May 21, 2015 8:28 AM
Posted by: ShaunSutner
, meaningful use attestation
, meaningful use stage 2
, meaningful use stage 3
E-prescribing has come of age.
Now it’s e-prescribing of controlled substances’ (EPCS) turn.
In 2014, 56% of U.S. physicians and 95% of pharmacies processed 1.2 billion electronic prescriptions on the Surescripts Inc. network, according to a new report from the company, which hosts the dominant U.S. e-prescription network.
But while e-prescribing has become commonplace, e-prescribing of controlled substances — such as Vicodin, Xanax, Adderall and other popular but potentially dangerous or addictive drugs — is still rare.
Even though EPCS increased 400% last year, according to Surescripts, to a total of 1.67 million controlled substances, the practice is still nearly unknown among physicians despite 73% of pharmacies being ready to receive electronic prescriptions for the controlled drugs.
The biggest challenge to EPCS adoption is the high security standards set by the U.S. Drug Enforcement Administration (DEA), said Sean Kelly, M.D., an emergency room physician at Boston’s Beth Israel Deaconess Medical Center and CMO of Imprivata Inc., an IT security vendor that sells authentication systems to healthcare providers.
However, Kelly, who is quoted in the Surescripts release announcing the EPCS study this week, told SearchHealthIT that the DEA’s recent reclassification of Vicodin and other opioid painkillers from Class III to more restricted Class II controlled substances – in response to opioid abuse – may end up driving more EPCS.
Because Vicodin, for example, is one of the most prescribed drugs, its ubiquity may spur more EPCS because CMS’ meaningful use program requires at least 40% of prescriptions to be sent electronically in stage 2, and the proposed stage 3 meaningful use rule ups that measure to 80%, Kelly noted.
“Printing out all those prescriptions really hurts your meaningful use numbers,” he said.
To counter abuse and fraud, prescribers can’t call in scripts for Class II drugs to pharmacies. That’s why most patients go home from medical procedures or doctor’s visits with old-fashioned paper prescriptions – unless, perhaps, they live in one of the 10 states that have certified a substantial number of e-prescribers.
Kelly said new DEA-approved authentication systems — like those from Imprivata that work by verifying a prescriber’s identity and require the prescriber to use a unique physical token, badge or biometric sign-on — can make EPCS happen now.
“The technology has arrived,” Kelly said. “Now it’s going to start taking off.”
In the report, Surescripts ranked the 10 ECPS states by a combination of the percentage of prescribers enrolled in EPCS, the percentage of enabled pharmacies, and the percentage of controlled substances prescribed electronically.
For the record, those states are, in order:
- Rhode Island
Among the top 10 states, the percentage of prescribers enabled for EPCS ranges from 9.07% to 1.39%, but in some of the states with fewer current e-prescribers, higher percentages of pharmacies are ready to handle EPCS.
In the top 10, percentages of EPCS-ready pharmacies range from 91.4% to 54.1%.
In most other states, the percentage of prescribers enrolled for EPCS is around 1%, though in most states the percentage of enabled pharmacies is well above 70%.
May 19, 2015 1:22 PM
Posted by: adelvecchio
clinical decision support
, EHR systems
Physicians have come a long way in a short time in getting comfortable working with EHR systems and other healthcare technology.
Nearly 80% of U.S. physicians say they are more proficient with EHRs than they were two years ago. American doctors made up 601 of the more than 2,600 physicians from six countries that participated in an Accenture survey about caregivers’ attitudes toward health IT.
U.S. physicians were also asked to report which electronic healthcare services they used during a care episode. The most common response was recording patient notes, which was an answer given by 89% of respondents. Using clinical results to populate EHRs and e-prescribing were both cited by 83% of physicians. Those three answers were the same three pieces of health IT that the most physicians believe do the most to help them provide patients with quality care. Nearly two-thirds of physicians said entering patient notes electronically benefits patient care, while 50% and 34% felt the same way about e-prescribing and using clinical results to populate patients’ EHRs, respectively.
Accenture’s survey report also included data on which electronic services used by physicians have experienced the largest jump the last three years. The top three are as follows:
- In 2012, only 13% of U.S. physicians said they routinely used electronic methods to communicate with patients. Three out of ten physicians said they do the same in 2015.
- Nearly a third consistently receive electronic notifications when one of their patients is treated at another healthcare facility, up from 19% in 2012.
- The percentage of physicians that use clinical decision support systems rose from 24% to 34% during that same period.
