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Health IT Pulse

June 25, 2015  12:31 PM

The reason some doctors quit? EHRs, says one noted columnist

Posted by: klee34
EHR, EHR adoption, EHR technology

The general consensus surrounding the movement to EHRs, at least from what I’ve heard and read, is that, although not perfect, EHRs are a good thing for doctors, healthcare organizations and patients alike. Where the problems come in are with the other stuff. For example, the lack of interoperability bars EHRs from reaching their full potential. The story of Janet Freeman-Daily, a lung cancer patient who keeps all her medical records in a 3-foot-deep file drawer and brings copies to her various appointments to keep her caregivers up to date, illustrates this roadblock.

But some in the medical community think EHRs are transforming healthcare in a way that severely detracts from the patient. In fact, for some physicians, EHRs are the reason why being a doctor today isn’t about patient care anymore. At least, that’s what Pulitzer Prize winning columnist Charles Krauthammer, M.D., expressed in a recent Washington Post opinion piece. Because of EHRs, he wrote, being a doctor is now about data entry. He also argued that EHRs are not more efficient, effective or beneficial to the patient than how things were done before like so many believe them to be.

EHRs detract from patient care because doctors spend more time dealing with data than directly with the patient, Krauthammer wrote. He cited a study by the American Journal of Emergency Medicine that found that ER doctors spend 43% of their time entering information into a patient’s EHR and only spend 28% of their time with patients. He also cited a JAMA Internal Medicine study that found that physicians spend on average 48 minutes a day just entering clinical data.

“Forget the numbers,” Krauthammer wrote. “Think just of your own doctor’s visits, of how much less listening, examining, even eye contact goes on, given the need for scrolling, clicking and box checking.”

Although I can see where Krauthammer is coming from, and the numbers are pretty damning, I’ve personally never had this experience with my own doctor. Maybe she’s one-of-a-kind but when I see her for my annual check-up she spends about the first five to 10 minutes asking me if there’s anything new she needs to know and updating my medical record. Then she spends the rest of the approximately 30 to 40 minute appointment engaging me, talking to me, asking me questions, and listening to any concerns I have. Truthfully, I feel like my doctor genuinely cares about me, advocates for my health and encourages me to advocate for my own well-being as well. I’ve never felt ignored by her or that I’m taking up too much of her time.

But Krauthammer is not alone in how he feels about EHRs. In a letter to the editor of SearchHealthIT, Alan Ducatman, M.S., M.D., professor of medicine and public health at West Virginia University, expressed the same concerns.

However, you can’t simply shrug off electronic records. EHRs offer many benefits, including:

  • Improved quality and accuracy of patient care.
  • The ability to better utilize e-prescribing.
  • Reduced costs by helping to eliminate unnecessary medical testing, dictation services, paper copies of medical records, etc.
  • Financial incentives from the government (although many debate whether these incentives are worth the hassle).
  • Improved information accessibility.
  • The ability to send bills more quickly.
  • The ability to sort patient data and look at specific demographics.
  • Saving trees.

Regardless, Krauthammer said the reason doctors are seriously considering quitting their jobs—he asserted that virtually every doctor and doctor’s group he’s talked to says the same thing—is because EHRs make medicine more about the data than the patient.

“Clicking boxes on an endless electronic form turns the patient into a data machine and cancels out the subtlety of a doctor’s unique feel and judgment,” Krauthammer wrote.

June 24, 2015  1:12 PM

CommonWell grows, despite Epic absence

Posted by: ShaunSutner
Epic, HL7

Despite the continued absence of health IT’s biggest name, the CommonWell Health Alliance, a vendor-backed interoperability group, keeps growing.

EHR giant Epic Systems Corp. is the notable non-participant, even defending its decision to stay out of CommonWell in a recent Senate hearing, but the nonprofit group announced four new members have joined, bringing the general membership count to 13.

The new corporate members are Caremerge, a cloud care coordination company, and T-System Inc., which specializes in emergency department and urgent care IT documentation.

