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All Things HIT

May 2, 2011  11:41 PM

Telehealth and mhealth calling attention to ACOs

Posted by: AllinHIT
ACO's, ATA 2011, mHealth, Telehealth

This week I am attending the American Telemedicine Association’s (ATA) annual conference and expo in Tampa, Fl.  I’ve attended executive roundtable discussions, sat in on sessions detailing successful telehealth pilots, interviewed key stakeholders and saw a few impressive demos of innovative telehealth technologies.

Unfortunately, I ended the day with most of the same questions I had prior to attending.  But when considering whether or not telehealth is a must-have component for ACOs, the I did get an answer, and it is a resounding “YES.”

As a healthcare IT consultant, I wanted to attend ATA 2011 to acquaint myself with the latest telehealth and mHealth products, pilots and ongoing initiatives, and most importantly speak to the industry leaders and innovators who are leading this charge.  The conference gave me a taste of all of these things, and I am convinced that telehealth — which includes mobile health and patient remote monitoring — is a truly effective measure for improving chronic care management.  There are multiple pilots that have put this point beyond debate, which was highlighted again during the executive roundtable discussions, the participants of which represented some of the largest, most influential thought leaders and vendors in the industry.

If accountable care organizations (ACOs) are to become an effective means of chronic disease patient management, we must begin utilizing telehealth technologies and harnessing the power of mHealth now. Though we — the industry — must keep in mind that what makes sense logically, might not make sense financially, and what I was not able to get a straight answer on was regarding the cost of these technologies. Even when I asked pointed questions on price and availability, I heard responses such as: “it depends on how many units are purchased” and “I’m on the product side, but sales will tailor a quote for customers.”

Telehealth is a device dependent model and will require scale in lowering the per unit price, not to mention device and network maintenance, inventory shrinkage and the myriad of support and training costs.  Until these costs are defined in granular, I wonder if ACOs will truly be able to answer the industry’s call?

Stay tuned — I still have another day at the conference, where I aim to get more answers, and quite possibly more questions!

March 1, 2011  11:51 AM

Aetna leads Payers in Health IT

Posted by: AllinHIT

As a HealthIT consultant, I undoubtedly watch with much interest, the payer landscape in Health IT. Besides it being my job, a contributing factor to this interest is being raised in New England’s Hartford/Springfield area (the nations insurance capital), working an Aetna internship during my college junior year, and having a host of relatives and childhood friends employed by the insurance industry.  Hence, I’ve watch two particular payer’s take the lead in using technology for better Healthcare, UnitedHealth Group and Aetna.  With UnitedHealth Group at its heel, I must crown Aetna the leader with their announcement on February 25th, that members in Florida and Texas, will now have access to telehealth services 24 hours, 7 days a week. The service offers telephone and video consultations, utilizing their partner, TeleDoc, a large network of primary physicians.  

Lets look at some Aetna properties in relationship to Health IT, and how it positions Aetna for the future.   Aetna owns two large Health IT vendors addressing MU requirements, ActiveHealth (CDSS) and Medicity (HIE data aggregation).  Its interesting to note that both had a huge and separate presence as HIMSS exhibitors last week!  The combination of these two companys’ growth and potential, aligned with MU and adoption, will increase revenue down the road for Aetna.  Having access to their employee’s PHI, is needed for cost containment and developing wellness programs, a great value proposition to their employer clients.  Now with using telehealth for allergies, colds, bronchitis, and other minor conditions, Aetna will reduce hospital visits and it requires less administrative/billing costs.  Lastly, lets not forget the benefits to the patient population it insures.  Patients having easy access to care, saving time and money, is truly what gives Aetna the edge among payers in Health IT.  

However, we must not overlook UnitedHealth Group, when answering the question of who is leading the payors.  Their subsidiary’s include the coding powerhouse Ingenix, AIM Healthcare providing claims management, and their valued priced ATCB-ONC certified CareTracker EHR, UnitedHealth is not far behind Aetna. I guess the real question is, where are the other payors in relationship to Health IT?  

