighter app-based platforms isn’t new. Harvard School of Medicine and Boston Children’s Hospital researchers Isaac Kohane, M.D., and Kenneth Mandl, M.D., have advocated this approach, and won a federal grant to build it. But Halamka’s comments are telling because they suggest that it is more than a researcher’s dream. It is something that can have real-world applications.

A number of factors will determine whether an app-based approach takes off. For one, Halamka pointed out that most CIOs are so focused right now on the minutia of meaningful use and the ICD-10 transition that they don’t have time to think about much else. Going forward it may take a good deal of support from the next round of meaningful use rules and certification standards to make this kind of approach standard beyond the large academic medical centers.

But if it does become more common there could be a big upside. Advocates talk of how individual app developers could find innovative solutions to specific problems and create apps to address them much faster than large EHR vendors could. Moreover, providers would only have to pay for the specific functions their institution needs.

The idea may need some refinement, but Halamka’s comments suggest its time may soon come.

I’m not Fake Judy Faulkner on Twitter, and I don’t know who is

Health IT satire is hard. Just ask the Fake Judy Faulkner on Twitter, an account launched earlier this month which has been very quiet lately.

For the record, it’s not me behind it, and I don’t know who is. This blog post is in response to rumors and accusations pushed in our general direction on Twitter and elsewhere in the weeks since Fake Judy went live.

In the context of speculating with health IT movers and shakers at HIMSS13 about the as-yet-unknown person behind the phenomenon that is Farzad’s Bowtie — also, not us — I suggested that a fake Faulkner feed might have more comedic potential than the Bowtie, judging from the way the Epic Systems Corp. CEO tends to be more of a polarizing figure in our industry. Logically, one of the folks with whom we chatted, or one of their associates, is the culprit.

It’s one thing to crack wise at a Tweetup at the end of the long trade show day and get some laughs, and quite another to actually launch such a thing. We’re in the business of summarizing the reality show that is health IT policy development and technology implementations in the U.S. health system. We’re telling that story in small enough chunks so busy CIOs, CISOs, data storage architects and other IT staffers can stay abreast of current developments in the few free minutes they have each day.

In the end, no matter what you think of Judy Faulkner, there’s no denying that she and her company are an American entrepreneurial success story. She built that. The rest of Epic’s story is to be written, as it faces challenges of interoperability with other vendors’ products and a changing IT landscape where cloud EHR and data analytics vendors seem poised to take away large chunks of market share from traditional self-hosted server/application environments. We’ll be there to tell that part, too.

Fake Twitter accounts? We’ll leave those to wiseacres who have more time and what appears to be — judging from the tenor of the Tweets — actual axes to grind. It also appears they have a willingness to open themselves up to criticism once the perpetrator is outed. As for us, we’ll get back to work, hoping the day of nationwide, interoperable health data exchange across all vendor EHRs will come sooner than later, and that Epic will be a big part of that network.

Electronic patient notes most used physician technology in 2012

Entering notes during or after a patient’s visit is the most common use of digital technology by today’s physicians, according to a survey from Accenture LLP. Physicians from eight countries, including the U.S., were asked about their use of healthcare technology.

Of the 3,700 respondents, 66% said they routinely entered electronic patient notes in 2012. In addition, the percentage of physicians who electronically accessed data of a patient who was seen by a different healthcare organization saw the greatest increase in the last year, according Accenture. Only 33% of physicians did so in 2011. That number rose to 47% in 2012.

Vendors continue to explore different products in response to increased physician use of digital technology. After purchasing Epocrates’ mHealth drug reference app, athenahealth, Inc. announced plans for a physician-to-physician short message service (SMS). The SMS service would be free to the 300,000 physicians who use the Epocrates app. Jonathan Bush, CEO of athenahealth said the company plans install HIE functionality into the app, allowing users to send medical records to other physicians. The company says their hope is that this will increase cooperation between physicians and specialists.

Physicians’ opinions on technology are also sought when gauging the usefulness of consumer healthcare technology. An eClinicalWorks survey showed the majority of physicians (80%) would recommend a mHealth application to a patient. The survey also revealed that 58% of physicians think it’s beneficial for a mobile health app to provide patient with appointment reminders and other alerts. The respondents nearly unanimously (93%) agreed that there is value in connecting mHealth apps to EHRs.

Physician’s increased use of technology has yet to have a significant effect on how patients communicate with their caregivers, however. Handwritten notes and printouts are the most common ways patients share their data or concerns with their physician, according to a survey by Manhattan Research.  The lack of high-tech communication between physicians and patients isn’t likely attributable to an overall lack of communication, as 70% of physicians reported that at least one of their patients has shared health data with them.

