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All Things HIT

February 28, 2012  8:57 AM

EHR employment, listening to the cry!

Posted by: AllinHIT
EHR training, ONC, Workforce Development Program

During the end of February, I had many discussions on the topic of health IT jobs with some of the graduates of the HHS/ONC workforce development program.  Summarizing, there was a feeling that EHR vendors, hospitals, and other possible employers were requiring specific health IT vendor solution certifications as a pre-requisite even for an interview.  Needless to say, with these new graduates lacking certifications, employers are turning to consulting firms and temp agencies for these resources. 

This got me asking: what changes can be implemented in the workforce programs to address this? What can employers do?  After all, it’s the vendors and hospitals that need these resources to implement EHR technologies. 

To meet the demand for workers with health IT experience and training, the Obama Administration has launched four workforce development programs that help train the new health IT workforce.  The training is provided through 82 community colleges and nine universities nationwide.  As of October 2011, community colleges have had 5,717 professionals successfully complete their training in health information technology.  Currently there are 10,065 students enrolled in the training programs across the nation.  As of November 2011, universities have graduated over 500 post-graduate and masters-level health IT professionals, with over 1700 expected to graduate by July 2013.

Over the summer I remember a Wall Street Journal Article printed July 9th, “A Reliable Job Engine Starts to Lose Steam”, which describes how the heated health care job market is cooling, noting that the number of hospital jobs declined by 4,000 in June, the first month-over-month drop since last year.  Of course, they describe the health care sector is a victim of the economy, Medicaid budget cuts, and uncertainties concerning the effects of healthcare reform.  However, the article failed to mention hospital’s draining their resources for meeting meaningful use and other technological initiatives.

The article itself notes that legislation giving more individuals health insurance in turn gives our industry a long-term healthy outlook, and provides a great example of how clinical jobs increased at the expense of administrative and support personnel at St. John’s Hospital in Springfield, Illnois.  Hospitals all over are realigning resources to meet this demand.  However, its the Workforce Development program that needs to realign its program.  

The workforce development program needs to give incentives to hospitals, providers and others who employ these graduates from the program.  This will “make up” for the training costs that they will incur by hiring these health IT newbies.  Additionally, this will solve the lack of human resources very needed in this HITECH world.  ONC: are you listening?!

February 27, 2012  9:44 AM

Stage 2, the final stage for lab ordering systems!

Posted by: AllinHIT

Last week during HIMSS, the long
anticipated proposed rules for Stage 2 Meaningful Use was revealed. Knowing there
will be plenty of experts dissecting the proposed rules, its effect on Stage 1
implementation, and its effect on vendors, etc. However, the effect of MU has
an even stronger “snowball” affect, on one of physicians and
hospitals most valued partners, the commercial lab! Stage 2 proposed rules, can
have an even larger impact of Labs, and can eliminate the “desktop”
space, they have long dominated.

February 9, 2012  8:15 AM

ePHI for marketing crossing the HIPAA line?

Posted by: AllinHIT

EHR adoption, as we know, has a snowball effect on the quality of patient care, the ability to access electronic protected health information (ePHI), avoiding the duplication of test and other services, also effecting patient compliance and engagement. Now, according to a new study, hospitals are using ePHI, as a marketing tool — matching medical needs to the services of the hospital. Here is an example of ePHI being a double-edge sword, cutting one way for better care, and the other for possibly crossing the HIPAA line.

According to a new study by Kaiser Health and USA Today, roughly 20% of U.S hospitals are now using ePHI to target certain services via direct mail. My first thought was that the mere fact of direct mailing clinical services to needy patients can easily reveal that information to everyone –from the postman, to your neighbors (haven’t you received your neighbors mail before?), and to others in the household you didn’t want tell. Hence, revealing private PHI and crossing the HIPAA line. 

