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Health IT Pulse


July 25, 2014  2:59 PM

Congress puts ICD-10 delay under scrutiny



Posted by: DonFluckinger
EHR safety, EHR usability, ICD-10, ICD-10 delay

Meaningful use and EHR safety are in Washington lawmakers’ sights, as we’ve highlighted recently in a story and a blog post. Congress isn’t done yet: Looks like they’re going after ICD-10, too.

Earlier this year, Congress mysteriously hardwired an eleventh-hour ICD-10 delay into the yearly Medicare reimbursement bill known informally as the “doc fix,” which was signed by President Obama without debate. Since then, CMS Administrator Marilyn Tavenner announced that transition will be Oct. 1, 2015; the earliest Congress would permit it. Last month, three senators and representatives wrote a letter seeking additional information and assurances that CMS and private industry will be ready to go on that day. On top of that, they asked for regular reporting of “ICD-10 activities associated with both the Medicare and Medicaid programs” to Congress.

Carl Natale, top-notch ICD-10 blogger, thinks the letter could be a precursor to Congressional hearings, which would shape up to be as exciting as watching paint dry. Natale makes a great point: “…just one round of testimony on ICD-10 preparation should be enough to persuade lawmakers that they have more interesting things to worry about.” Because on the surface, ICD-10 may look like a fun hot potato with which political pot-stirrers can play catch. But it’s not.

Imagining pols like Representative. Dave Camp (R-Mich.) and Representative Sander Levin (D-Mich.) getting down and dirty with justifying the implementation of more granular diagnostic codes (“Tell me precisely why it’s important to note whether it was the left or right hand on which the patient broke his finger, and enumerate which digit!” someone could question Tavenner, dramatically, peering over his half-lenses with a holier than thou look) might be fun, but it’s unrealistic. You think C-SPAN is boring now? Wait ’til this one hits the docket.

While imagining some of these bitter HITECH program rivals — Reps. Camp and Fred Upton (R-Mich.), signatories to the letter, have been challenging it for years — attempt to boil down ICD-10′s complexities to TV news sound bites might make for a fun lunch hour among us HIT observers, there’s a very serious undertow to this letter. If Natale’s right, there’s more potential lambasting of HIT systems at public hearings to come. It could be one more thing Congress goes after this upcoming election season.

Healthcare provider CIOs and CFOs have enough problems figuring out how to spend their already inadequate budgets. Playing guessing games about what federal technology initiatives will or won’t be in place next year is by extension playing games with patient care quality….especially for those living in underserved areas already strapped for resources. It’s time for Congress, vendors and regulators to come to a consensus for the benefit of the patients, healthcare providers and constituents they serve and drop the political battles.

July 24, 2014  11:58 AM

EHR safety battle could be looming



Posted by: DonFluckinger
CDC, EHR, EHR safety, interoper

Both the Centers for Disease Control and Prevention and the U.S. Senate are examining the matter of EHR safety and preventing errors. That’s nothing new. But, as they tie into matters of meaningful use, these fresh looks at EHR safety could point to louder drumbeats come this fall.

Meaningful use, it appears, could be under scrutiny; sources told us earlier this month that some D.C. forces are considering bringing it to a peak this fall during midterm elections.

Earlier this year a CDC report examined the lack of interoperability between lab systems and EHRs as a source of adverse events, and  Megan Sawchuk, lead health scientist for CDC’s Office of Public Health Scientific Services, in the Division of Laboratory Programs, Standards and Services told Healthcare IT News “Enough’s enough.” ECRI Institute named interoperability problems one of its top 10 health technology hazards of 2014.

Health Data Management reports that Ashish Jha, M.D., professor of health policy and management at the Harvard School of Public Health, testified most hospitals don’t even know when adverse events occur before the Senate Health, Education, Labor and Pensions Subcommittee on Primary Health and Aging.

EHR safety is a matter industry watchdogs and patient advocates have discussed for years. But the crescendo is getting louder this month. Why? With health data interoperability a focus of meaningful use, and pressure mounting on ONC from groups like the American Medical Association regarding its rollout and schedule, its safety implications appear to be another wedge being driven between federal HIT authorities and the healthcare system.

