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Meaningful Health Care Informatics Blog

October 23, 2011  9:10 PM

HHS announced final ruling for ACO

Posted by: RedaChouffani
Accountable care organizations, ACO, ACO final rule, ACOs

The Centers for Medicare and Medicaid Services (CMS) issued its final ruling last week for Accountable Care Organizations (ACOs). The proposed ruling was initially released in March and after public comment period, some significant changes were made and released last Thursday.


Within the 696 page document, there are sections that outline the measures on which reporting will be required. Currently the number of measures has been decreased from the original count of 65 down to 33.


In addition, HHS has also announced that it has reduced its requirements for the number of physicians required to use a certified EHR system. Now, only 50% of participating members will need to be meaningful users for ACO participation, welcome news by many groups still in the laggard adoption phase. There was also the announcement for a new program that will provide funding for care providers to hire staff and upgrade IT infrastructure with EHRs in order to support their participation in an ACO.


Several health care associations welcomed the news and noted that HHS seems to have taken into consideration much of the feedback from providers and health care professionals as they’ve taken steps toward the meaningful use journey but have yet to reach the pot of incentives gold.


October 17, 2011  8:53 PM

Commercial payers actively investing in ACO and PCMH

Posted by: RedaChouffani
Accountable care organizations, ACO, ACOs, EHR adoption, Health plans, Medical Home, Patient Centered Medical Home, Payer, Payer collaboration, PCMH

For many years, both commercial and non-private payers have engaged physicians in improving patient outcomes through the various pay for performance initiatives. Many of the programs have had monetary incentives associated with them as well as rankings listed for participants. In other cases, payers have sponsored and funded certain initiatives for physicians and associations.

Blue Shield of California, announcing the news on Monday Oct. 17, did just that. They have announced that they would grant nearly $20 million to hospitals and other health organizations to help them participate in an ACO within the state of California.

BS of California had previously participated in three pilot ACOs, and this investment shows a clear interest from a commercial payer for the ACO model to succeed. Private payers are investing more and more in some of these initiatives, as they show improved patient outcomes and reduced costs, which is inline with their business model as it is.

Recently, in North Carolina, Blue Cross Blue Shield of NC invested $15 million in NC Path to provide over 85% subsidy for physicians to cover EHR software and set up costs. NC BCBS, considered one of the largest commercial payers in the state, selected AllScripts as the vendor and partner of choice to roll out the EHR.

In both cases, having commercial payers support the patient centered medical home (PCMH) and ACOs is significant. While there are still many questions around the true costs and if ACOs can be a sustainable model, these types of grants are a good sign for many physicians that PCMH and ACOs are going to be supported from the state, federal and private sectors.


October 17, 2011  8:50 PM

6 reasons not having an EHR will put your practice at risk

Posted by: RedaChouffani
EHR, EHR adoption, Electronic health records, EMR, Physician groups, risks

For many physicians who are not currently using electronic health records (EHRs), they are constantly being told through one form or the other of how EHRs will help to improve patient health, reduce their operational costs and allow them to see more patients. And study after study shows the benefits of capturing patient health information electronically.

But as we continue to see EHR flyers and marketing brochures outlining the benefits of switching from paper charts, we can pause and recognize that there are factors other than the typical benefit that will eventually drive physicians to seriously consider adopting EHR technology. There are several reasons that can put a medical organization who still relies on paper chart at risk, especially considering the transformation that is currently happening the US health care system.

The following is a list of six items that can put paper-based practices at risk in the near future if they don’t adopt an EHR:

  1. More patients will be asking for it: As more patients get exposed to the benefits of their physicians using EHRs and see how health care providers can communicate as well as share medical information with them electronically (such as: X-Rays lab results, treatment plans, e-prescriptions, and PHR data), many consumers will begin asking and looking for physicians who are utilizing these technologies. This would provide many organizations with a competitive edge and enable them to differentiate themselves from others. This could also potentially penalize physicians who are not using electronic health records by losing new patients to their competitor.
  2. Telemedicine and servicing a broader geographic area: Several large health systems are beginning to provide basic health services and specialist consults over video conferencing, and for a reduce rate! Many of these services are provided via secure communication channel and do not require for the organization to have a physical office near the patient they are servicing. But many physicians who provide telehealth services will be in need of an EHR to be able to share information quickly. This provides them with a competitive advantage as they can efficiently service a broader patient base outside of their immediate community.
  3. Everyone will be collaborating but you: Some states have already implemented an HIE and as more adopt the health information exchange and some of the care delivery models, many physicians are starting to exchange and collaborate on care. These physicians are able to receive complete patient summary of record electronically and share their information about a patient with others as well. This is also the vehicle that will used by physicians to communicate and collaborate on care as well. But for physicians who are still paper based, they may encounter more challenges when attempting to collaborate and be a member of the care team for certain patient population.
  4. Using remote health monitoring to manage chronic conditions: Given the increase in patients with chronic diseases and need for chronic care management, in additon to the current competitive market, many health organizations are looking to adopt technologies to assist with remote patient monitoring services. They are exploring new ways to capture health information and monitor patient vitals in real time, remotely, though these technologies would require physicians to have some sort of EHR in place to be able to transmit the information.
  5. Recruiting new physicians: As part of the medical school curriculum, many new graduating physicians have had exposure to electronic medical records. This would most likely suggest that many of them would favor practices and health organizations utilizing EHR for their future employment opportunities. This would make it difficult for paper-based practices to recruit talent.
  6. Penalties, employers and payers will demand it: Some of the current incentives through MU may not fully cover the costs associated with software and hardware for a new EHR, however some predict that penalties and lower reimbursements may cause more heartburn for physicians who elect to stay with paper charts. These pressures will continue to mount, as there is an increasing push for modernizing the US healthcare.

October 9, 2011  10:16 PM

Virtual office visits to compete with local specialists groups

Posted by: RedaChouffani
mhealth, mobile health, outsourced, Remote patient monitoring, Teleconferencing, telehealth, virtual office visits

Often when discussing outsourcing in healthcare, the first things we tend to think about are outsourcing software development, billing, call center and general helpdesk functions. But given the curren model of care, the reality is that we will eventually see more outsourcing in the form of care delivery, where outside groups step in to provide specialty care.

As medical information becomes readily available to clinicians, regardless of their location and via health information exchanges that connect provider networks, certain groups will lead by providing services that will both benefit the patient and organization through outsourcing care delivery.

As patients, we are already seeing some of these services in action today.For many of the small to mid size primary care providers, the use of outsourced radiologists to read x-rays is a common practice. This basically means that the reading of x-rays taken at the primary care physician’s office is being outsourced to an outside service provider. What is interesting here is that we will actually see a slightly more advanced flavor of outsourced care that brings value to both patients and provider.

Kaiser Permanente, for one, has long been using telemedicine to get patients to see a specialists without their even needing to leave their primary care provider’s office.So if you need to be seen by a dermatologist or orthopedic specialist, you can simply connect with them via video conferencing immediately after your visit with your PCP. So long, waiting for the referral!

This expansion of the care continuum opens the door for a new model of delivery and structure.It means that physician groups can now compete for patients across state lines (keeping in mind the different state accreditation requirements and such).This means that a patient can request to be referred to a specialist of their choice  — or the one that has to most persuasive TV ads — which may create more competition for the local private groups.Right now, most large private specialists groups tend to have a significant percentage of the patients in their community.But if care providers from out of state provide the same professional care, same day appointments, reduced fees, and virtual visits, then patients may just simply opt for the virtual office visit instead.

Several years back, this would have been an impossible scenario, but with today’s connected health environment and increasing adoption of electronic health records and standards for interoperability, physicians are able to do more remotely.Teleconferencing technology has also enabled users to do this quickly and easily.This does not mean that virtual office visits would eliminate the need for one on one with care providers, but for follow-ups and simple “minute clinic” types of illnesses, it only makes sense to seek alternatives that reduce cost, increase efficiently for everyone.

October 9, 2011  10:12 PM

Can patient information one day be sold?

Posted by: RedaChouffani
Data mining, Data privacy and security, EHR adoption, HIPAA, Patient privacy, Population health

No one can argue that there has been a recent increase in the adoption of electronic health records (EHRs) in both the hospital and outpatient settings. As those in the industry are well aware of by now, this has been mostly due to the federal incentives put in place through the ARRA and the HITECH Act, with one of the requirements, or measures, of the program being the actual exchange of health data and information criteria. This applies to both certified EHR solutions as well meeting meaningful use.

We are also seeing a trend of health data starting to converge and become more centralized across large health systems. This has created large data repositories of health related data.

When reviewing the advantages of adopting electronic medical records, the most significant value that comes to mind is the use of digital information to help improve patients’ health and save lives. But there have been prolific results that go well beyond that when using electronic charts, such as cutting costs, improving efficiencies and outbreak detection. But as organizations begin and continue to utilize patient information to improve care, there are many entities and organizations that would potentially benefit from accessing the bulk of this information.

What we are talking about here is the ability for the data banks of health records to be used for purposes other than patient care. While health care organizations are required to protect health information under HIPAA’s regulations, it is hard to ignore how other industries could potentially benefit from accessing this data and what they could do with it.

Some of the examples of different uses of patient health information databases are:

Clinical trials:

Drug makers spend millions of dollars each year to recruit patients for clinical trials. There are many factors that impact the costs for clinical trials, some of which are the cost of advertisements, medical documentation, health assessments, labs, and physicians visits. The selection process for the appropriate candidate is complex and costly for research firms, and this unfortunately has a direct impact on the costs of drugs, which are then transferred to payers and ultimately the patients.

But many clinical trial firms recognize that, with access to large health systems’ databases, they can potentially have the ability to identify much quicker the appropriate candidates for their research. This can be done in two ways, with one option being to proactively flag patients that maybe good candidates for a new treatment during the visit and alert the physician of the newly available treatments. The other option would be to have a report generated by the health system based on predefined criteria and submit a patient list to the research firms, who would then contact the patients.


Pharmaceuticals and drug manufacturers:

For many drug makers, the Internet has been one of the best marketing tools available. It has extended their reach and has been the tool to derive the highest ROI. But while it has not been necessary for the advertisers to touch the intended audience every time (spam emails, pop-up ads, and the like), drug makers are continuously looking for new ways to fine-tune their marketing and advertising machines.

Right now, it is common practice for physicians to recommend specific drugs for certain conditions. However, we are seeing more and more of patients requesting certain brands for their conditions now, or self diagnosing the problem. This has only increased along with the high number of TV ads for drugs which highlight the effects and “healing” ability of their product. But if drug makers have access to actual patient charts, this will provide them the ability to target patients with specific conditions, as well as patients using a competing drug, and send targeted ads to fitting candidates. Unfortunately, this will most likely cause some heart burn for physicians, too, who have to spend more time explaining why one drug is not a proven, better option vs. another that a physician prescribed.


Scientific research:

It is without a doubt that EHR provides access to an unprecedented amount of clinical information. Through research, this data can help accelerate the level of knowledge and efficacy of medical treatment. The VA is just one system who has voiced their interest in providing full access to scientists and other entities to the unidentified patient information. The intent is to have one of the largest patient clinical databases in the world that can be used to further improve population health and define effective treatment plans for certain conditions.

Employer health and human capital:

Most large employers can’t ignore that health care costs are rising at an alarming rate. This means that they will need to continue to identify creative ways to recognize savings and work to cut costs. Currently most employers do provide some incentives for employees who are enrolled in wellness and/or nutrition programs.  And while employees are usually incentivized to work hard through performance reviews and other such measures, access to an employee’s health information can open the door for employers to review the health and progress that employees make while managing their health. Employers can then create incentives for employees (patients) to maintain a healthy lifestyle by simply tracking specific measures within their health record. There are, of course, privacy concerns that would need to be addressed; however, access to a limited amount of information can be useful to reward everyone, including non-smokers and patients who lead actively lead a healthy lifestyle.

Clearly there are more values that can be draw from the use of the electronic health information and making the data available to a larger degree (with specific terms and conditions, of course). Companies like Google, Facebook and LinkedIn already use similar tactics to track their members’ browsing habits and preferences in order to deliver specific, targeted ads online, which had a significant increase on the effectiveness of their campaigns. Health information, however, is protected under the HIPAA law, and using that information for use other than improving patient care will receive tremendous resistance and scrutiny from the public. My main bit of advice then is to proceed, but with caution!

October 2, 2011  9:46 PM

Improving the population’s health with technology

Posted by: RedaChouffani

As healthcare in the US continues its transformation form a fee base health system to a outcome measure model clinicians will begin requiring frequent visits with to the doctor, collection of more information and finding creative ways to reduce costs and improve efficiently to offset the shrinking reimbursements.

While there reforms to help transform our health care, patients with chronic disease have been increasing at an alarming rate. Some of the numbers released by the Center for managing chronic disease show:

·7.0 million (9.4%) U.S. children have asthma

·2.4 million – 4.5 million Americans are affected by Alzheimer’s disease

·10% of adults 20 years+ have diabetes (diagnosed or undiagnosed)

·67% of adults age 20 years+ are overweight or obese

·26.6 million (12%) adults have heart disease in the United States

These were the result of the national Health interview survey in 2008. What these numbers are telling us is that the task of helping patients with Chronic disease will be a critical step to improving the population’s health. It would be critical to ensure that the transformation of our healthcare will be able to improve the health of the population.

But many physicians are concerned about the current health of the population and increase number of patients with chronic diseases. While in the past there has not been significant adoption of consumer-based technologies to help manage chronic conditions, physicians now are discovering there may be some promising innovations that will change the way physicians care for their patients.

Ease access to Information:

With many of the current EHR system integrations available through interfaces with hospitals, radiology groups, lab companies and Surescripts for Rx, access to a patient comprehensive health records help physicians better care for their patients.

Improved communication:

As more patients use web portals, secure email, and SMS to communicate with their care providers, these methods are making it easier for them to efficiently and immediately communicate without having to leave voicemails and wait for a call back.

Efficient and near real-time Collection of health data (such as vitals, glucose levels):

As we continue to see more innovation in the mobile world such as: wireless vitals data capture, smaller and connected glucose devices, and heart monitors that communicate with smart phones, these medical devices are allowing physicians to have near real time to critical data and be able to react to any early signs.

There are several additional technological and scientific advancements that are providing support to physicians in help improving population’s health. Many of these require adoption from both patients and healthcare professionals.

October 2, 2011  9:17 PM

Bluetooth 4.0 encouraging adoption of medical devices

Posted by: RedaChouffani

For some physicians, having access to health information such as Vitals, glucose level, and heart monitors can provide key information that can help care for the patients and provide them with assistance when they need it the most.

In the past there were several devices available in the market that were portable but unfortunately did not provide an easy and efficient way to access the information that is being collected by these gadgets. Fortunately with some of the innovations around Bluetooth and specifically Bluetooth 4.0, many device manufacturers can design smaller electronic devices that can collect information for longer periods of time and transmit them via BLE (Bluetooth Low Energy). These data transmissions can be to smart phones or any other Bluetooth enabled receivers. This wireless technology can help boost the use of wireless medical devices in the market, as well as encourage for more innovation.

Many of these devices will be a critical piece as part of the patient’s comprehensive care. This is especially the case for medical homes and ACOs where physicians are required to help mentor patients and help them take control when possibly of their chronic disease.

Amongst the first products that will hit the market with Bluetooth 4.0 are: pedometers, blood glucose meters, weight scales, heart rate and blood pressure monitors.

September 25, 2011  6:05 PM

Ambulatory practices preparing for ACOs and medical homes

Posted by: RedaChouffani
Accountable care organizations, ACO, ACOs, Care coordination, EHR adoption, