May 17, 2012 1:30 PM
Posted by: AllinHIT
The Scenario: Prior to walking into the exam room, the physician reviewed the patient’s vitals, BMI, and social history, marking them as “reviewed” in the Epic system to meet the new payor requirements. After reviewing the patient’s clinical information, especially the BMI, he knew this patient qualified for the new Obesity Management program, an initiative that will allow for him to increase his level of service whereby if certain patient goals are met, co-pays could be reduced. In this case, the physician views the program as a win-win for both doctor and patient. Since this is a Medicare patient, the physician gets a higher Medicare SGR and the patient reduces his co-pay, simply by getting healthier!
The physician walks into the room to deliver the news: “I must enroll you in Medicare’s Weight Goal program.” The physician then logs into Epic Hyperspace (their portal), accesses the Visit Navigator and opens the patient chart. He inputs “obesity” into the problem list and “associates” the goal of losing 20 pounds with the obesity problem. The patient learns that if the goal is met, he has an opportunity to earn “goal points”, which he can put toward co-pays. However, if weight is gained, he could face a reduction of benefits. The physician will use the Epic system to record the progress, and if the patient complies with the care plan and meets the goal, it’s a win-win for both patient and physician.
While the scenario is fictional, the steps described in recording the “problem” and associating a “goal” in an Epic system is very real. This “Epic” feature will possibly get more use after reading excerpts from recent reports on obesity authored by the Institute of Medicine (IOM) and the CDC.
The IOM report is extensive, with over 450 pages, and argues the U.S. needs multiple strategies to fight obesity, including a possible “soda” tax. The soda tax will be applied to all those fitting the scenario as described above. Considering the IOM is a division of the National Academies, an organization consulting the U.S. government on health issues, this scenario (or something similar), is not unrealistic. As many of us industry folks know, as Medicare goes, so do commercial payors (ex: PQRI started P4P). The CDC report reveals the staggering cost increases we will face if the obesity problem is not addressed, noting that care for obese Americans in the next 18 years is projected to reach $549.5 billion!
I don’t know if this “Epic” scenario is part of the answer. However, it’s obvious that something must be done. We, as a society, can not continue to support a preventable disease/condition while it bankrupts our healthcare system. It will take a team effort from payors, employers, EHR vendors, and of course, personal responsibility. I give Kudos to Epic and other EHRs for having the capabilities! However, it’s the user — the patients’ application of these features — which makes it an “Epic” solution to a really BIG problem.
May 8, 2012 9:43 AM
Posted by: AllinHIT
, Structured-Based Design
When I first started writing my blog a couple years ago, I knew I would write about “All Things HIT”, hence the origin of the name. However, I really didn’t think about, nor expect, the wide scope of technological advancements, and its effect on healthcare. This blog feature is the epitome of my ignorance.
I was fascinated recently by a Wall Street article on April 16 ( yes, I’m a couple weeks behind my reading due to my Epic training), entitled Drug Discovery Gets an Upgrade. Without getting too clinical, the article describes the art of structured-based design (SBD) — a method of using computers in tailoring existing drug molecules.
SBD is able to create custom compounds from existing drugs, allowing the new derivative to attack disease-causing proteins. The computer is basically able to analyze drug molecules (even drugs that were not FDA approved) and determine if those molecules could bind and fit the “lock” to a particular disease. Without very powerful computers analyzing the data, this would be impossible.
Now, all the pharmaceutical companies are using SBD to find cures and treatments to diseases. It was utilized by Pfizer to create Xalkori, a therapy to fight a rare and intractable form of lung cancer. Eli Lilly & Company used it to create an antibiotic for Alzheimer’s disease, which is in its mid-stage trails. Sanofi used it to create a new blood thinner and its in the final stages of development.
I profess, I don’t know all the ins and outs of the structural-based design. However, I find the various shades of health IT fascinating because each shade profoundly effects healthcare. EHRs, HIEs, telehealth, CDSS, eRx, IBM’s Watson, and now, structural-based design. Shades of health IT are giving me an optimistic view of healthcare’s future!