The survey also asked physicians which electronic healthcare services are available to their patients. More than half answered that patients can now ask for prescription refills, securely communicate with their caregiver through email, access their medical records and receive reminders for follow-up appointments. Use of those services increased at least 35% between 2012 and 2015.
May 13, 2015 3:15 PM
Posted by: ShaunSutner
, Farzad Mostashari
, Karen DeSalvo
, open health data
, Todd Park
It’s probably the only major health IT industry event at which you can play mini-golf all day.
Welcome to Health Datapalooza 2015.
The name of the May 31-June 3 conference pays homage to rock music festival culture, and Health Datapalooza flaunts its own roster of health IT, business and media rock stars networking amid a pretty free-form setting that also includes, yes, all-day mini-golf, yoga, and a “genius bar.”
This year’s scheduled keynoters include Bruce Brassard, president and CEO of insurer giant Humana Inc.; HHS Secretary Sylvia Burwell; DJ Patil, M.D., chief data scientist and deputy chief technology officer for the White House Office of Science and Technology Policy; Andy Slavitt, CMS acting administrator; and Steven Brill, author and founder of Court TV and The American Lawyer magazine and website.
One rising health IT star who will be on hand for the first time at the Washington, D.C. confab as chief organizer is Chris Boone, CEO of the Health Data Consortium, parent organization of the conference.
Boone, 35, an informatics expert and former health IT consultant, took over leadership of the group last October. He has moved quickly to beef up the consortium’s presence on Capitol Hill as a lobbying force for open data and as a serious group known for more than Health Datapalooza alone.
So with the consortium’s growing heft, the conference — always a must-attend for health IT thought leaders since its inception in 2010 — promises to be more interesting than ever.
In addition to the keynoters, the panelist lineup is a veritable all-star team of health IT luminaries.
Some of the main stage panelist names: former national health IT coordinator ; Ed Park, chief operating officer and executive VP of cloud EHR vendor athenahealth, Inc.; Niall Brennan, chief data officer for CMS; Karen DeSalvo, M.D., national health IT coordinator and acting assistant HHS secretary; and Todd Park, technology advisor to the office of the president (and brother of Ed Park).
Not surprisingly, many of the panel session topics revolve around big data.
Indeed, the Health Data Consortium’s main mission is to free big health data from its constraints in isolated storehouses in government, academia and business to make it more easily usable by researchers, developers and patients.
May 13, 2015 1:43 PM
Posted by: klee34
, health reform
, healthcare CIOs
CIOs must be able to clearly communicate and demonstrate the business value of the IT services they provide, Barry Runyon, research VP at Gartner Inc. who focuses on healthcare provider research, wrote in a report. He added that CIOs also need to have a firm grasp on IT costs and be able to intelligently defend those prices and rates.
“Historically, the IT department has been a cost center within the HDO [healthcare delivery organization]– where IT infrastructure, data center, applications and support services have been procured and dispensed –based on budgets not always closely aligned with hospital business requirements or strategic vision,” Runyon wrote.
This approach has led to the mismatch of services offered by IT and other hospital departments and, while this may have worked in the past when the cost of IT was a smaller percentage of the overall revenue, it no longer does, Runyon wrote.
He added, “it is time to better understand how the price of healthcare IT facilitates and undercuts the goal of providing quality, affordable care.”
Ultimately, the value of IT will be determined by the CIO’s ability to govern, deliver and manage a complex and extended IT infrastructure and application portfolio along with increased cost and service level transparency and accountability, Runyon added.
Here are Runyon’s tips on how healthcare CIOs can run IT like a business:
Allow the customer to decide.
“One approach for determining the value of IT is to allow the enterprise customer to decide what type and how much IT they want to purchase and, ideally, from whom,” Runyon wrote. “This would make the annual exercise of crafting an IT budget one based on real choices and business demand and more transparent.”
This kind of transparency would increase trust and elevate the role of IT from a cost center to a strategic business partner. It will also assist the healthcare organization in achieving the right level of spending.
“Competitive advantage will be increasingly determined by competencies needed to select, implement and manage IT, and the budget is the tool for steering resources toward desired business objectives,” Runyon wrote.
Define a set of services the business values and understands.
It’s important that the CIO and IT department define services in terms that the business will not only understand but will value, Runyon wrote. This will help support the healthcare provider as it evolves into a digital business and adopts new business models.
He added, “a strong business orientation will allow IT clients to better understand the IT value proposition and related costs and overhead, and will make it easier for them to identify and select the services and level of support they require.”