Other payers are participating in Health IT pilots in telehealth, remote monitoring, texting medication reminders, etc.  However, Aetna has stepped up from pilot to reality.  By paying physicians a consultation fee of $38, with normal co-pays for patients, TeleDoc physicians have an opportunity to increase revenue, something rare, but welcomed among primary physicians!

February 26, 2011  8:26 AM

HIMSS 2011: On my home court!

Posted by: AllinHIT
HIE, HIMSS 2011, HIMSS11, ICD-10, Meaningful use

HIMSS11 was held in Orlando Florida this year, my home base of operations.  The weather was hot and beautiful, giving those who came from cold climate an opportunity to thaw out on the convention center lawn during lunch.  I spent some time giving local resturant advice, and served as a personal GPS to my buddies with Ingenix.  The conference, as usual, was filled with parties, product and acquisition announcements, and lively discussions on health IT adoption, meaningful use (MU) stage 2, security breaches, REC effectiveness, HIT adoption, and the high number of new vendors exhibiting.  Aneesh Chopra, the nation’s CTO, referred to HITECH as a catalyst to innovation and entrepreneurship during his opening speech.  This was proven to be true as I visited some of the new vendors’ booths as well. 

If I had to summarize HIMSS, it would include the words ‘health information exchanges (HIEs),’ ‘meaningful use’ and ‘5010/ICD-10’ (and I know those aren’t necessarily all words!).  HIE topics dominated the conference in both seminars and conversations, while the Interoperability Showcase seemed larger than years past and had a new vitality when you visited the area.    Meaningful use was a hot topic of course, given CHIME’s suggestion that the ONC delay stage 2.  Hence, there were many discussions centered around the following: “Should they, or shouldn’t they? and “Will they, or they won’t they?”. The ICD-10 deadline dominated the discussion among HIMs, too, and rightfully so.  as there were discussions on extending that deadline too!

Overall, HIMSS11 was exciting, informative, and alot of fun.  I had the opportunity to meet some great people, see some great products, and had the chance to tape my “HIMSS Home Court” program, sponsored by’s Health IT Exchange communinty.  The program feature interviews with “home court” initiatives in Florida — please look for the interviews to be up on the site in the next couple of weeks. 

Be sure to come back and visit to see can’t miss interviews with Jim Traficant (of Harris Corp.), Lisa Rawlins, Executive Director, of the market-leading South Florida REC, and Dr. David Willis, one of the drivers of a the Healthy Ocala HIE.  For good measure, I decided to include an interview with an International health system, the Dubai Health Authority, a fun and exciting group!  

Lastly, it wasn’t the conference I most enjoyed, but was YOU, the people who I met.  Networking and learning from my peers — this is what is most valuable at HIMSS. It reminds me that there are some smart, dedicated people in health IT, many of whom have a passion for delivering better care to patients through innovative technologies.  These are the folks I talked to in the sessions, on the exhibit floor, and as part of my HIMSS Home Court interviews.  And while this year is over, I look forward to more of the same in Vegas — I hope to see you there!

February 15, 2011  12:32 PM

Direct Project “User Stories” are full of push!

Posted by: AllinHIT
direct project

The Direct Project, a NHIN effort to provide a simplied, scalable, transport method for exchanging PHI will now be tested by the Rhode Island Quality Institue and the Hennepin County Medical Center in Minnesota. However, as I explained to a physician recently who confused the Direct Project with the state HIE, there are limitations to the Direct Project.  It is designed only as a secure mechanism to transport and push PHI between two parties (It could be three parties if there is a Health Information Service Provider or HISP).  For example, this project enables physicians that do not adopt EHR’s, to push PHI to referring physicians. It allows for physicians to push office visit information to their patients, and will enable Critical Access Hospitals to push patient discharge summaries to their personal physician.   Hence, pulling information, such as in a HIE, is not the goal of the project.