April 29, 2012 11:32 AM
Posted by: AllinHIT
, EHR training
Generally speaking, physicians, like most of us, can sometimes be an enigma. This was certainly evident after reading the Joint Survey of Physician Digital Behavior study. This survey conducted by the San Franciso based ON24 organization and MedData Group based in Boston, surveyed 970 physicians about their online behavior/attitude and use of technology. The survey results directly mirror the same mindset which exist when it comes to physicians adopting Electronic Health Record software, “it makes sense but I don’t want to do it”. Now before my physician friends get all riled up, I am generally speaking. I’m betting that if you are a physician reading this blog, you too are the exception. However, looking at the healthcare industry, physicians are definitely the last holdout in adopting technology.
Lets look at one result of the survey and how it relates to EHR’s. The survey reveals 84% prefer to attend continuing medical education (CME) training online. However, only 6.4% actually participate in these virtual events, and only 18.5% do it often. This reveals a huge gap in their preferences versus their usage. 75.5% of the respondents realized virtual events, webcasts are increasing in acceptance and 91% of them see the benefits of having them virtual. However, when it comes to EHR training, physicians rarely prefer that type of training, regardless if its at little cost, or in some instances, free! Instead, they want a physical trainer in their office, although they rarely want to pay for those services. Most feeling that it should be included in the cost of the EHR, as oppose, to a separate line item.
The gap between physician views and behavior, just don’t apply to the healthcare industry, nor to just physicians. I think of my own mother who has an understanding of the advantages of having online resources for looking up ailments, communicating with senior communities all over the world, skypeing with the grandchildren, etc. However, this understanding does not translate into the act of doing. I believe these gaps will narrow as technology grows within every industry, every household (some don’t have access!), and of course, within the physicians office!
April 17, 2012 9:40 AM
Posted by: AllinHIT
, EHR functionality
, Patient portals
Within one hour this morning, I read two documents/articles on patient / physician relationship that influenced me to write this blog. First I dove into the Agency for Healthcare Research and Quality (AHRQ) report titled Medical practice satisfaction: mean section score for “Moving Through Your Visit”, which is a comprehensive survey on all facets of the patient experience when visiting a physician’s office. The second piece I focused on was the Healthcare IT News article describing what the author calls five keys to IT and the patient/physician relationship.
Both the article and the report got me thinking about the use of technology and how it can improve the patient/physician relationship. Not because of their contents, because, in my opinion, both were lacking a technological perspective.
The AHRQ report, surveying patients’ office visit experiences, did not distinquish between those physicians with electronic health records(EHRs), and those that were paper charting. I know for a fact that a patient experience can be vastly different in each case. For example, a physician that is utilizing an EHR can monitor how long a patient has been waiting during each phase of the visit (check-in through walking out the door). Hence, the physician and the staff are more attentive to the process of delivering care in a timely fashion.
Additionally, once an office is proficient on the EHR, office efficiency increases, again effecting the patient experience more positively. I will suggest to the AHRQ to use this report as a baseline and revisit their efforts as EHR adoption increases. This would give us some idea on the affect EHR’s have, not only patient care, but patients’ overall experience in obtaining care.
The article that appeared in Healthcare IT News was a good attempt, however, based on the article’s title it just missed the mark. When I saw the title, I was certain the “keys” would refer to how a physician can use technology to increase patient compliance, provide patients easy access to protected health informationPHI, and possibly the use of technology to increase access to care. Although the author mentioned the use of technology referring to patient portals, and the use of email and texting, it was obvious to me that the author had limited knowledge on EHRs, physician workflows, and the use of technology to really improve the physician/patient relationship within those workflows. If they had, they would of talked about how the physician can use flowsheets to increase compliance, and real examples on how the patient portal can enhance the physician/patient relationship.
Although it was a decent article, neither of those are what I would call “keys” to using health IT to enhance the physician/patient relationship.
April 5, 2012 2:54 PM
Posted by: AllinHIT
, EHR alerts
, EHR functionality
On April 3, 2012 the Richard L. Roudebush VA Medical Center in Indianapolis released a survey revealing that EHR medication alerts cause physicians to get “alert fatigue”. The main cause for this “fatigue” is the nature of there being too many, providing too much, non-relevant details, and the alert not pertaining to the specific patient, but instead to their condition.
After reading the high points of the survey, I thought back to when I was selling a stand-alone eRx application, and the lack of system parameters pertaining to alerts. I thought about the different alerts one can receive, besides medication alerts, and how those can/should be handled so they are relevant during the point of care. Then, I thought about my experience with Epic, and its capability with “Best Practice Advisory alerts”, and the process of overriding any system alerts. I then came to the conclusion that EHRs are not equal when it comes to having flexible EHR parameters, driving the functionality of alerts. Let me explain what I mean.
When it comes to medication alerts, EHR system parameters — part of the building process) — should have an area where one can set their own individual alert parameters, based upon user ID. Within those “alert parameters” should be various “alert severity levels that they can accept or not accept. I could be a physician that only wants to see alerts with the “highest of severity”, hence reducing the number of low or moderate alerts. Additionally, the alert severity should be applied separately to each type of alert (medication, best practice, out -of range lab results, etc.). Alerts and severity levels should have an alert hierarchy (system, department, individual) with one overriding the other, ending with individual alert settings.
In addition, physicians must be able to setup patient specific alerts and be able to override them based on alerts generated by the system within the parameters. This will allow for the physician to override system alerts one time, avoiding constant overrides for a condition specific to the patient. For example, if I know that an out of range blood pressure is normal for my patient, I can go into the “alert parameters” and have the alert ignored for this patient.
This is the type of flexibility that EHR vendors must consider when designing their system. Giving physicians the ability to avoid un-necessary alerts, will encourage physicians to really pay attention to the alerts, knowing that they are not getting alerts that waste their time. Some EHR’s have these capabilities, others don’t. I say choose wisely because alerts can hurt when they are constantly interrupting the delivery of care!
April 2, 2012 8:14 AM
Posted by: AllinHIT
, Health IT
, Minority hiring
Ok, let me just state for the record, I am a seasoned, proven professional in HealthIT, and I happen to be an African-American. I have been in healthcare many years and have a plethora of caucasian friends in high level positions across the healthcare arena. I only know of a few minorities in these same caliber of positions, but I know very few minorities working in healthcare, and fewer in Health IT. These fore-mentioned facts are the basis of my interest in the continuing dialogue concerning minority hiring at hospitals.
It all started last summer when I read about the Connecticut Hospital Association and the National Association of the Advancement of Colored People (NAACP) battled over diversity reporting with their 30 hospitals (http://www.fiercehealthcare.com/story/hospital-association-and-naacp-embattled-over-diversity-reporting/2011-06-16was). Knowing that there was a lack of minorities represented at conferences (HIMSS, AHIMA, ATA, MGMA, etc) I’ve attended over the years, I wondered was it because of a lack of minorities in the field or was it that they weren’t just being hired. My experience as an African American professional, unfortunately, leaned me to thinking it was probably the latter! My suspicions were confirmed in January, 2012 after reading executive search firm Witt/Kieffer study titled “New Study: Hospitals have failed to close the diversity gap in healthcare leadership” (http://www.fiercehealthcare.com/press-releases/new-study-hospitals-have-failed-close-diversity-gap-healthcare-leadership). The title alone tells the story and if you have been reading my blog for the past couple years, you wouldn’t be surprised that I’m asking myself, what can I do about it?