FDA site encourages patient feedback on medical devices, processes

The Food and Drug Administration took a step toward greater patient engagement with the development of a website aimed at receiving patient feedback on prescription drugs and medical devices. The site also offers resources on the drug development process, from federal approval to regulating the safety of each drug once they’re publicly available. On the FDA site, patients also can apply to be patient representatives and serve on FDA advisory committees.

Margaret Hamburg, M.D., FDA commissioner, announced the  agency’s patient engagement site and said she hoped it would allow for feedback from a wider audience. “We hope, with the launch of this new Web site, to expand the role of patients beyond the select group of patient representatives and to engage a wider audience of patients in new and broader ways,” she wrote.

The FDA has other spaces for manufacturers, device users and patients to report problems with devices and use feedback to study adverse events but the new site marks a greater focus on receiving patient input. A study in the Journal of AHIMA said that involving patients in their care can prove beneficial. The study discovered that patients can improve overall data integrity by confirming the validity of their individual patient data and patient portals are one way for providers to allow patients to do so. Providers must be prepared for patient responses before implementing a portal. They should designate an employee to review and address patient feedback.

Giving patients access to their own personal health records is another way to get them involved in their care. A study from 2011 noted that less than 10% of Americans had a PHR. Web-based PHRs, like the discontinued Google Health, haven’t been as widely adopted as provider-offered PHR options. Some PHRs are becoming more versatile, allowing patients to monitor their vital signs through smartphone apps. Giving patients the chance to monitor their own health has benefits, but some physicians are hesitant to include self-monitoring data in formal patient evaluations.

Patients should validate personal health records for data integrity

Patients who question and validate their own health data can help improve data integrity, according to a report in this month’s Journal of AHIMA.

Data integrity is an ongoing challenge for most healthcare facilities. EHRs present more chances for copy-and-paste errors as multiple users enter data into patient files. Further complicating matters is meaningful use, which requires patients have timely, secure electronic access to their health information. The two may be mutually beneficial, the article suggests: If patients can help improve the accuracy of their data, clinicians can draw more accurate health intelligence from the data and in turn yield better decision-making.

To facilitate the patient do-it-yourself validation process, experts recommend that healthcare organizations develop portals that make patient collaboration easy, directly encourage patients to routinely check their personal health records and then report any inaccuracies. Physicians should also make a point of discussing test results or exam findings with patients, so they understand the content of the records.

In doing so, though, the authors said that healthcare providers should be prepared for an influx in reported errors and requested amendments. In other words, they need to designate someone to review and respond to these appeals. Educating patients on how to make these requests goes hand-in-hand with this too, of course, so patients understand what kinds of amendments may be approved or denied.

On the whole, giving patients access to their personal health records and involving them in their healthcare can yield improvements in care quality, as well as more accurate health information, the authors conclude.

ONC revokes meaningful use certification of EHR products

The process of selecting the right EHR vendor to qualify for meaningful use has been long and involved for many healthcare facilities. A recent government ruling may further complicate that process and make providers think twice before they consider a potential EHR system as a long-term investment.

Two EHR systems that were previously qualified for federal incentive payments had their meaningful use certification status revoked by the Office of the National Coordinator for Health IT (ONC). National Coordinator for Health IT, Farzad Mostashari, M.D., said in an HHS release that the products do not meet standards and can’t be used to meet the Medicare and Medicaid reimbursement requirements. The products, EHRMagic-Ambulatory and EHRMagic-Inpatient, must be re-certified by an ONC-authorized certification body before qualifying for the meaningful use program.

“By revoking the certification of these EHR products, we are making sure that certified electronic health record products meet the requirements to protect patients and providers,” said Mostashari in the release.

CMS has raised the bar for reimbursement qualifications, in addition to revoking the qualified status of the aforementioned EHR products. Physicians will be required to report data on clinical quality measures to CMS or state Medicaid authorities in order to comply with meaningful use in 2014. Stage 1 simply required physicians to attest that they had captured quality data. This new regulation puts a strain on vendors as well as providers, as vendors must ensure their products can electronically capture and report the necessary meaningful use data.

EHR certification also has expanded to include a new set of regulations tailored specifically for treating children. The CMS and the Agency for Healthcare Research and Quality collaborated to produce an outline of items necessary for a child-focused EHR format. The format contains more than 700 statements on what should be include in a child-friendly EHR. Each statement is sorted into one of three categories, based on level of necessity. These regulations will likely be incorporated into future meaningful use standards, according to CMS.