Also signing up were two health information exchanges (HIE), Michigan Health Information Network Shared Services and the Texas Health Services Authority.

General members pay lower subscription dues than contributor members, a category that includes the seven founding members: Epic competitors Allscripts Healthcare Solutions, Inc., athenahealth, Inc., Cerner Corp. and McKesson Corp., and Evident, a subsidiary of EHR vendor CPSI (Computer Programs and Systems, Inc.), Greenway Healthcare and Sunquest Information Systems, Inc.

There are nine other contributor members.

In a blog, Nick Knowlton, chairman of CommonWell’s Membership Committee and vice president of business development for Brightree LLC, said the new members broaden the range of CommonWell participants to include not only vendors, but also other healthcare organizations, such as HIEs.

While most of Epic’s peers are now part of CommonWell, the Verona, Wisc.-based EHR market leader has resisted signing up. During a March hearing of the Senate Committee on Health, Education, Labor and Pensions, Peter DeVault, Epic’s director of interoperability, defended the company’s stance when  a senator asked why Epic isn’t part of CommonWell, Healthcare IT News reported.

DeVault said Epic finds the annual subscription and membership fees excessive (Epic would have to pay more than $1.25 million annually, based on its size), and also doesn’t want to sign the required non-disclosure agreement.

“The lack of transparency didn’t sit well with us,” DeVault said, according to Healthcare IT News.

However, Epic is participating with some of its biggest competitors, including Cerner and athenahealth, in HL7 International’s Argonaut Project to develop the FHIR (Fast Health Interoperability Resources) standard.

Among the services CommonWell offers members are: patient identification and matching; record location and retrieval; patient access, privacy and consent management; and trusted data access.

CommonWell’s service provider is RelayHealth, a McKesson subsidiary.


June 23, 2015  3:12 PM

FDA makes a deal with online patient group to study patient-reported drug safety data

Posted by: adelvecchio
adverse event reporting, drug safety, FDA, patient engagement, social media

The U.S. Food and Drug Administration (FDA) is teaming up with the largest online patient network to collect and study patient-reported drug safety data. The research agreement between PatientsLikeMe, an online network of more than 350,000 patient members, and the FDA was announced at the Drug Information Association’s annual meeting.

The two entities will work together to see if patient-reported data, starting with what’s in the PatientsLikeMe network — can be used to guide risk assessment and management regulations. The FDA’s current postmarket drug safety surveillance program only requires drug manufacturers to report adverse events. Reporting an adverse event is done voluntarily by healthcare providers and patients. By studying self-reported drug safety data to inform its decision-making, the FDA is giving patients and their providers a chance to be more involved in the governance of healthcare.

As part of the research agreement, the FDA will also consult the PatientsLikeMe archives, which hold 110,000 adverse event reports on 1,000 different medications. PatientsLikeMe has cooperated with other government agencies in the past, including: the U.S. Department of Health and Human Services, the Institute of Medicine, the Centers for Disease Control and Prevention and the National Institutes of Health.

In a blog post on PatientsLikeMe’s website, Sally Okun, vice president of advocacy, policy and patient safety, explained the company’s growth and what it hopes to accomplish by working with the FDA. Okun said PatientsLikeMe made a customized version of the FDA’s MedWatch safety information and adverse event program for its multiple sclerosis patients in 2008. The following year, the company released the first drug safety platform on social media. Okun said patients’ self-reported data will give the FDA an accurate picture of the effects of taking certain drugs. The FDA currently generates medication safety information from the results of clinical trials, which don’t always represent the patient population that will be taking the medication.

“Most clinical trials only represent the experience of several hundred or at most several thousand patients, making it impossible to anticipate all the potential side effects of drugs in the real world,” Ben Heywood, co-founder and president of PatientsLikeMe, said in a release.

June 18, 2015  3:35 PM

Steps to achieve a value-based contract

Posted by: klee34

A shift to value-based payments and benefit designs is underway — accelerating, even– despite the significant obstacles, a health policy brief from the Brookings Institution has found.

The piece is co-authored by a heavyweight: Mark McClellan, M.D., Ph.D, senior fellow and director of the Health Care Innovation and Value Initiative at the Brookings Institution, former administrator of CMS, and former commissioner of the U.S. Food and Drug Administration.

The brief’s findings stem from literature reviews, a roundtable with stakeholders, and interviews with the roundtable attendees. It also cites statistics from the Catalyst for Payment Reform which estimates that 40% of payments are tied to quality or financial performance or intended to reduce waste. That’s a 29% increase from 2013.

The brief offers key steps to enable the shift to value-based contracts. Data will serve as the foundation for this effort — specifically, data related to the results and costs of care.

Here are three key steps to help achieve a value-based contract:

  • Build trust among payers, providers and purchasers. The authors of the brief believe that value-based payment models will compel meaningful partnerships and cooperation among parties, driven by their mutual goals of improved healthcare quality and lower costs. They suggest investing in long-term relationships among parties, identifying mutual goals, developing best practices, and cultivating a win/win mentality.
  • Identify opportunities for valued-based care via information sharing. Sharing meaningful information and data between payers, providers and purchasers is critical for managing patient populations and improving healthcare quality, the brief said. Furthermore, transparency encourages trust and collaboration. For example, parties could share data reports on a monthly basis. The authors also suggest that stakeholders have ongoing discussions of data needs and use of reports to make it easier to take action on the data.
  • Set standard core measures. “All stakeholders agree that standard core measures along with the supporting data infrastructure are helpful to accelerate the adoption of value-based payment models,” the brief said. “Not only do standard measures and supporting data minimize the administrative burden of implementing these programs, but it also provides a clearer signal for what is valued in the healthcare system.” A pointer the brief provides: Develop consistent, timely methods to promote data sharing across parties.

June 17, 2015  3:34 PM

Practice Fusion CEO talks market share in solo practices and relationship with bigger vendors

Posted by: ShaunSutner
athenahealth, Cerner, cloud EHR, EHR adoption, Epic, mckesson, Practice Fusion

Ryan Howard, the 40-year-old founder and CEO of cloud EHR vendor Practice Fusion Inc., certainly doesn’t lack for confidence.

In some ways, Howard’s brash charisma resembles that of  a market nemesis, Jonathan Bush, president and CEO of athenahealth Inc.

Practice Fusion, athenahealth and eClinicalWorks LLC, are probably the highest-profile vendors of EHRs for physician practices, though you could also include NextGen Healthcare and Amazing Charts, LLC as well.

In a media blitz this week, Howard has worked to promote the idea that Practice Fusion has distinguished itself from competitors by being number one in a rarefied space: the market segment of solo physician practices and practices with three or fewer physicians.

As evidence, Howard cites the American EHR web site’s recent survey of 1,366 physicians and clinicians, which found that Practice Fusion leads in that small space, with 15% market share.

Sure, athenahealth and eClinicalWorks have a longer reach in that they generally target bigger practices, and in athenahealth’s case, even small hospitals after a couple of recent deals.

But Howard told SearchHealthIT he is confident that Practice Fusion will stay strong in the solo practice area even as small doc practices are being snapped up practically every day by big healthcare systems, whose EHR suppliers are generally among the top five in that arena: Epic Systems Corp., Cerner Corp., McKesson Corp., Medical Information Technology, Inc. (Meditech), and Allscripts Healthcare Solutions Inc.

At least three of those – Epic, Cerner and Allscripts – are also strong in the ambulatory sandbox that Practice Fusion plays in.

Howard maintains that even when a larger healthcare system gobbles up a small practice, the system usually lets Practice Fusion customers stick with their smaller cloud EHR, which Practice Fusion provides for free in exchange for letting pharmaceutical companies market to his customers.