Typically, a minority could address industry hiring inequities, if they are influential within that industry, sort of like solving the issue from within. Some firms, committed to diversity, will hire a “Diversity” championed with the mandate to increase minority hiring and to become a voice for those minorities already employed. The Witt/Kieffer study revealed the majority of the 470 executives surveyed, stated there were a lack of diverse candidates for positions, a common theme for corporations with a dismal record of hiring minorities.
As a minority in healthcare, who has been a featured speaker at conferences, has a popular blog, and a rich history of successes, I’ve never been approached by a hospital for an employment opportunity! What makes it most sad is that I know a few hospital executives, a few payer executives, and other executives within the healthcare industry. However, I’ve always felt my obvious desire for independence as a consultant, was the pediment. Now, I’m wondering if that is the case, or not. Due to my visibility, excellent track record in healthcare and C-suite network, and the majority of hospital executives stating there aren’t enough diverse candidates, you would think that someone would approach me! However, this hasn’t happen and now I’m wondering, why?
Looking at solutions to this old civil right, I believe there is a combination of needed actions. First, hospitals need to develop a plan on the hiring and recruiting of minorities in healthcare. This plan should include real action items and should have a budget representing the effort. Secondly, we need to do more to get the word out on the vast amount of opportunities which exist in healthcare. This effort should be a collaboration among high schools, colleges, hospitals, home healthcare facilities, and healthcare organizations like HIMSS, AHIMA, ATA, and MGMA. Lastly, taking a lesson from my colleague and friends Tiffany Crenshaw and the lntellect Resources team, maybe minorities need a special “Big Break”!
March 26, 2012 10:26 AM
Posted by: AllinHIT
, EHR adoption
, EHR usability
I was recently perusing through my email and came across a study on EHR users by Anoto Digital Pen, a Swedish based company who manufactures a digital pen, a device that captures hand written text and is capable of uploading that text into an application. Like most of us, with lots of email subscriptions, I glanced at the heading and kept perusing. However, after seeing the survey on other email subscriptions, I decided it was worth a review. What I found was the survey had me asking many questions, outweighing any worthwhile tidbit of survey fodder.
The survey’s main revelation was that, despite healthcare organizations’ increase in EHR adoption, there is still a heavy reliance on paper. As Anoto’s SVP of Americas, Pietro Parravicini, concludes, “healthcare remains a paper driven industry and will likely stay that way for the foreseeable future”. The survey contributes this conclusion to an industry ingrained in the paper culture and the expense of EHR adoption related to training and disruption of care. After reading this, I immediately understood the problem with this survey, and it had nothing to do with not knowing how many organizations responded, or if the survey was for American or Swedish users.
What was it that immediately grabbed my attention? On the one hand, the survey respondents have implemented an EHR. But on the other hand, they say it costs too much to train staff and disrupt care. Here in lies the problem. One of the barriers to EHR implementation is the cost of training the staff. This cost, usually compromised in the budget, is a key driver for user acceptance, user satisfaction and effective workflows. Just by these users stating that training costs is a barrier, I suspect they are among a popular group of implementors who have sacrificed training in the budget. Hence, it is no surprise that this group leans on their paper processes and runs a hybrid operation.
Secondly, this group identifies disruption of care as a barrier, which means that users aren’t proficient on the EHR (maybe because of a lack of training), and hence the EHR is slowing them down and keeping them from accomplishing the magic number of daily/monthly encounters needed to maintain revenue. So what do they do? Resort back to paper of course!
Lastly, another interesting revelation was that 75% of those surveyed concluded that the Affordable Care Act was going to increase this reliance on paper! This made me ask, “do the users think this increase in paper will improve care”? Just when I asked myself that, I read that 90% of the users with an “active” EHR state that it does improve patient care! This was even more confusing. What is an “active” EHR, and how many of those surveyed were “active” users? How do they survey results differ between active and non-active EHR users?
All a perfect example of why some surveys leave you with more questions than answers!
March 16, 2012 11:57 AM
Posted by: AllinHIT
I will never forget my response after reading the 1999 report authored by the National Information Administration, Falling through the net: Defining the Digital Divide. The report revealed the huge digital divide facing minority communities because of a lack of internet access, especially broadband, and the lack of funding for computers in the homes and urban schools. It was this report that motivated me to create the Webmenders brand. I decided that I will not accept letting minorities “fall through the net”, so I created Webmenders, mending the hole on the web to prevent minorities from slipping through.
The program received computers donated by Compaq, and my childhood friend still works there (now HP), Andy Wilkerson. The program trained minority youths on the interworkings of the Internet, web development, and online education resources. The final project was a website called “seeing the community through the eyes of youth”, containing pictures and profiles of community places, people, and things. The program was a top 25 finalist among thousands of entries with the AOL foundations community fund. I tried to do my part in addressing this divide, and much kudo’s to the Bill & Melinda Gates Foundation for doing their part putting computers in classrooms across America. Although minorities are still falling through the net, much progress has been accomplished. However, once again, I am reminded that the digital divide lives on, and has taken another life form.
In the March 2012 edition of Health Affairs, there was an article on the new life of the digital divide in those providers that do not qualify for meaningful use, and hence are not adopting EHR technologies at the pace of those who do qualify. Victims of this digital divide? Specialties, long term care facilities, acute care hospitals, inpatient providers, rehab facilities and psychiatric hospitals are all not Eligible Providers (EPs) qualifying for meaningful use incentives dollars. This digital divide not only affects minorities, but also affects the whole healthcare delivery system, which all of us belong. So here I am, once again, thinking about solutions for this digital divide.
March 16, 2012 9:20 AM
Posted by: AllinHIT
Affordable Care Act
I recently read an article in The Hospitalist about Massachusetts’ Healthcare Law
going into its sixth year in existence. The article states that Massachusetts is a microcosm of what we should expect with the Affordable Care Act. The author states that access and cost challenges still exists in Massachusetts, and the ONLY solution is with fundamental payment reform. I agree that payment reform is PART of the solution (fee for service vs bundled payments/quality measures); however, it’s not the only solution.
There are other solutions that collectively can aid Massachusetts, other states and the federal government in addressing access to care issues and lowering healthcare costs. One solution, for example, is giving Medicaid patients better access to primary care physicians (PCPs) as a preventive measurement. A PCP’s role is central in lowering costs, especially when it comes to providing post-acute care, by eliminating unnecessary hospitalizations, which brings up another question: how do we increase the number of PCPs? This is an especially difficult question to answer in a time when PCP’s are dwindling due to reimbursement cuts, Medicare’s low sustainable growth rate (SGR), state delays in raising Medicaid fee schedules, and even the transition to EHRs, are getting some PCPs to retire?
Speaking of retired PCPs, one of my proposed solutions for increasing access and lowering costs is to develop a post care “volunteer” program involving retired PCPs playing a central role. This group can conduct “house calls” or utilize telehealth tools in order to provide follow-up care, especially in post discharge/post-acute care for Medicaid and Medicare patients.
We can also include retired specialists, where they could provide post care for their specific condition specialty with the retired PCP coordinating the effort. I know, it sounds like a Medicaid ACO. I do believe that as an incentive though, these “volunteers” should receive an honorarium from payors and other stakeholders and should be free of taxes if they are of retirement age.
Another idea for increasing access to PCPs, and hence lowering costs, is to take a Teach for America approach with medical students. Like Teach for America, the “PCP for America” program can subsidize the student’s medical school costs and delay student loan payments, all for “volunteering” to provide post-acute visits under a supervising physician’s guidance. I can continue to refine and define these programs, however, I think you get my point. We must think “out of the box” to address the systemic issues with access and costs, especially since 200 million people are coming into the healthcare delivery system with the Affordable Care Act.
Lastly, there are lots of solutions and not just one magic bullet. It will require a “shotgun” approach, spraying pellets everywhere and seeing what hits the target!