Additionally, this study points out hospitals are data mining financial records, along with ePHI.  This marriage of data can result in what I call elitist healthcare!  What do I mean?  Well, sometimes you have to answer a question, with a question, and this is one of those cases. Here it goes: if a hospital only markets its new cancer care unit to those with commercial insurance and/or self-pay, will those on Medicare/Medicaid also have access, or does not knowing about the new care unit lessen the opportunity for access? This was a concern expressed by Doug Heller, executive director of Consumer Watchdog.  He basically says “it is inherently discriminating against patients who have every right and need for medical information”. 

With all that said, hospitals, especially those designated as for profit, do have the right to market their services to targeted patients.  Hospitals, like many other businesses, can and should utilize their data mining capabilities for increasing revenue. I do believe there are ways to accomplish the goal, without, crossing the HIPAA line, and without creating an elitist effect. For example, making sure the unopened mailing doesn’t reveal the services of the hospital. As my mother used to tell us, it’s not what you do, it’s how you do it!

January 27, 2012  10:06 PM

Beacon shines a dull light on Hospital HIEs

Posted by: AllinHIT
Health information exchange, HIE

Beacon Partners, the large, Massachusetts based health care consulting firm, recently came out with a Health Information Exchange (HIE) survey, titled “Health Information Exchange Study: Assessing the Interest and Value in HIE Participation“.  I hated this title and took interest in the fact that most hospitals, of course, are interested in HIEs.  Sharing information between community hospitals is a no brainer, which every health care professional knows!  Additionally, with the birth of ACOs, of course hospitals are interested in connecting their physician operated practices via a plethora of different types of EHRs.

The report surveyed a little over two hundred C-level health care executives, and again, there is nothing new and surprising. However, the report did shine a dull light on those that have yet to commit to HIEs. How do you define this commitment?  I could say it’s in a dollar amount, but the truth is that something more important must come first.  What can that be?

First and most important is a committed governance/oversight body, dedicated to the concept and hence making it happen.  As the report indicates,  HIEs with a committed “oversight group” are the ones operating.  How you can REALLY be interested in developing an HIE without a committed team in place is beyond my understanding!

Not only is there a need for a committed team, but there must be a committed community as well.  I have seen the power of individual commitment and community support firsthand.  Consider the efforts of the Healthy Ocala HIE, the dream of two physicians I know, Dr. Melvin Seek and Dr. David Willis.  For years, they preached the possible benefits of an HIE in this rural city, located 70 miles from Orlando.  Due to their multi-year effort, Health Ocala is one of the most successful private HIE’s in Florida. I witnessed their “spiel” for years as they marched thoughout Florida garnering support, and their ability to involve the major employers, and competitive hospitals has been very impressive indeed.

Second, is the current efforts underway, driven by my friend Christopher Sullivan, PHD, the HIE manager of the South Florida Regional Extension Center.  I sit on a workgroup for this HIE, and Christopher has garnered the support of private hospitals, the health care physician community, an HIE vendor and the State of Florida HIE stakeholders.  His “stick-to-it-ness”, competence, and ability to draw others to his cause I expect will have good results. However, there will always be that dull light shining on sustainability.  Maybe if we can get payers, employers, and the community involved, there will be a beacon of hope, just like in Healthy Ocala!

January 15, 2012  11:46 PM

Order sets, a prescription for defensive medicine

Posted by: AllinHIT
CDS, Chronic care management, clinical decision support, Defensive medicine, EHR usability, Order sets

According to CMS, health care costs in the state of Florida are at $132 billion annually. Although this is an astounding amount, and worthy of a huge gasp, learning that $40 billion of that cost was a result of defensive medicine was the most alarming! Defensive medicine, the act of providing clinical care combined with unnecessary testing for covering ones onus in case of malpractice, is a necessary evil in the eyes of some of the best doctors.

At the end of 2011, a Florida physician poll conducted by Oppenheim Research and Patients for Fair Compensation found that 88% of them practiced some form of defensive medicine in 2011.  Considering the amount of retirees in Florida, and that the “baby boomer” generation is aging, I expect this cost to increase substantially.  Hence, physicians will spend even more on this act of fighting lawsuits, meaning that taxpayers will be paying more as a result!

