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All Things HIT

December 2, 2010  12:52 PM

Some thoughts on Black Book’s EHR ranking!

Posted by: AllinHIT
EHR, EHR vendors

On November 29th, Black Book Rankings, a market research firm owned by Brown-Wilson Group, released their list of the top EHR’s.  This is a respectable, internationally recognized market research firm, with a huge sampling of responses having interviewed 30,000 professionals in healthcare.  The quality of this sampling, the firm, and the methodology of rating 18 key performance indicators, is a marketing gem to EHR vendors that made the list.  However, the list’s marketing effect on the physicians’ buying decision, may be limited, based upon some factors.  Simply, the physician must ask a series of questions. 

As I have always recommended to physicians, look at the functionalities, reputation, workflow match, and other attributes of EHR vendors, then short-list your choice to three (3) vendors.  The short-list process itself, with various rating and scoring methodologies, can be developed and implemented, and usually is done when using consultants.  So, lets consider the physician has properly follow a methodology and have picked 3 vendors to choose from.  Here are some of the questions, the physician buyer must ask; Which of the 3 have made the list?  Black Book’s, EMR Research Director, acknowledged there are unique elements to each hospital and physician practice.  Considering this, how did the various individual key performance indicators used in the ranking, match up with the uniqueness of my practice?  The practice workflow, existing practice or revenue management system, interfacing needs, mobility needs,  growth plans, and even delivery plans (maybe they are going to be a member of an ACO pilot), must all be considered. 

Additionally, there are some overall questions any physician practice must ask, in reference to these rankings, regardless of where they are in the buying process.  The obvious one, “Is the vendor also on the  Certified HIT Product List (CHPL)?  This means they have been certified for Meaningful Use by one of the ONC-ATCB’s (Office National Coordinator, Authorized Testing and Certification Body).  This could put at risk the EHR incentive dollars!  Matter of fact, one of Black Book’s key performance indicators, was Meaningful Use.  However, since there is not one user, who can testify to the “ease of submitting MU reporting to HHS”, the results could be questionable.  We all know most vendors are “guaranteeing Meaningful Use”, but that only pertains to the EHR’s capabilities, not how easy it is to extract and report the data! Maybe, after attestation, there will be a large sample group (due to a projected higher adoption rate), reporting on  “MU capabilities and ease of use”.    Then this ranking could become even more important, to the prospective physician buyer!

November 23, 2010  11:18 PM

Cutting IT Disparities Should Go Beyond “ASKING”!

Posted by: AllinHIT

Dr. Blumenthal and Dr. Garth Graham, HHS deputy assistant secretary for minority health, recently “asked” for EHR vendors to address the low EHR adoption rate within their communities.  This weak and insulting request, will receive a vendor response equal to those attributes.  The real answer is to dedicate some funding to educating, and implementing Health IT, within physician practices serving the urban, and underpriviledged communities.  Don’t get me wrong, there are HHS HIT allocations to Community Health Centers, the Indian Service Agency (more on that later).  However, considering 10.8 % of African Americans as well as 10.6% of Mexican Americans, there is a great case for allocating dollars to the African American community and the providers that serve them.  As a minority, I must say the insulting part of them “asking”, is not throwing any of that 20 billion HITECH dollars directly to addressing it.

The dollars are justified, regardless of ethnic reasoning. Lets agree that treating diseases such as diabetes will benefit with implementing EHR’s, connecting to the HIE’s, reaching Meaningful Use, and other Health IT projects. By the way, more “bulls-eyed” targeting of dollars; taking advantage of technology, within ACO’s, lowering eposodic events among the medicare, diabetic community, the largest population of those with the disease! Consider the savings of addressing the high cost of diabetes, among the population that it effects most!  This I coin as a “bulleyed approach” to controlling costs.  As reported in the 2007 American Diabetes Association’s, Economic Costs of Diabetes, 1 of every 10 dollars spent on healthcare is on this disease, it is one of the largest contributors to the high cost of healthcare.  

To their credit, HHS’s Indian Health Service, has recently announced that Vangent, one of Health IT’s largest consulting firm, will spend 3.3 million dollars within the Indian community, implementing Health IT.  This is great considering that 9% of Indians will have diabetes, and implementing CDSS and other technology tools, will assist in disease management for their community.  However, the same amount of effort should be placed on the community, with the need most.  This “bulls-eyed” approach to managing cost, through Health IT, deserves more than “asking”!

November 15, 2010  8:26 AM

Working together for HIT….ePrescribeFlorida a Case Study

Posted by: AllinHIT
ePrescribe HIT Surescripts

Prior to taking a long vacation in October, I was invited and attended the SureScripts SafeRX Award Luncheon, in Washington DC.   This annual luncheon held by SureScripts recognizes the Top 10 ePrescribing States, determined by their ePrescribing Rate ( percentage of electronic prescriptions to all prescriptions).  I was elated to attend this event, as a representative of ePrescribeFlorida, an organization that was most responsible for the State of Florida, being honored as the 10thranked State in electronic prescribing on the SureScripts Network.

 In 2007, ePrescribeFlorida, was the brainchild of one person, Walt Culbertson, a former Availity executive, whose wife eventually died from cancer, but nearly died for receiving the wrong medication during her treatment!  Knowing her adverse drug effect, could have been easily avoided had the physician electronically prescribed the medication.  The ePrescribe system would of created an alert, detailing an allergy to morphine, hence saving Walt, his wife, and his family from unnecessary stress, in an already, stressful situation.  Walt, having connections in the industry, met with BCBS of Florida, and together they started ePrescribeFlorida, with the goal of increasing the ePrescription rate in Florida, through education.  Walt was able to bring all of the stakeholders in the State together, government,  payors, pharmacists, medical societies, IPA’s, software vendors, SureScripts, eRX, and many others.  Our ePrescribe team, worked tirelessly for 3 years promoting and educating physicians on electronic prescribing.   What were the results of our efforts?    

In 2006 Florida’s electronic prescription rate was less than 3%.  Since, our e-prescription rate is closer to 15% and rising.  From 2006 to 2007, Florida experienced an annual increase in the number of electronic prescriptions of 1.6%.   From 2007 to 2008, after the formation of ePrescribe Florida, the increase was 4.3%, then last year our rate increased to 10.3%.  In 2008, Florida’s ranking by SureScripts was 20th, now in the Top 10, within 2 years!  This is a great case study on how stakeholders can work together to influence the adoption of health information technology.  Thanks Walt, Catherine Peper, of BCBS of Florida, and the many people that had a stake in this effort.  By working together on a common vision we influenced the adoption of ePrescribing in our State……..well done!  

November 11, 2010  10:17 AM

Selling on EHR Benefits supercedes Political Climate!

Posted by: AllinHIT

Now that there is talk of Health Reform being repealed by the new House, and there will be substantial cutbacks to the behemoth government budget , does that mean EHR incentive dollars are in jeopardy of being cut?  That was the question I received last week while speaking to some physicians at the Polk County, Florida Medical Society.  I was not surprised by the question, actually I was surprised it took that long for me to hear it.

I do not really know the answer to their question, if the talks of cutting the “fat” in the US  budget, means cutting out incentives.  I do believe our government knows how important it is to control Medicare and Medicaid cost, and the important role of healthcare technology in accomplishing it, hence am optimistic.  However, this question relates to my earlier postings about why EHR salespeople and others, must focus on discussing the benefits of EHRs to the practice, the patient, and the healthcare community at large. EHR salespeople who focused on making sure the physician offices understood the incentives, instead of the benefits of EHRs, will now have to revert back to selling based on ROI and other intangible benefits.

What are some of those benefits that physicians should be aware of? Reducing cost and increasing efficiencies in the office by eliminating lost charts, chart pulls, pharmacy refill requests, transcription and billing costs, accurate billing, and increasing the office’s Revenue per Sq. Foot by utilizing medical record space/storage square footage more effectively.

Lastly, the physician should really understand why an electronic record is better than a paper chart, for their patients. Keeping patients PHI is a separate, silent silo, is a huge disadvantage in emergency care!  Reducing Adverse Drug Effects (ADE’s) in prescribing medications, reducing tests and unnecessary treatment, eliminating mistakes due to misinterpretations of paper charts during “hand-offs” (from physicians to hospitals and vice versa), can be accomplished by having an electronic chart.

If physicians really understand these benefits, then the threat of incentives being eliminated, will never affect adoption!

September 10, 2010  10:28 AM

Hurrah for Mobile Health in New Study!

Posted by: AllinHIT
ACO's, Mobile Health, Remote Monitoring, Telehealth

There has never been any doubt in my mind, we must embrace the benefits that telemedicine, remote monitoring, and other mobile health applications bring.  This week Pricewatercoopers (PWC) released a report confirming the huge opportunity we have in changing our health delivery system to a low cost, easily accessible, quality and evidence based, ACO like compatible model!

The study stated physicians are willing to use the technology, at an astounding 88% surveyed.  Patients, they found, are willing to use medical devices, but not pay for them if the device is over $50.  However, a small percentage (41%) will pay for the mobile device on a monthly subscription basis. This gives much evidence to society’s openness to mobile health.  Within, the ACO model, mobile health can prevent episodic events from occurring by getting real time monitoring of their assigned population segment. Controlling High Blood Pressure, managing CHF conditions and heart devices, like pacemakers, will reduce hospital visits, hence, reducing delivery cost for the ACO. 