Jha, for his part, deflected that pressure off ONC and on to the vendors in his Senate testimony, suggesting that automated adverse event reporting be built into federal EHR certification. Peter Pronovost, M.D., senior vice president for patient safety and quality, and director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine, testified that while the federal government and healthcare providers have spent billions of dollars on HIT upgrades, they “have little to show for it.” He said productivity has decreased, in part, because of another vendor issue: Poor usability.

It will be interesting to watch the coming months, as HIT thought leaders, policymakers and pols line up to assess a very real problem and assign blame when given public platforms. No matter who’s at fault, one truth remains: Patients deserve better, and no matter the political stripe of who’s elected this November, EHR safety should be addressed together by vendors, healthcare providers and ONC.


July 23, 2014  12:08 PM

Substance abuse research comes to social media



Posted by: adelvecchio
data analytics, drug diversion, drug tracking

For those trying to track and shut down the spread of illicit drugs, there may be no need to hit the streets. A developing product, the National Drug Early Warning System, will help health experts scan social media to spot and combat the outbreak of common illicit drugs such as heroin as well as newer “designer synthetic compounds.” The identification system will also pull information from traditional national and local resources.

The National Drug Early Warning System is being developed by The University of Maryland’s Center for Substance Abuse Research, with funding from National Institute on Drug Abuse (NIDA). “By monitoring trends at the local level, we hope to prevent emerging drug problems from escalating or spreading to surrounding regions,” NIDA Director Nora D. Volkow, M.D., said in a release. Mining social media holds a few time-sensitive advantages over standard resources, which typically don’t report on emerging drugs and take more than a year to collect to obtain and analyze data.

Though social media outlets can be good places to source patient opinions and population health trends, healthcare policy researchers are reluctant to use those channels as means to spread their findings. Of 325 health policy researchers registered for the 2013 Academy Health Annual Research Meeting, only 14% said they tweeted, and 21% said they blogged about their research or other healthcare policies in the past year. Some of the reasons respondents used to explain their collective lack of interest in social media for professional purposes included: it’s incompatible with their research, it puts them at risk and they are unfamiliar with the technology.

Even in a controlled environment of medical professionals, inappropriate drug use can still be problematic. Hospitals have taken to using data analytics to stop drug theft, or drug diversion, among employees. Facilities that deploy automated drug-dispensing machines can set their analytics systems to trigger an alert whenever they come across irregular drug patterns, something that isn’t readily apparent when drug records are manually reviewed.


July 21, 2014  4:04 PM

American Medical Association blasts meaningful use guidelines



Posted by: ShaunSutner
AMA, EHR attestation process, Meaningful use

The American Medical Association is blasting the federal government’s proposed changes to the EHR meaningful use incentive program for 2014.

“The proposed rule does not address our overarching concern with the MU program, which is the “all-or-nothing” mandate on physicians, James Madara, M.D., executive vice president and CEO of the American Medical Association (AMA), wrote in comments on the proposed rulemaking addressed to CMS Administrator Marilyn Tavenner. “The proposed rule is generally aimed at early adopters of electronic health records and larger providers, leaving other participants with little relief.”

In particular, the AMA is urging CMS to remove what the medical group calls the “existing pass-fail approach” and replace it with a 75% pass rate and to allow physicians who meet at least 50% of the meaningful use requirements to avoid a financial penalty.

The AMA’s position, according to Madara’s letter, is that unless the meaningful use program itself is modified, most doctors won’t move to stage 2 of the program and will never reach stage 3. He reiterated previous AMA complaints that many doctors are facing major problems using certified EHR software systems to meet information exchange and patient engagement objectives.

“Too much emphasis has been placed on future stages of MU, when 50 percent of physicians have yet to even make it to stage 1,” Madara added. “We are concerned that CMS and ONC (the Office of the National Coordinator for Health Information Technology) have not spent enough time learning from those who have participated in stage 1 before the agencies design, propose and execute subsequent stages. We therefore believe that CMS and ONC should conduct a rigorous study of the meaningful use timetable before proposing any future stages.”

The AMA says the hardship provisions and extensions proposed to allow doctors who were scheduled to move to stage 2 to stay another year in stage 1 are inadequate, with CMS’ own data indicating that only 1% of physicians have attested to stage 2 so far in 2014. “Accordingly, the one-year exception provides little relief,” Madara wrote.