The three fore-mentioned “push” scenarios are referred to as “User Stories” by the NHIN. The project is in three (3) stages, each developing transport for different “user stories”, starting with Stage 1 for meeting MU.  The Rhode Island pilot will be testing some stage 1 user stories, physician PHI to another physician.  The  Minnesota pilot will be testing a stage 2 user story, sending immunizations to the State of Minnesota (probably Medicaid data).   Regardless of the maturity of the project, its important to stress the pushing of this data is in every stage, and not the pulling of data.  Hence, a scenario with an unconscious patient in the ED, and a hospital needing PHI to properly care for the patient, the Direct Project can not be accessed to get important PHI, like allergys!  This is a huge distinction, compared with a HIE, and its important to educate physicians on the difference!

February 1, 2011  11:01 AM

Stanford report reveals EHR and CDS quality myth

Posted by: AllinHIT
CDS, clinical decision support, EHR, electronic health record

Last week, an extensive report by Dr. Randall Stafford of Stanford University, and Max Romano, the National Heart Lung, and Blood Institute, revealed electronic health records (EHRs) & clinical decision support (CDS) use did not improve quality of care. This was shocking news initially, until I went past the headline.

Its conclusions were derived by analyzing data from the National Ambulatory Medical Care Survey, and the National Hospital Ambulatory Medical Survey — data that is 3 years old.  Noting this was the basis of the analysis, I thought of the importance meaningful use, health information exchanges (HIEs), and alternate service models ( like accountable care organizations (ACOs), telehealth, and remote monitoring) can play in improving quality.

It’s not surprising to find that individual EHRs, in their separate silos do not improve quality of care.  How could they, when important personal health information (PHI) is locked away in a physician’s office, and the hospital ED doesn’t have access to them during their patient’s episodic event?  How could quality be improved, when a person’s allergy to morphine is noted in their physician’s EHR but during a catastrophic event a hospital administers the drug?  In both examples by having access to that data via an HIE, the hospital could improve the quality of care of those patients, benefiting all parties.

The Stafford/Romano analysis that EHR use, with CDS “turned on,” had no effect on quality was not shocking. I know many physicians ignore these plans.  It would have been interesting if the surveys gather data on the CDS solutions used, and the various care methodologies in use.  This would have told us if one solution was used more than another. (It would be interesting for a company like ActiveHealth to do this analysis with their Aetna patient base!) Regardless of the care plan, the reviewing of such information — as well as the act of consciously overriding the suggested care plan, and sometimes acting upon that care plan — will soon be a part of MU.  I have no doubt that CDS will be go from a “menu” item, to a requirement in stages 2 & 3.

It is my hope that along with the requirements physicians are rewarded for adherence.  Good pay-for-performance (P4P) plans, alignment of the physician quality reporting initiative (PQRI) with meaningful use for  easier reporting, and a better consumer rating as transparency is enforced, will encourage physicians to spend the time needed to review CDS plans.  This along with MU adherence and HIE connections will improve quality of care, giving the next survey a different outcome.

January 20, 2011  12:13 AM

Independent, office based physician on the verge of extinction?

Posted by: AllinHIT

As a technology consultant for Quest Diagnostics, I met with almost every physician in the State of Florida.  Hence, I have a huge network of physicians that I converse with regularly.  I noticed recently that more and more of them are selling their practices to become an employee of the hospital.  Organizations like Orlando Health, Florida Hospital, and Baptist Hospital are making it widely known that they are interested in buying practices.   As a result I decided to look at this more analytically.  

I found an article dated Nov. 8, 2010, in the Wall Street Journal that stated more and more physicians are working for hospitals, versus, hanging their own shingle.  In the latter part of 2010, a MGMA survey found that hospital – owned physicians in 2009 had jumped to 55%, up from 50% in 2008, and approximately 30% in 2003. Meaning in 6 years the number of hospital vs. independents rose by 25%.  The article also references that the largest U.S. physician recruiting firm, Merritt Hawkins, recruited more physicians for hospitals, then recruit physicians for physicians groups.  So, why is this happening?  What makes physicians reluctant to “hang their shingle”? 

The answer is probably a “no brainer” to most of us, but lets recap some of the reasons.  Shrinking reimbursements lead to seeing more patients for revenue, the arduous task of renewing payer contracts, high insurance costs, litigations and lack of tort reform, high receivables from patient copay – and of course, being “forced” to adopt EHR technologies!  Wow, no wonder this trend is upward!  It just may be that some physicians just want to focus on practicing medicine and not operations, and all of the aforementioned!