I know all of this sounds simple, but I do understand the challenges ahead.  The wireless PHI floating in the air, scares the medical privacy advocates, and the naysayers in general, whose argument has a wide range of reasons.  However, pilots and programs are being implemented in many areas.  Cigna and Piedmont Healthcare, Atlanta, recently announced an ACO pilot with 100,000 Cigna patients, and 100 Piedmont affiliated physicians.  The 1:100 physician/patient ratio effectiveness, a mobile health strategy, and its relationship to cost, will be an interesting measure during this 1 year pilot.  The willingness to comply, by patients, and the physician real-time monitoring of data, can that be an effective combination, leading to an effective evidence based medical society?  What will be the overall cost reduction be in this Atlanta ACO? Having attended college (Morehouse), and living in Atlanta for 18 years. I have a special interest in getting these answers? 

Anyway, I do know, despite an active discussion on whether hospitals or physicians will lead the way in the ACO model, hospitals and physicians will have to work together in sharing PHI data, outlined in HIE and Meaningful Use guidelines.  Real-time data from mobile health devices, can be available for HIE’s, and to ACO’s as they go from pilot to true Medicare re-reimbursement programs, January 2012. Either way, Hurrah for mobile health being acceptable to patients and physicians alike!  Message to Cigna and Atlanta’s Piedmont Healthcare, I’ll be calling!

August 30, 2010  10:01 PM

ATCB’s are ready to certify vendors, but are they really?

Posted by: AllinHIT

On June 18th, the ONC issued a final rule on the temporary program for Authorized Testing and Certification Bodies (ATCB’s) for EHR Meaningful Use certification.  I was also elated that CCHIT was not grandfathered in (however, we all knew that they was going to be one of the ATCB’s).  The industry has needed more than one certifying body for a long time.  Now on August 30, 2010, 10 weeks after the final rule, we know that Drummond Group Inc., is joining this lonely group of certifiers.  The Drummond Group is based in Austin, Texas, and currently operates a test laboratory for interoperability, conformance testing, and certification for several industries. Hence, it made sense for them to explore a new vertical.  Now, we have to wait and see what other firms will become certifiers, and it can’t come soon enough! 

We will see a plethora of new EHR’s vying for this certification.  It seems that every entity in the healthcare industry, is developing an EHR! If we don’t have more than two ATCB’s, by year end, there will be a huge backlog of vendors waiting for certification.  This could seriously effect vendor sales, as no physician or hospital will consider anything but a certified vendor….and can you blame them?

The ONC claims that vendors can immediately apply for certification.  However, I have some serious concerns about CCHIT and Drummond not being able to handle the amount of inquiries.  I wonder how will they prioritize?  Is it first come, first served?  Will there be some bias as to the size of the vendor, its history with CCHIT certifications?  This all remains to be seen, but I wish them luck, and I think the vendors will need a little bit of luck themselves.

August 21, 2010  11:34 AM

Selling based on HITECH incentives is the wrong approach!

Posted by: AllinHIT

I had recently had a discussion with some peers on the adoption, or lack thereof, of EHR and other technologies.  Some in the discussion maintained that physicians are reluctant because of a “parent to child” affect.  Basically this means physicians feel the parent (CMS) is telling them (the child) what they must do in their practice, hence there is a natural rebellion to adopt.  

Of course, some of us feel the HITECH incentives, coupled with the CMS requirements for 2015, will be a shining light for increased adoption.  Most of us will agree this will have a huge effect.  However, I believe adoption and the industry as a whole, is better served, by helping physicians understand the real benefits of adopting these technologies.  If the value proposition is that CMS will require an EHR, or that you can get $44,000 to adopt the technology (which is only 20% of the cost), then it’s the wrong approach.  .

Educating on the possible benefits of adopting technology is a better approach.  Increasing office efficiencies, the reduction of billing errors, preventing adverse drug effects and poly-pharmacy, increasing compliance by providing patients with electronic information, and many other benefits are now being overshadowed by HITECH incentives.  After all….which is better for the patient should be the focus?  Is a paper chart better for the patient than an electronic one?  Is a paper script better than an electronic one? Leading discussion points in this direction, the physicians will understand the value of adoption to their practice, and of course, to patients!

Lastly, I don’t think physicians are so petty, that they won’t adopt, because their “parents” say do so.  I think they will eventually do what will increase the quality of care for their patients, and improve office efficiencies. Due to the different needs and comfort levels physician practices have, it’s just a matter of implementing the right applications, in the right practice! 

August 9, 2010  10:25 PM

Applauding Insurers for Aligning with HITECH and MU

Posted by: AllinHIT

There is no surprise here, insurers Highmark, Wellpoint, UnitedHealth and Aetna have announced they will give incentives to physicians that adopt EHR’s under the HITECH Meaningful Use umbrella.  I say its no surprise because it only makes sense!  Lets look at the logic, 32 million insured people estimated to come into the health delivery system, because of health reform, will undoubtly have conditions that need to be managed. Hence, in order to reduce costs by preventing hospitalizations, disease states , evidence-based healthcare will be crucial.  Considering that 80% of physician practices, and 90% of hospitals are still on paper, you can’t enforce an evidence based delivery system with paper charts! 

Lets take a look at a couple other logical points.  Insurers will also have increased costs because of Health Reform, for the mere fact that in 2014, they can not discriminate against those with pre-existing conditions. Those with these conditions, individuals, small businesses, and even members of Congress, will access competitive insurance exchanges, giving them coverage from private insurers.  Who will those private insurers be?   It doesn’t take an einstein moment to come up with this answer.  Insurers will want physicians to manage these pre-existing conditions, avoiding episodic events, hence lowering the cost.  The management tool needed is EHR technologies combined with claims data, offering a complete picture of a persons health, and possible gaps of service.  My last logical point is that insurers are diversifying their business models by investing in technology companies and products.  UnitedHealth’s Ingenix unit will be offering a cloud application for community health centers.  Aetna’s ActiveHealth is partnering with IBM, offering their “cloud” solution, giving physicians access to a best of breed CDSS application. It only makes sense that they give incentives for using these technologies that they are investing in.  

Finally, I applaud the insurers for jumping on the EHR incentive bandwagon.  I’ve learned that just because something makes sense to do, doesn’t mean its always done!  The challenge now will be to address the those who are concerned about what they will do with all that data?  We’ll talk about that at another time!

August 9, 2010  9:26 PM

REC’s, people and partners will make the difference!

Posted by: AllinHIT

I ended, a previous blog, with this question, is the REC’s being put in a position to fail?   I have been ask this question by many, and I did not want to answer, until I sat down with Florida REC’s, for in-depth discussions.  I did exactly that during the Florida Academy of Family Physicians summer meeting, last week.  

I was honored to get invited to a “REC dinner” held after the second day of the conference.  The dinner was arranged by the Agency of Health Care Administration (AHCA), entity responsible for Florida Medicaid, and a partner to the REC’s.  Three out of the four, REC’s were present, and the discussion at the table were ALL THINGS HIT!  Vendor selection, EHR implementation, EHR seminars, REC marketing efforts, partnering with health organizations, and of course Meaningful Use, were some of the topics we discussed.  What was particularly interesting, was a discussion on the myriad of REC models across the country.  We all acknowledged healthcare is local, hence, a model in Maryland, may not work in Florida.  Acknowledging this simple fact, we discussed the various Florida REC models and plans.  After, probing questions on the various models, and getting updates on their latest operational plans, I realized that the REC’s can be successful despite the various models, if they have the right people, partnering with the right organizations. 

This is not to say, that I believe all of the REC awardees, will be as successful as others.  I have serious concerns for those REC’s, birthed within the academic world.  I believe the academic awardees have a challenge of being nimble and quick, in an ever-changing, fluid HIT environment.  Every decision that needs to be made, requires a meeting.  Once that decision is made, it even takes longer to implement it.  Additionally, the academic world, referring back to my first blog on the subject, has not been in a small physicians office for years.  

Despite all of my concerns above, they can be successful, with the right people and partners. Reaching outside of their academic pool of resources, will be crucial to their success.  Having MBA students, with no experience in the physician office, will undermine trust within the physician community, and will shift a heavier burden to their partners.  Its the REC people in the field, and the various partnerships, that will truly make the difference in their success!

June 29, 2010  10:36 PM

Increasing EHR adoption through patient education?

Posted by: AllinHIT

Harris Interactive released the results of a patient poll on EH’s.  Close to one-half of approximately 2,200 people surveyed,  stated EHRs will improve efficiency of our healthcare delivery system. However, it also revealed that patients really don’t understand the impact EHRs have on their care.

This should be a wake up call to the ONC, the RECs, and lastly, physicians. Strategies for educating the public on the benefits of EHR adoption, should be developed and financed as a part of HITECH.  The RECs should be used as educators, not only to the physician community, but to the general public.  Once the public really understands how EHR benefits their delivery of care, physician’s will have added pressure to adopt and use the technology. Physicians who have adopted EHRs, can show patients their electronic chart, giving them an added confidence in your service.

A few years ago, I educated all my friends on the benefits of electronic prescribing.  I discussed about real benefits, like not having to go back to the pharmacy (formulary issues), reduction of ADE’s (Adverse Drug Effects) from drug contraindications (knowing what other meds you are on), and saving you from losing that written prescription.  Once I explained these benefits, my friends really understood how this impacts them directly, and some have discussions with their physicians about adopting the ePre!

I think we all can have a positive effect on adoption, by educating those around us.  Our small efforts, along with some ONC intitiatives,  will increase EHR adoption and its value to the physician.  After all, isn’t quality of care for patients the driving force behind EHR adoption?

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