The AMA also criticized the time of the proposed rule. The comment period closes July 21 and the final rule is not expected before Sept. 1, so doctors will not know meaningful use requirements until the year is almost over, Madara argued.

Therefore, the group is again asking CMS to extend the hardship deadline until 30 days after the final rule is published.


July 16, 2014  2:13 PM

Doctors must register now to dispute Open Payments info



Posted by: ShaunSutner
conflicts of interest, Open Payments, sunshine act, transparency

It’s decision time for doctors.

At least it is for those docs and teaching hospitals that will dispute or think they may want to dispute public postings of certain payments or items of value given to them by drug manufacturers and makers of medical and biomedical devices as stipulated by the Physician Payments Sunshine Act.

The Sunshine law and accompanying Open Payments system, which is part of the Affordable Care Act, really kicks off Sept. 30, when the Centers for Medicare & Medicaid Services (CMS) first releases the information publicly.

But docs and officials at teaching hospitals need to act quickly if they want to be able to question payments. CMS will not mediate disputes; if payments are disputed and not resolved by Aug. 27 they will appear on the Open Payments system as “under dispute” while the doc or hospital tries to resolve things with manufacturers or group purchasing organizations (GPOs).

So, doctors and hospitals have from July 14 to Aug. 27 to review and initiate disputes of data submitted about them. That’s the first 45-day period of the process. The next step is a correction period from Aug. 28 to Sept. 11 during which applicable manufacturers and GPOs can try to resolve disputes. Corrected data will be noted as resolved on the Open Payments system.

In the meantime, CMS recently updated its Open Payments User Guide.

CMS says Open Payments is about helping beneficiaries, consumers and healthcare providers better understand relationships between teaching hospitals and companies Agency officials also say they are hoping to encourage transparency; prevent inappropriate influence on research, education and clinical decision-making; avoiding conflicts of interest; and minimize risk of increased healthcare costs.

“Collaboration among physicians, teaching hospitals, and industry manufacturers can contribute to the design and delivery of life-saving drugs and devices,” CMS says on its Open Payments website. “However, while some collaboration is beneficial, payments from manufacturers to physicians and teaching hospitals can also introduce conflicts of interests.”

Naturally, all this hubbub around sunshine has some physicians worried, and the AMA is urging members to get moving if they’re concerned about their data.

The front page of the physician trade association’s Web site right now is emblazoned with a step-by-step process urging physicians to complete the CMS e-verification, register with the Open Payments system, and review and dispute data by Aug. 27.

In a statement emailed to SearchHealthIT, Robert Wah, M.D., president of the American Medical Association, said:

“It is imperative that physicians make sure to register, review, and if necessary, dispute inaccurate reporting under the Physician Payments Sunshine Act as soon as possible since the limited, 45-day review period before the information goes public has already begun.

“The American Medical Association (AMA) is aggressively spreading the word about how physicians can protect themselves from potentially inaccurate reporting, raising awareness of the August 27 deadline to have potentially erroneous data flagged in the initial public release, and is providing an online toolkit to help physicians go through the registration, review and dispute process.”


July 16, 2014  12:28 PM

National use of e-prescribing software hits 70%



Posted by: adelvecchio
e-prescribing, e-Rx, ONC

Amid staff changes and departmental reshufflings, the ONC can point to one sustained national health IT success: Physician adoption of e-proscribing software. All U.S. states have physicians e-prescribing through EHRs at a rate greater than 40%. The national average for e-prescribing is 70% — a percentage that 28 states meet or exceed — according to Surescripts, Inc. data analyzed by the ONC.

The ONC has been tracking e-prescribing since December 2008, when all but one state’s e-prescribing rate was less than 20%. That year marked the passage of the Medicare Improvements for Patients and Providers Act, also known as the eRx Incentive Program, which allowed for dispersal of incentive payments to providers “to facilitate the use of e-prescribing.”

The ONC’s 2012 update on the growth of e-prescribing in showed that that 48% of physicians were using-prescribing software. The percentage of physicians e-prescribing through an EHR rose in all 50 states from December 2008 — when only 7% of all American physicians were on board — into June 2012. At the time of that ONC report, 23 states had more than 50% of their physicians using e-prescribing software.

The ONC’s reports aren’t the only indicators that e-prescribing is a turning into a healthcare standard. A report published by Transparency Market Research forecasts the U.S. market for e-prescribing — valued at $250.2 million in 2013 — will be worth 887.8 million in 2019. Their prediction is based on an estimated compound annual growth rate of 23.5% through 2019. The high cost of e-prescribing systems and patient privacy and security weaknesses are listed as common drawbacks to e-prescribing.

In an analysis of health IT use patterns from 2009 to 2012, a study done by The Commonwealth Fund found the percentage of physicians that engaged in e-prescribing rose from 40% to 64% in that timeframe. The number of physicians with the ability to send their prescriptions electronically to pharmacies also nearly doubled — going from 34% to 66%.


July 11, 2014  12:02 PM

Two-factor authentication a must for cloud health IT



Posted by: DonFluckinger
cloud implementation, EHR security, HIT cloud, Meaningful use, multifactor authentication, two-factor authentication

Two-factor authentication – using a second identifier beyond a password to access data, be it a smartphone text code, retinal scan, fingerprint, DNA sample or other pound of flesh — has been discussed as a mandate in meaningful use for years, the latest in 2013 as federal advisory committees mulled their wish lists for stage 3.

Forget what the government says: For providers using cloud health IT services, especially public cloud providers such as Amazon Web Services (AWS), it’s time to enable two-factor authentication, now.

Why the hurry? A recent story, posted on SearchSecurity, our sister site, tells a tale of Code Spaces, a company driven out of business when a hacker  launched a  distributed denial-of-service attack and on top of that, gained control of its AWS control panel login credentials. The hacker, trying to ransom the company in return for stopping the attack, began destroying data when Code Spaces didn’t cooperate.

The lesson of the story? With two-factor authentication, the hacker would have had a much more difficult — if not impossible — time taking control of the dashboard, sources said, and the company would still be in business.

Multifactor authentication, it turns out, has an outdated reputation of being a lot more inconvenient than it is today, because earlier versions were more difficult and cumbersome. Today’s multifactor authentications are cheaper and less painful than, for example, RSA security tokens of yore.

We know that in healthcare, organizations typically spend less on IT than their counterparts in market sectors such as finance and education. But we also know that cloud vendor utilization is on the rise in healthcare, and that data breaches can cause headaches that diminish patient trust and cause fines with federal and state health privacy and consumer protection authorities.

So forget what a future edition of meaningful use may or may not require; if your shop is using a cloud provider for storage, applications or both, protect your data with a multifactor authentication system. Today. That, or risk being the next Code Spaces.


July 10, 2014  5:10 PM

Tool crunches meaningful use compliance with proposed rule



Posted by: DonFluckinger
AAFP, EHR, EHR certification, Meaningful use, meaningful use stage 2, ONC

Some IT leaders for healthcare providers wonder what is going to happen this upcoming election season as rumors swirl around the future of meaningful use stage 2.

Others, according to DirectTrust CEO and longtime Senior Policy Advisor for the American Academy of Family Physicans David Kibbe, M.D., read ambiguity into a proposed rule that would loosen compliance rules for 2014. Some, he said, interpret the rules to read something along the lines of, “this year, do what you can and we’ll figure out next year.”

Turns out, there’s an app for that.

For providers, CMS released a tool creatively named the “CEHRT NPRM Tool,” which refers to the agency’s Certified EHR Technology Notice of Proposed Rulemaking. The rule, which we point won’t be finalized until later this year, suggests providers can use both 2011 and 2014 certified EHRs (or a combination thereof) to qualify for incentives; the regulations in force now say only 2014 qualifies for stage 2 attestation.

Confused yet?

Well check out this tool. Depending on what stage your organization is attesting to, and what version clinical quality measures (labeled all over the tool as “CQMs”), it offers some advice on what to do.

Then again, any advice anyone gives on stage 2 compliance, at this point, should be used for entertainment purposes only, regardless of the source. After all, the latest proposed rule is just that — proposed.


July 9, 2014  3:42 PM

Practice Fusion launches searchable database of de-identified open health data, allowing consumers to track disease and prescribing trends.



Posted by: ShaunSutner
Infographics, open health data, Practice Fusion, searchable database

Bet you didn’t know that shoulder contusions are trending up as the number-one reason for doctor visits, and that post-trauma headaches and middle ear infections account for the next two biggest increases in doctor visits lately.

These developments were flagged in a free, searchable database of de-identified open health data for consumers, “Insight,” launched by Practice Fusion, Inc. a San Francisco cloud EHR vendor. It aggregates data from Practice Fusion’s 112,000 physician users, who see an average of 250,000 patients a day, according to the company.

Of course, consumers beware: As with any “free” vendor initiative, be aware that the claimed real-time data users can play around with was collected by an EHR vendor with its own agenda, including generating sales and leads. While it’s fun to explore, it’s not necessarily thoroughly objective, third-party-vetted, peer-reviewed stuff. But it sure is interesting.

Trending down, by the way, are conjunctivitis, abdominal tenderness, and cellulitis, according to the interactive infographics found in Insight’s diagnosis section, which tracks visit volume for a few dozen diagnoses on a week-over-week basis.

Meanwhile, the top 10 from 2013 through the present are: hypertension, hyperlipidemia (otherwise known as high cholesterol); diabetes; depression; osteoarthritis; reflux disease; hypothyroidism; obesity; anxiety; and insomnia. The database goes on to list the rest of the top 100, and each one’s share of the total pie.

Insight also allows users who register with an email address to check market share of prescribed medications by drug class. For example, within the angiotensin blocker class, Lisinopril enjoys a 72% market share. Among SSRI antidepressants, Zoloft has 17% of the market, while old standby Prozac clings to 12%, Celexa takes 11% and Paxil CR, 1%, as of July 6.

As for patient data (all anonymized), here are some notable data points gleaned from Insight. Fifty-nine is the median age for all patients, 53% of whom are male. The median body mass index of all patients is 33, which, somewhat distressingly, is well over the 18.5-24.9 normal range stipulated by the American Cancer Society.

In the prescriber section of the database, we learn the specialties are ranked in this order among clinicians who prescribe Invokana, a Type 2 Diabetes drug: internal medicine, 37%; family medicine, 31%; endocrinology, 25%; general practice, 4%; and cardiology, 1%.

Here’s the catch. To obtain access to the full range of 2,000 pharmaceuticals as well as a broader range of data views including drug switch trends, though, customers have to pay for a premium account.


July 8, 2014  1:16 PM

Test of certified EHR systems finds flaws in document exchange process



Posted by: adelvecchio
C-CDA, certified EHR technology, EHR certification, meaningful use stage 2

Federal regulators proposed to extend the meaningful use compliance deadline for providers who may still be working to meet stage 2 regulations in 2015. It turns out some certified EHR systems aren’t quite ready yet, either.

Stage 2 of meaningful use requires use of the Consolidated Clinical Document Architecture (C-CDA) to facilitate the electronic exchange of documents between EHRs; something certified EHRs should be equipped to handle in order for providers to receive incentive payments for stage 2. A study published in the Journal of American Medical Informatics Association evaluated C-CDA documents from 21 vendors, 14 of which were certified EHRs, and found 615 errors. Ten of the vendor applications were error-free, while the remaining 11 averaged 71 errors per application. Omitting or misusing medication dose quantity and omitting or misusing a patient’s allergic reaction data were two of the most common errors or inconsistencies discovered by the study.

Research on EHR adoption rates, done by data scientists at the University of California Berkeley’s School of Information, was recently summarized in an infographic. The data showed the percentage of office-based physicians using any type of EHR rose from 18% in 2001 to 78% in 2013. Four of the five states with the highest level of EHR usage among physicians checked in at over 70%, while the five territories (including Washington, D.C.) at the bottom of the list were still over 50%.

Some EHR systems may not be able to handle the electronic document exchange requirements of meaningful use stage 2, but their other functions can still add up to savings, according to a study published in the American Journal of Managed Care. The main takeaway from the study was that patients treated in hospitals with advanced EHRs cost 9.66% less than patients treated in hospitals that haven’t deployed advanced EHRs — an average difference of $731 per patient. The study notes, “The majority of hospitals have yet to reach the stage of implementation where cost savings are possible, since they are not using advanced EHRs,” and thus “must anticipate that the financial savings may not exist until advanced, ‘meaningful’ use is attained.”


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