Software-based telemedicine solutions expand the boundaries of healthcare

As telehealth systems continue to gain acceptance in U.S. healthcare, new models will aim to expand the boundaries of care delivery, employing software-based telemedicine technology.

David Plummer, global business leader for Cisco Systems, Inc.’s HealthPresence, said that, looking forward, telemedicine systems are being designed with the goal of improving both patient and provider accessibility. This means designing systems to interoperate with users’ pre-existing interfaces and EHR systems, as well as integrating with medical devices such as digital stethoscopes, general exam cameras and picture archiving and communication systems.

Plummer said the industry is moving away from a “large, one-size-fits-all” telemedicine system – commonly a kiosk or pod-based system – to a single software-based solution, which allows for easier integration into a customized healthcare environment. Conversely, healthcare organizations can tailor the solution to their pre-existing technologies to create a scalable, flexible telehealth network. With a software-based telemedicine solution, providers need only medical devices that meet basic interoperability standards to bring them online.

What’s more, providers are seeing the increased accessibility offered by software-based telemedicine solutions as a business opportunity, expanding the reach of their physicians to remote users outside the hospital setting, such as local county schools, on-site corporate clinics and correctional facilities.

“Whether it’s accessing specialists or having to in to see a doctor, everyone has the same issues in terms of limited access to healthcare,” said Plummer, who will be presenting at the 18^th Annual American Telemedicine Association Meeting this May.

Few patients consider healthcare reviews when choosing a care facility

Only a third of patients consider other patients’ reviews when making a decision on where to receive care. Less than half (48%) of respondents to a PricewaterhouseCoopers (PwC) survey said they have ever read health-related reviews. Despite these statistics, some businesses in the healthcare industry are being rewarded as a result of patient reviews. Insurers that serve Medicare beneficiaries are in line to earn more than $5 billion from patient feedback before 2014. Physician and patient enthusiasm for healthcare reviews has been mild thus far.

Recent developments, like the Patient Engagement Index’s report on Florida hospitals, have made care facilities more aware of the benefits of pleasing their patients. Reaching out to engage patients is one way that can be done. Hospitals can use social media and review sites to interact with patients and control the message potential patients receive about their facility. Patients’ use healthcare reviews fewer times than expected, but it’s still another avenue through which hospitals can interact and provide patients with credible information.

Individual physicians remain skeptical about the benefits of online review sites. In response to an American College of Physician Executives survey, only 12% of physicians feel that such sites are beneficial and should be made available to the public. There is a slight disconnect between this study about the value of individual physician reviews and the PwC survey, which focused more on facilities as a whole. Still, when comparing the data between the surveys, it’s clear that more patients find value in online reviews compared to the number of physicians who agree with the practice.

The PwC report suggests that quality care is still most commonly spread by word of mouth. Providers and physicians are aware that patients are judging the care they provide, whether through word of mouth or online review. This has resulted in patients being catered to as consumers. Doctors will sometimes prescribe a less effective treatment for an illness solely because that treatment method is preferred by the affected patient.

Doctor-patient communication still commonly low-tech

Patients most commonly share their data with their physicians through non-electronic means, despite the high availability of remote monitoring applications and communication devices, according to a new report. In response to a survey by Manhattan Research, 70% of physicians reported that at least one of their patients has shared health measurement data with them. Patients most commonly handwrite a note to the doctor or give them a printout containing their health information.

The study notes patient-physician communication as a possible result of patients increasingly monitoring or tracking their own health. “Self-tracking is already a part of the care paradigm and its prevalence is going to accelerate rapidly as digital connection, payment reform, and outcome-focused delivery make advances,” James Avallone, director of physician research at Manhattan Research, said in a release.

Self-tracking is part of the “quantified self” movement. Some apps and devices unveiled at the recent CES show fall under the quantified self umbrella. Personal monitoring devices like the Fitbit and the Nike+ Fuelband have advanced and now measure blood pressure, heart rate and skin temperature; going far beyond the pedometers of old. Use of these devices arms patients with more information, though the technology has yet to change how patients share data with their physicians.

Healthcare apps are another potential platform through which patients and physicians can interact. Apps that allow doctors and patients to meet in the middle — as opposed to apps that skew more toward either audience — have proven to be the most popular. DrawMD is an iPad app that allows doctors to depict procedures to their patients by adding their own illustrations to built-in images. The Panda Health app allows patients to directly message their physicians. The Manhattan Research study suggests that patients favor face-to-face interaction with their physicians over instant communication.