So what are the answers to fighting defensive medicine?  Although this study focused on Florida, I am certain that you will find similar results in every state. The results might not be as profound as they proved to be in Florida — one third of overall costs is high — but any defensive medicine cost should be unacceptable.  I know Florida physicians are banding together to reform liability laws as the answer.  However, I believe another prescription to this ailment can be uniformity order sets for the most chronic, prevalent conditions.

Imagine if EHRs, upon receiving certain diagnoses, utilized a clinical decision support tool which automatically creates a certain order set for that diagnoses.  Imagine further that these order sets are agreed upon uniformally within the medical community, hence eliminating any unnecessary tests and care plans that are not a part of that order set. Defensive medicine will become a thing of the past, health care costs will go down and outcomes will likely improve! This could be the best prescription for an ailment, even greater than focusing on liability laws and tort reform!

January 9, 2012  4:18 PM

New EFT payor requirements, better late than never!

Posted by: AllinHIT
EFT payor requirements, EHR billing, eRx, HHS rinal rule on electronic fund transfers

As a previous small business owner, I know the importance of cash flow to operations.  Having thousands of dollars in arrears because of client’s processing manual payments, has always negatively impacted cash flow.  Matter of fact, increasing cash flow was the impetus for me selling the” cash cow” of that business.   However, this was in the late 90’s! Now, in this first month of 2012, HHS has published its interim final rule on electronic fund transfers requirements, and from my standpoint, it is decades late!  However, I will reference the adage that “it’s better late, than never”.

In the late 80’s, I worked for NDCHealth (acquired by McKesson) as a marketing specialist.  My role was to market the NDC DataStat pharmacy system to independent pharmacies.  Part of the system was an online, real-time adjudication module for prescriptions.  I remember a particular pharmacist/owner asking, “since this transmission is two – way and the payor knows this script is being filled, is there a way I can receive the payment electronically?” At that time, EFT was not implemented in the module, so I remember discussing about the other benefits of implementing real-time adjudication for these claims.  I mentioned lowering rejection rates, easier pay reconciliation by payor and cutting remittance times.   His next question was, “why not?”.

Today, because of these new requirements, physicians will no longer have to ask that question. I found it interesting that only 15% of remittances are being electronically transmitted, a small percentage considering 99% of physician offices have EDI capabilities, either through their PMS or biller.  Physicians will now be able to increase their cash flow for operations (maybe they can buy that EHR!), reconcile easier by matching the remittance to the appropriate payor, eliminate some  paper and increase the overall efficiency of the practice.  I applaud HHS for this final rule, despite its late arrival!

December 30, 2011  6:46 PM

Seniors and health IT: A match made to avoid heaven!

Posted by: AllinHIT
Cost of care, eRx, Senior care, Senior Citizens League, telemedicine

Last week I wrote a ceremonious, empathetic, “Christmassy” blog about being reminded how effective “no tech” methods can be in achieving better medical outcomes, increasing medication compliance, and so on and so forth. Well after reviewing the results of a most recent study by the Senior Citizens League, one of the largest nonpartisan seniors advocacy groups in the USA, based in Alexandria, Virginia, I’m back on the health IT soapbox. 

The study reviewed how the financial concerns of senior citizens affect their behavior when it comes to visiting the physician’s office, taking their medications and approaching their end of life care.  The study surveyed 1200 seniors and revealed the following:

  • 50% of respondents postponed filling prescriptions
  • 61% postponed visits to dentists, opticians, or hearing specialists
  • 44% postponed filling prescriptions or chose to take a lower dosage than prescribed
  • 44% are spending at least $300 per month on medical expenses
  • 10% are spending at least $750 per month

I admit, the results weren’t that surprising.  Anytime a person has less money and/or no health insurance, they will put off visiting the doctor, dentist, and even not-comply with their medication.  What was astounding to me, however, was the metrics’s large percentages and the high out-of-pocket monthly cost (points four and five above).  After reviewing the results, I couldn’t help but think about solutions that, not surprisingly, were in the health IT realm!  How can e-prescribing systems with a generic pricing default reduce the cost of the prescription? How can a clinical decision support systems be used for prevention, possibly eliminating that office visit and/or prescription?  I thought about how we can use telehealth appointments, in lieu of physical office visits, and hence increasing visit compliance, as this would reduce their costs and is more convenient, especially for those in rural communities.  Seniors wouldn’t have to get dressed, get driven, and spend valuable gas dollars visiting the doctor office.  