Regardless of the reason, the trend is moving in the hospital direction for physicians.  As John Strange, CEO of St. Lukes Hospital in Duluth, Minn., said: “You need patients to support your facilities, and doctors bring patients.” 

Let’s hope that this is not the end of the independent physician.  If all physicians worked for hospitals, this will undoubtedly increase cost to the payers, and most importantly, to patients!

January 19, 2011  11:33 PM

HIMSS’s Missed Opportunity!

Posted by: AllinHIT

On February 20th HIMSS 2011will commence where I live and work, Orlando, Florida.  We will attend all types of educational workshops, make the acquaintance of old co-workers and friends, network with new ones, and of course, there will be the nice parties.   Lastly, vendors will show their wares in exuberant booths, hoping they land a big customer.  Not denying the fore-mentioned activities are good thing, but HIMSS will be missing the boat on an opportunity that I’ve been advocating for years, the opportunity to educate local physicians on EHR technologies, Meaningful Use, and other HITECH attributes.  

Of course, a local physician can register to attend the conference for a fee.  Adding to the cost, the physician will also have to take time away from their practice.  This is during a time of lower re-imbursements, uncertainty about their industry (ACO’s, P4P, EHR’s, ICD-10, 2015 deadlines, etc.), and of course, adoption and implementation of technology.  Hence, the value proposition for local, office based, physicians, is a little thin. 

HIMSS should recognize that these physicians have more of a need to attend the conference, then say, you and me.  I have seen/done many EHR demo’s, am constantly educating myself on the fluid, ever-changing world of ALL THINGS HIT, hence I really don’t need as much education, nor do I attend it for those reasons.  So what should HIMSS do for these local physicians…..give them free admission into the conference!!

This will be of benefit to the physicians of course, but it will also give the many EHR vendors an opportunity to showcase their application to local, office-based physicians.  If HIMSS was bold enough to do this, it will increase the value proposition to vendors, give office-based physicians a voice at the conference, and possibly, increase adoption!

January 10, 2011  9:05 AM

Implementation for One, when others won’t!

Posted by: AllinHIT

Two years ago, I assisted a three (3) physician family practice with installing a bridge connecting their Practice Management System to a lab providers LIS.  After explaining to the founder that he needed a bridge (for demographics) and not an interface (results).  I then asked him about implementing e-Prescribing, which he wasn’t interested in doing.  However, one of the other physicians, a young woman new to the practice,  asked me questions about it, and she decided she wanted to implement it for her patients.  She also relished in the fact that SHE would qualify separately for the CMS e-prescribing incentives (Kudos to CMS for knowing this scenario was common in mult- physicians practices)!    

This is a common problem in a multi-physician owned practice, whereas, one physician embraces technology, but the one with the purse strings does not.  Knowing that this exists is the reason why CMS incentives are given to physicians, not practices!  Utilizing technology disparately within the office, could disrupt office workflow, confuse the staff, create more work, and can ultimately effect patient care.  The technologist physician’s assistant will probably be well trained on the technology, but the people in the office who has to “cover” for that person during absence, is probably not trained.  Hence, the technologist physician must have a “paper” workflow based upon this scenario, and a procedure for manually updating the system. 

Here are a few suggestions that you must consider in your plan.  First, the physician should consider cross-training another employee.  Typically this is avoided because of training cost.  However, consider using the vendor web seminars, video training, or internal staff for training.  Secondly, have different manual order forms, then the rest of the practice has.  If you have to implement a manual paper process, making sure that the forms are distinct, will make the information easier to find for updating in the system.  Thirdly, have the process written out and make sure the whole staff is familiar with the process, and where to find the procedure.  Fourth, test the manual backup system because you will undoubtly use it!

December 16, 2010  11:33 PM

Personal Health Information is crucial from Birth!

Posted by: AllinHIT

When I was prematurely born, I had serious breathing problems, and according to my parents, was diagnosed with a form of asthma.  This resulted in a month-long stay in a pediatric ICU with my mother along my bedside.  Now, directly related to my occupation as a Health IT professional, I reflect on my birth circumstances often.  

There are many questions I have about my condition at birth.  What was the official diagnose?  What drugs were administered? What were the subjective and objective facts of my condition?  What are the hospital discharge notes?  What education was provided to my parents? What was the assessment and treatment plan? What were the survival rates at that time for my condition? (I would like to think I was beating the odds) I have lots of questions, and no answers!  The act of getting these answers, among the myriad of questions, would be a daunting task, maybe even impossible. 

I have many reasons for advocating EHR adoption, and my personal birth experience,  mixed with my knowledge of EHR’s, PHR’s, and all things HIT, is one of those reasons.  The technological capabilities didn’t exist then, but they do now, and EHR adoption will be a welcome site among children hospitals.  In the December issue of the monthly publication, Archives of Pediatric & Adolescent Medicine, a survey revealed that less than 3% of children hospitals have a compreshensive EHR.  Of course, like all other providers in the delivery system, the 108 hospitals that responded, are blaming cost as the main culprit. Regardless, we are in a different period of time, and in this HITECH world of today, I am hopeful of change. 

Of course, hard and soft costs associated with implementing EHR technology, cannot be ignored.  However, in juxtaposition, I can develop a worksheet showing a positive ROI by increasing efficiencies, reducing errors, eliminating duplicate tests, and even can include HITECH incentive dollars in the calculation.  Hence, I am not debating EHR adoption,  nor all the relevant statistics, and possible ROI’s.  We know the ability to reduce ED visits, hospitalizations, adverse drug effects, are all possible and probable, using a comprehensive EHR.  The thought of this technology being applied to children hospitals, the entity responsible for treating and managing diseases for these precious humans, is even more tantalizing.  Don’t we owe it to our children?  After all, doesn’t valuable PHI begin at birth?

December 10, 2010  10:45 AM

CIO Survey on EHR Challenges, Reveals Human Nature

Posted by: AllinHIT

CHIME, recently revealed the results of their recent November survey on the optimism, and challenges centered around acheiving Meaningful Use with EHR systems.  What was particularly interesting, was the waning attitude of success, indicated by the variances from their last survey in August.  Another point, less surprising, was that one of the biggest challenges for implementing CPOE, is to get the clinical staff to use the system.  After reading this, I thought about despite the millions being spent on Health IT, the financial incentives, and the many “water cooler” conversations on HITECH in the hospital, the real success of HITECH, will depend upon fighting human nature’s nemesis, CHANGE!

This is really no surprise to most of us in the Health IT world.  EMR adoption, especially prior to HITECH, was not necessarily at the top of a hospital or physician’s list.  Now times have changed, and hospitals, physicians, nurses, PA’s, MA’s, and all other healthcare workers know that adoption is a matter of when, not if. The challenge is transferring acknowledgement of this fact, into “buy-in” among the clinical staff.  Making them a part of the change, not resistant to it.  But, how can that be done? 

First, take a survey of your clinical staff to identify attitudes towards adoption.  You can design the survey to identify three separate groups.  The Enthusiatics, the Fencers, and the Naysayers.  The enthusiastics are looking forward to adoption, the Fencers are those that can take it or leave it, and the Naysayers, well are naysayers!  Identifying clinical staff in this way, will assist in developing training and implementation schedules and strategies.  For example, I would have pair an Enthusiatic with a Naysayer for training.  The Enthusiatic will probably learn the system faster, and could become your champion to the Naysayers.  Also, it may help in developing your project team, having Enthusiastics representing their perspective areas.

Second, create “buy-in” beginning with the planning process prior to vendor SELECTION.  The short-listing process of vendors should include a hospital team that representing stakeholders from each user group within the hospital.  Physicians, nurses, hospitalist, ED, Radiology, patient registration, pharmacy, and others effected should be able to voice opinions on vendors.  The clinical staff “having a say” on vendor selection, will garner support even if a stakeholders’ particular choice is not selected!  Knowing that one’s opinion count, is a basic human nature you can use to combat its nemesis, CHANGE!

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