Create an IT service catalog that the business understands.
Although the business often has trouble seeing the value in IT, one thing is clear: costs. Therefore it is essential the CIO create a list or catalog of services that describes the business capabilities IT services provide instead of focusing on the technology itself, Runyon said. Oftentimes, the business side doesn’t understand the technology, but they will understand if the CIO and IT team tell them about the business benefits those technologies produce.
When crafting an IT catalog, Runyon suggests it support existing operations and lines of business as well as new business models resulting from healthcare reform, and enable the healthcare provider as the provider evolves to digital business and optimize IT total cost of ownership.
In addition, the catalog should also be more performance-based and service-oriented to achieve the right level of enterprise IT budgeting and spending, Runyon wrote. He also asks the CIO and IT department to consider the role and purpose of the underlying related technologies to the end service and understand their direct and indirect contribution to value.
Deliver acceptable prices and service levels.
“The purchaser ultimately determines value, and the money they spend is an important indicator of how much a product or service is valued,” Runyon wrote. “The healthcare provider CIO’s ability to deliver the right services at acceptable prices and service levels will ultimately determine their value to the business.”
Runyon wrote that the CIO and IT professionals will need to provide comparative pricing for their services so business stakeholders can make informed purchasing decisions. In addition, the annual IT budget should also be based on the decisions the business makes regarding IT service capabilities and performance levels.
Runyon added that healthcare provider CIOs must benchmark their IT services against industry performance and price norms so they can be delivered competitively.
Create an architectural vision.
The growing infrastructure, application and support requirements that healthcare providers have to deal with will continue to drive them toward a hybrid IT environment, Runyon wrote. He added that this means third-party IT products and services will play a more prominent role. Therefore, the CIO needs to construct a portfolio of services built from internal and external sources with IT serving as a direct service provider. The IT department will also need to govern and manage the sourcing and delivery of the external product.
Here are the portfolio considerations CIOs should be thinking about:
- Third party IT products and services may be a good choice for higher-risk innovation initiatives where the project may be short-lived, Runyon wrote. Especially if that third party offering provides the price, quality, performance and time-to-value constraints that IT cannot.
- He also advises CIOs seek to simplify the complexity of the technologies by bundling services –for example, storage, network, enterprise content management, etc.– as a flat-rate shared service.
- Pace layering– a methodology for categorizing, selecting, managing and governing applications to support business change, differentiation and innovation– should be considered in simplifying and differentiating technologies, Runyon wrote.
- Runyon also advises healthcare provider CIOs “prepare for an IT ecosystem made up of traditional on-premises IT capabilities augmented by managed, hosted and cloud-based IT services –an ecosystem that they will continue to be responsible for from governance, security and service level perspectives.”
All of this means healthcare provider CIOs can expect to face pressure to transform as their organizations confront the industry’s challenges of cost reduction and value-based reimbursement and payment models, Runyon wrote, adding that this “will result in healthcare providers incorporating more and more external service provider services within their solution architectures.”
May 12, 2015 2:05 PM
Posted by: adelvecchio
, ICD-10 conversion
, ICD-10 implementation
Most healthcare professionals are confident enough in their organization’s internal ICD-10 preparation that they haven’t consulted with an outside source to measure their readiness prior to the Oct.1 coding changeover date. Less than a quarter of high-level healthcare pros that responded to a QualiTest Group survey said their organizations have used outside contractors to perform ICD-10 testing. A significant majority (83%) believe their health information systems will work properly when it comes time to start operating with the expanded ICD-10 code set.
None of the respondents believe there will be another ICD-10 delay. A portion (17%) is unsure if the ICD-10 deadline will stay where it is, while the remainder is certain Oct.1, 2015 will be the day the American healthcare industry makes the move to ICD-10.
Providers have taken advantage of CMS’ ICD-10 end-to-end testing opportunities. More than half of respondents said they participated in the end-to-end testing trial in January, with an additional 61% planning to engage in future CMS testing periods.
The results of a previous CMS testing session offer more reasons for providers to be confident as they finalize their ICD-10 preparations. More than 600 organizations submitted claims during the nine-day period, and only 3% of those claims were rejected by CMS. Those failures were the results of improper ICD-9 code submissions. Of the nearly 15,000 total testing codes, more than 12,000 — or 81% — were accepted. Most of the erroneous submissions were the result of improper test claim formatting and were unrelated to ICD-10 codes.
The QualiTest survey respondents aren’t assuming everything about converting to ICD-10 will be business as usual. Two-thirds of them anticipate there will be change in revenue at their healthcare organization after Oct. 1.
May 7, 2015 11:44 AM
Posted by: klee34
certified EHR technology
, EHR certification
Despite 94% of hospitals in the United States having already adopted a certified EHR system, many state regulations are still focused on paper records. That’s the word from Niam Yaraghi, a fellow at the Brookings Institution, and Joshua Bleiberg, a research analyst at the Brookings Institution, which is a private nonprofit organization that focuses on independent research and policy solutions. And despite the fact that it costs basically $0 to reproduce digital records, patients in certain states are forced to pay if they want paper copies of their medical data.
The researchers argue that state regulations should change so that medical providers are required to give patients their medical data for free.
Yaraghi and Bleiberg did the math to see what the maximum cost for copying 75 pages of records in different states would be. They found that states with some of the highest paper copy costs are Georgia ($101 for 75 pages of records), Pennsylvania ($95), Indiana ($93) and Mississippi ($90). They also found that the states that have the lowest costs for copies are Tennessee ($29), Wisconsin ($23) and California ($19).
When patients have access to and are provided their medical records, studies have found that they become more engaged with their treatment and tend to experience better care outcomes, Yaraghi and Bleiberg wrote. Furthermore, patients with access to their medical data can make up for the lack of interoperability among health IT systems by sharing it with various medical providers and help to avoid redundant medical testing. Although the HIPAA Privacy Rule requires medical providers to give patients copies of their medical records, the fact that paper copies cost so much is a huge turn off for patients.
Yaraghi and Bleiberg conducted a survey and found that 68% of respondents are not willing to pay a single cent to have access to their medical data.
State regulations need to undergo a major revision, Yaraghi and Bleiberg wrote, adding that “the intention behind suggesting a copying fee in the privacy rule of 2000 was to ensure that medical providers are adequately reimbursed for the additional efforts that they have to make in order to copy medical records at the patients’ request. Although the EHRs are very expensive, one should note that the majority of medical providers used HITECH incentives to adopt such software.”
May 6, 2015 3:24 PM
Posted by: ShaunSutner
LOS ANGELES — The American Telemedicine Association’s (ATA) annual meeting and trade show came barely a month after the raucous, sprawling health IT industry-wide must-attend show HIMSS 2015.
The mostly sunny, laid-back setting for the ATA confab this year underscored how different in style and scale the telemedicine gathering was compared to HIMSS 2015, which was held in gritty Chicago this time around.
HIMSS brings together all the sometimes fractious tribes of health IT — from EHR vendors and users to health data security firms and government regulators. The ATA conference, not surprisingly, focuses on a still fairly narrow, but nevertheless important, niche.
On the show floor in L.A., the dominant buzz was quiet seriousness of purpose as opposed to HIMSS’ frantic, loud atmosphere. Of course, this year’s HIMSS event drew some 43,000 attendees, and ATA about 4,000.
That low-key but intense vibe meshes with the dedication people in the telemedicine services field have for their technology. Telemedicine advocates hold their commitment of necessity.
Their passion for telemedicine is also undergirded by strong belief in telemedicine’s amply demonstrated power to bring healthcare to the underserved in remote, rural communities and also to patients in urban settings without easy access to specialists or even decent primary care.
The industry has been around for a couple of decades, but it is slow-growing. That is in large part because of the legal and regulatory hurdles telemedicine has to overcome to be considered the equal of in-person healthcare, but also because telemedicine has struggled to make inroads with consumers who are still used to seeing their doctors face to face in three dimensions.
But these days, telemedicine, while not exactly enjoying boom times, is making notable progress. More and more states are approving laws mandating parity with brick and mortar medicine in terms of government reimbursement to providers, and the videoconferencing technology that so many telemedicine providers rely upon has matured.
Now, as video vendors such as and Zoom Video Communications, Inc. demonstrated with startling clarity on the show floor at ATA, the technology to make virtual doctor’s visits is now almost transparent.
In contrast to the herky-jerky, prone-to-crashing video linkups of yore, clear, reliable two-way video is available on nearly any mobile device and with a wide range of cameras, from tiny laptop-mounted ones to consumer grade video cameras to professional quality rigs.
One major challenge for the telemedicine industry, as a panel at the show focused on, is bringing entertainment industry quality programming standards to telemedicine.
May 5, 2015 2:05 PM
Posted by: adelvecchio
, EHR adoption
, EHR standards
, EHR usability
, HITECH Act
A member of a Republican group that previously targeted the meaningful use program has crossed party lines to work with Democrats on a mission to improve the use of EHRs. Lamar Alexander (R- Tenn.), chairman of the U.S. Senate Committee on Health, Education, Labor and Pensions and Ranking Member Patty Murray (D-Wash.) announced the formation of a group that aims to improve EHRs so that they simplify and enhance healthcare.
The Senate health committee working group’s mission is to identify a handful of ways the use of EHRs can be optimized, something that can’t necessarily be accomplished by throwing money at the issue. “After $28 billion in taxpayer dollars spent subsidizing electronic health records, doctors don’t like these electronic medical record systems and say they disrupt workflow, interrupt the doctor-patient relationship and haven’t been worth the effort,” Alexander said in a release.
The working group is also focused on other healthcare areas beyond EHRs including interoperability, patient data security and supplying patients with access to their personal health information. The group also has an overarching objective of bettering the delivery and safety of patient care.
Starting this year Medicare eligible professionals are subject to payment adjustments or a reduction in financial reimbursements for not qualifying as meaningful users of EHRs. Alexander spoke out against that measure earlier in 2015, “The administration seems to have complicated the process [of transitioning to EHRs] by rushing ahead with penalties for those who don’t adopt EHR systems.”
Senator Alexander was one of six U.S. Senators responsible for a document titled REBOOT: Re-Examining the Strategies Needed to Successfully Adopt Health IT. The Reboot group published its initial plea — which begged a thorough re-evaluation of the national EHR deployment strategy — more than two years ago and followed it up in a blog post published in March. The group was unable to find solid evidence that the HITECH Act’s $35 billion price tag has paid dividends for patients. The lack of progress toward interoperability was noted as a foremost concern of the group.
April 30, 2015 2:31 PM
Posted by: ShaunSutner
, ICD-10 conversion
With ICD-10 nearly certainly on its way in October, attitudes toward the sometimes controversial new medical coding system among many providers in small and medium-sized physician practices range from resistant to uneducated, according to a new survey from Nuesoft Technologies, Inc. a cloud-based practice management and billing software vendor.
Nuesoft, developer of the NueMD cloud platform for medical practices, surveyed 1,000 respondents from all 50 states and in settings including small and mid-sized practices and billing companies. More than half those surveyed (564) are at practices with one to three providers.
The largest segment of those surveyed, 30%, said there should be no transition from ICD-9 to ICD-10, effectively saying they don’t like the new generation coding system at all.
Some 25% said they aren’t familiar with ICD-10, which could mean they aren’t ready for the changeover in the fall and probably will have big problems handling the new codes.
Less than a quarter of the respondents, 23%, reported that they’re satisfied with ICD-10, though 6% said ICD-10 coding standards — which already represent a big expansion in the number of codes from ICD-9 — should be expanded further.
Meanwhile, 18% opined that the ICD-10 coding set should be abridged.
“Making the switch to ICD-10 will greatly improve our ability to understand medicine, but it can also introduce some serious struggles for practices while they try to maintain cash flow through the transition,” the Nuesoft survey designers wrote.
Not surprisingly, the great majority of the providers and staff who answered the survey expressed worry about the transition, with 28% highly concerned, 25% significantly concerned, and 27% moderately concerned.
Only a few were OK with the expected change – 14% said they were minimally concerned and only 6% said they weren’t concerned at all.
For the worried majority, the main areas of concern, in descending order, were:
- Training and education
- Payer testing
- Software upgrade cost
- Claims processing
- Compliance timelines and deadlines
Negative outlooks about ICD-10 also extended into expectations about how the transition will affect various aspects of their businesses, with 70.4% saying it would hurt operations, and 69.7% reporting it would hurt their finances.
Overall the findings were consistent with those Nuesoft found in similar surveys the last two years, though the current survey indicated a mild softening of resistance to ICD-10, the survey designers said.
“We think it’s fair to say the level of concern for ICD-10, especially among small practices, is a little too high for comfort,” they said. “We did see some small, yet positive shifts in respondents’ level of concern, but there weren’t any striking changes over the last three years.
“We know it’s tough to find the time to train and prepare for ICD-10, but every minute is worth it,” the company’s survey staff wrote.
To make the transition easier, Nuesoft is recommending that providers lean on CMS’ “Road to 10″ website.