While I know this is utopian, our seniors definitely deserve these impactful technologies, especially towards the end of life.  The costs associated with care and the mere inconvenience of an office visit during the time when a person is the least mobile seems inhumane when these barrier-breaking technologies exist. Although there are some “no tech” solutions that could address theses concerns, such as lowering prices, this seem less likely than implementing the technologies. Yes, health care IT and seniors can truly be a match made to avoid heaven.  

December 21, 2011  4:37 PM

The health care cloud: Increasing the need for disaster recovery

Posted by: AllinHIT
Disaster planning, Disaster recovery, Servers, Uptime

There is no doubt, and rightfully so, that the topic of cloud computing has been dominating technology infrastructure conversations as of late. We have EHR vendors, who only sold a client-server application, now reformatting their application for the “cloud”.  We have physicians that two years ago screamed they would never use an EHR on the internet because of security who are now using an SaaS EHR vendor. Mobile health, ACOs, HIEs and CDS support can all be dependent on the development, availability and security associated with cloud computing. This is a good thing, since cloud computing can lower capital equipment costs and assist in implementing applications more rapidly.  However, as health care depends more and more “to the cloud”, it also opens up organizations to additional vulnerabilities.

As a consultant for Navigant Consulting, I had the pleasure of writing disaster recovery plans for the utility industry. Like the utility industry, health care operations are critical in delivering very needed services. Actually, considering human life, I would say that a good disaster recovery plan for health care entities is absolutely vital!  Having a transformer out, hence not having lights in a home, can’t compare to not having the ability to perform a surgery or electronically look up live saving patient information. That is why an updated disaster recovery plan is actually a necessity for saving lives.

One of the key terms in disaster recovery is redundancy. Most people believe redundancy refers to mirroring servers, however, there is more to redundancy than initially meets the eye.  For example, one can have redundancy at the hardware level (servers, gateways, routers, etc), network level (local loops, VPN), and component/device level (iPhones, iPads, laptops).  Having redundancy at all these levels insures more reliability than only having it at one level. 

Another common term and task for disaster recovery is developing a “hot, warm, or cold site”. The hot site is having the ability to stay up and running despite a network or equipment failure (like having all servers mirrored).  The cold site is a physical building or place where you have local circuits and a network, but you have to install the necessary hardware to be “up and running”.  Depending on your needs, location, and budget, these sites will be crucial to your disaster recovery plan.  Here in Florida, thanks to our history of hurricanes, its crucial that hospitals have a hot site, located outside the State of Florida, and a possible cold site in close proximity in case the hospital building is hit by the hurricane. 

There are many other aspects of a disaster recovery planning that aren’t discussed here. For example, the “notification list” containing the list of people to contact, their contact information and their role in the disaster recovery plan is of key importance, and I mention this list for my last point.  The disaster recovery plan is a fluid plan and must be updated continuously, and if the notification list has a person listed who is no longer employed at a facility, well, you can see why this plan has to be reviewed and updated constantly.

So, where is your updated plan?

December 20, 2011  11:46 AM

No tech better than high tech in providing real care!

Posted by: AllinHIT
All Things HIT, Beneficiary management, Care coordination, Medicaid, Medicare, No tech solutions, Population health

As a health IT professional, I am often talking, writing, or giving speeches on the role of HIT in lowering overall cost of health care. Wellness programs, chronic disease management, EHRs, HIEs, and the quality versus fee-for-service (FFS) focus I think will ultimately improve care! However, when it comes to population health, HIT plays a smaller role compared to some “no tech” solutions, and I was reminded that providing better health care and reducing costs isn’t just about managing workflows, CPOE, and chronic disease care.

I hear all of my EHR technologist friends asking, “How can ‘no tech’ solutions possibly be more important than high tech solutions?”  Well, as you can probably guess, it has to do with providing access to health programs and health care.  I was recently reminded about the basic needs for two large population groups: Medicare and Medicaid beneficiaries! I’m not just talking about adhering to office visits or providing access to a community clinic.  I’m talking about other necessary, preceding steps that most of us don’t even think about. Simply providing access to healthy fruits and vegetables leads to better population health, and hence reduces population health care costs with the ultimate “no tech solution”!

This need has not been ignored by some.  The AARP, in partnership with UnitedHealthcare’s “Do Good. Live Well” initiative has provided food to seniors  in need during this holiday period.  The Aetna foundation recently awarded two grants totaling $381,000 to several food assistance programs; one for Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps, and the other for Special Supplemental Nutrition Program for Women, Infants and Children (WIC).  The grants will monitor the effectiveness of programs that help low-income families buy more fresh produce and other healthful foods.  Fresher, healthier foods lower the risk of obesity and other related diseases, such as diabetes and heart disease.

Happy holidays to my friends who are helping me see the tree’s beyond health IT forest, reminding me that there is a huge “no tech” role in our battle to improve outcomes and reduce costs. I’m reminded of Dr. Amani in Atlanta, phoning patients each Wednesday, discussing their new prescriptions.  She increased compliance and had better outcomes, all without adopting an EHR.  Yes, “no tech” solutions, such as having access to healthy food and a well-balanced diet, are the cheapest, simplest solutions, and yet are the most complex to provide.  I guess it’s much easier for society to adopt technology, implement quality measures, provide telehealth/remote monitoring rather than implement wellness programs after the fact.  With that said, it’s back to All Things HIT in 2012.  Happy Holidays!

December 2, 2011  12:42 PM

December, already a month to remember in health IT

Posted by: AllinHIT
CMS, EHR, EHR adoption, Electronic health records, Meaningful use, MU stage 2

December can already be marked as a month to remember for those of us in health IT.   HHS leader Sec. Kathleen Sebelius’ announcement that MU qualification is being extended until 2014 is sweet music to the ears of those in the industry still struggling with adoption of electronic health records (EHRs).

Once again, I have to give it to the ONC for their flexibility in chartering the course to adoption.  Can you imagine if the HITECH incentives were initially based on adoption with a certified solution and no MU criteria? As HHS reported this week, adoption has doubled in the last two years, and by delaying MU qualification, they believe it will increase adoption even more.

This ends the year with a huge upside for those preparing to implement EHRs in 2012! Depending on where one is in the process (selection, implementation/go live, or post launch), more time can be spent on refining workflows and processes, training staff, and aligning efforts cohesively with other health IT projects, such as ICD-10 migration. And let me caution those of you who are at the beginning of this implementation and adoption journey and think you can delay the selection process — you can’t! You will need this extra time.

This announcement also aligns EHR adoption and MU with infrastructure building, needed for such things as the NwHIN and the esMD networks.  Vendors like my friends at EHRDOCTORS and MRO Corp can spend more time testing their communication products, and CMS can spend more time testing the network. NwHIN for transporting PHI and the esMD for transporting required auditing documents will have to be very reliable and secure. These vendors and CMS can now adopt a more “gradual loading” of the network, since adoption will be more gradually staged in the marketplace, without these time-constrained, MU qualifications!  In data center speak, it is a natural “load balancing”!

Most important, this announcement affects every one of us as patients, and is really a mixed bag.  I believe adoption is better for patients, so “the sooner, the better”.  However, it is important to patient care that the systems are reliable, secure, increasing efficiency, and that all those ROI variables are there. For example, more time left for providers to implement CDS/clinical informatics can lead to more define order sets, leading to better care for chronic diseases.

So, thanks to HHS, you have us a gift during this time of year!  Now, can you really make it a December to remember and delay ICD-10?

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