“Rarely do they rip and replace us,” Howard said in a telephone conversation.  “Because we’re in the cloud, they want that data injected into their system.”

He says it’s a lot easier to stay with a practice’s existing systems, and argues this hypothetical case to explain his view:

Let’s say an Epic hospital system acquires 100 solo practices and tries to replace each doctor’s existing EHR. Doing so would cost about $25,000 per customer, Howard said. And it would take Epic a lot of time and effort to install its system.

“That’s expensive and slow,” he said, which is enough reason to keep a small practice’s current EHR intact.

Like athenahealth, which has intimated it will someday seek to bring a cloud EHR to big hospitals – a development health IT hasn’t yet seen – Practice Fusion also dreams of bigger things and much bigger customers.

But achieving that would be a Herculean technological feat.

“It’s easier said than done,” Howard said.


June 16, 2015  11:14 AM

Cerner CEO Neal Patterson tells Senate committee of wife’s interoperability dilemma

Posted by: adelvecchio
AMIA, Cerner, EHR, Interoperability, Neal Patterson

Neal Patterson, CEO of EHR vendor Cerner Corp. — a founding member of CommonWell Health Alliance — has a personal reason to pull for CommonWell to realize its goal of greater health IT interoperability. Patterson’s wife, Jeanne, has been a breast cancer patient for eight years and keeps paper copies of her records in shopping bags. The absence of interoperability between the 20 different healthcare organizations’ EHRs that have some of Jeanne’s medical record forced her to maintain her own archive.

Neal Patterson told an abridged version of his wife’s story during testimony at a meeting of the U.S. Senate Committee on Health, Education Labor & Pensions on healthcare interoperability. Patterson stated that all EHR vendors must cooperate for nationwide interoperability to happen and they must accept “that once technological silos are eliminated, they will have to compete on innovation, quality and cost.”

Others who gave testimony to the Senate committee were Christine Bechtel, National Partnership for Women & Families chair and a member of the federal Health IT Policy Committee; Craig Richardville, senior vice president and CIO at the Charlotte, N.C.-based Carolinas HealthCare System; and Thomas Payne, M.D., medical director of IT services at UW Medicine and the University of Washington School of Medicine, and chair-elect of the AMIA board of directors.

Richardville stated poor interoperability isn’t limited to patient data held in EHRs; some of it is also stuck in registration, billing and lab systems. He emphasized that becoming more interoperable can be a costly process for providers and that “care providers are missing opportunities to improve people’s health and welfare when information about care or health status is not easily available.”

Payne gave a brief rundown of a recent report published by an AMIA task force. The report was created over the course of a year and culminated in 10 recommendations, separated into four categories. The task force concluded that documentation should be improved to allow patients to contribute to their care, regulations should be adjusted to focus on patient care, transparency should be heightened to benefit EHR safety and usability, and innovation should be encouraged to inspire the next generation of EHRs.

Bechtel spoke about how healthcare consumers can bring about change in the industry if given the chance. She suggested equipping patients with an application that stores their complete medical record and allows them to share it with anyone who treats them — the electronic equivalent of Jeanne Patterson’s bag collection.

June 15, 2015  4:12 PM

New research: FDA-regulated digital health devices could save U.S. healthcare billions

Posted by: klee34
digital health, FDA, mobile devices

Last year, the FDA seemed to lean toward deregulation of wellness, wearable and mobile devices when it downgraded — from Class III high-risk to Class I low-risk — mobile device data systems, which include app-tethered wellness devices.

But recent research from Accenture, an IT services company, shows that FDA-regulated digital health solutions—which include Internet of Things devices and software created for detection or treatment of a medical indication — are estimated to save the U.S. healthcare system more than $100 billion in the next four years.

Accenture estimates that in 2014, FDA-approved digital health devices and software saved the U.S. healthcare system $6 billion, and that number is expected to rise to:

  • $10 billion in 2015
  • $18 billion in 2016
  • $30 billion in 2017
  • $50 billion in 2018

Accenture made these estimates based on the idea that regulated digital applications and devices will improve medical adherence, make health-related behavioral changes in patients as well as decrease emergency room visits therefore reducing spending in these three areas.

The company also predicts that FDA-approved digital health solutions will triple by the end of 2018 from 33 last year to 100.

Accenture found that there are several factors that will accelerate the growth of FDA-approved digital software and devices:

  • Increased use of healthcare IT—driven by meaningful use mandates– by physicians and patients. Accenture found in a recent survey that one in four U.S. physicians use telemonitoring devices for chronic disease management.
  • The growing demand by patients to manage their own care, as seen by the rising number of people who own and use wearable devices. Accenture estimates the number of consumers who own a wearable fitness device will double in the next five years.
  • The shift to value-based reimbursement is creating a prime environment for clinical and business strategies that incorporate digital health devices. Accenture estimates that by 2018, funding for value-based care will reach $6.5 billion.

”The proliferation of Internet-connected solutions and evolving regulatory guidelines are blurring the lines between clinical and consumer health solutions,” Rick Ratliff, managing director of digital health solutions at Accenture, said in a press release. “As consumer health platforms support more ‘medical’ devices, rather than just today’s wellness trackers, they’ll create a viable self-care model in a segment that today is occupied by chronic-disease monitoring companies.”

Whether the FDA will further regulate digital health software and devices is yet to be seen, but the agency’s move towards deregulation last year sparked criticism among advocates who are worried that some of these devices could be under-regulated once wellness systems enter medical settings.

June 11, 2015  7:28 AM

ICD-10 codes elicit humor

Posted by: ShaunSutner
AHIMA, AMA, ICD-10, Meaningful use

“Struck by Orca” is by no means the most obscure or unintentionally humorous entry in the voluminous catalog of new ICD-10 codes for medical conditions.

But it is, indeed, the memorable Twitter handle of the publisher of an illustrated guide to ICD-10, an entertaining roadmap for the much-delayed new coding system that appears nearly certain to go into effect Oct. 1 despite howls of protest from groups such as the American Medical Association (AMA).

The guide’s creators tout the graphic compendium as a guide to 72 of the most important codes, but that could be tongue in cheek, because many of the included codes are just as quirky as the one denoting being injured by a whale.

Among the chosen examples:

  • Sibling rivalry
  • Acquired absence of unspecified great toe
  • Opera house as the place of occurrence of the external cause
  • Prolonged stay in weightless environment
  • Burn due to water skis on fire, subsequent encounter
  • Bizarre personal appearance

The contributing artists include physicians as well as professional illustrators.  And, yes, the guide is actually a physical object — a 6-inch square paperback promoted as perfect for the coffee table or doctor’s waiting room.

The guide’s lighthearted tone — meant to “educate and cause smiles” — is not mean-spirited. It appears its creators bear no serious grudge against ICD-10, even though many physicians and healthcare CIOs think the coding system with its huge array of codes is needlessly complicated and hard to manage.

No one really knows who was directly behind Congress’ 2014 vote to delay the transition from ICD-9 (which has half as many codes) until this fall, but many in health IT felt providers and payers simply weren’t ready.

Despite the grumbling, ICD-10 has some influential advocates, including the American Health Information Management Association (AHIMA), and in the end they have prevailed with their message that ICD-10’s added complexity provides greater accuracy, detail and data about patients’ medical  conditions.

Meanwhile, for a similar educational chuckle about the meaningful use program, check out the ICD-10 guide’s companion, MU2 Illustrated.



June 9, 2015  11:05 AM

Switching to cloud-based EHRs reduces data breach concerns for most small practices

Posted by: adelvecchio
cloud EHR, EHR implementation, EHR security, Interoperability

Significantly fewer physicians that deploy cloud-based EHR systems in solo or small medical practices are worried about their system’s security than their counterparts that use server-based EHRs. More than 80% of users of server-based systems are fearful their system or hosted files may be breached, compared to only 38% of small practice physicians that feel similarly about their cloud-based EHRs.

Making the jump to a cloud-based EHR eases providers’ security doubts, according to data gathered by Black Book Market Research. Almost all (92%) physicians at small practices that installed a cloud-based EHR in the last six months believe they now have a lesser chance of experiencing a large breach of patient records.

Despite that evidence, swapping out an EHR for a cloud-based version isn’t a no-brainer decision or a flawless process. Nearly half of small practices that did so from June 2014 to May 2015 say the cost of that transition put them in delicate financial territory. Another drawback of moving to cloud — one that could worsen money problems — is system downtime. More than 50% of respondents who traded their former EHR for a cloud product said they are more apprehensive about downtime now than when running their previous system.

The top 20 ranked vendor systems targeted at small and solo physician practices, according to 5,729 survey respondents, were all cloud-based EHRs. Praxis EMR, based in Canoga Park, Calif., has the highest level of customer satisfaction among 349 vendors. The other vendors that rounded out the top 20 all received customer satisfaction scores greater than 90% and were listed in alphabetical order by Black Book.

Black Book’s research also offered some insight into broader EHR issues. Two years ago, a substantial chunk of physicians (82%) cited implementation as the top EHR concern for their organization, a figure that nosedived to less than 20% this year. Now, more than 91% of physicians believe dysfunctional EHR interoperability is the biggest obstacle in the way of better clinical and financial outcomes.

June 4, 2015  1:40 PM

In Texas, regulators dig in on the other side of telemedicine

Posted by: klee34
american telemedicine association, telemedicine, telemedicine services

Telemedicine can and will do a lot of good when it comes to improving patient care and saving money. But lawmakers in Texas are pushing back, making it more difficult for telemedicine technology companies to provide their services in the state, such as Teladoc, the Dallas-based telemedicine provider—and the largest such company in the U.S.—that hundreds of employers offer to more than 2 million employees.

The Texas Medical Board recently released new rules that make it harder for doctors to prescribe drugs remotely and for patients in Texas to receive them. However, the rules do allow e-prescribing under certain exceptions. For example, if a patient is at a medical clinic or with a healthcare worker who can examine the person in place of his or her actual doctor— sort of a surrogate examination— then the doctor could remotely prescribe prescription drugs to the patient.

In response to the new rules and restrictions, Teladoc has filed a lawsuit accusing the board of limiting supply and increasing prices. Both sides have had an ongoing battle over this issue for four years now.

Mari Robinson, the executive director of the Texas Medical Board, told NPR that these new rules and restrictions have been put in place to ensure patient safety.

“How can a physician make an accurate diagnosis when they have no objective diagnostic data?” Robinson told NPR. “All they have is what the patient told them,” which, in her opinion, is not enough information.

Rene Quashie, an attorney at Epstein, Becker & Green who spoke with NPR, thinks Texas should reconsider telemedicine and the benefits it could bring. After all, Quashi pointed out, Texas has 200 counties that are considered medically underserved, and more than a dozen counties have just one primary care doctor. Telemedicine could make a huge difference for those populations.

But when it comes to embracing telemedicine, Texas is at the bottom of the list of accepting states.

According to the American Telemedicine Association’s (ATA) recent state report card, 22 states have received the highest possible telemedicine composite score– which means that those states have a policy in place that accommodates the adoption and use of telemedicine. These states include:

  • Colorado
  • Connecticut
  • Delaware
  • Illinois
  • Indiana
  • Kansas
  • Maine
  • Maryland
  • Massachusetts
  • Minnesota
  • Montana
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • Ohio
  • Oregon
  • South Carolina
  • Tennessee
  • Utah
  • Virginia
  • Wisconsin









The ATA also reports that the District of Columbia, Idaho and West Virginia have dropped their scores from an “A” to a “B” due to new, more restrictive telemedicine clinical practice policies in those states. Texas and Alabama are the only states with the lowest telemedicine composite scores.

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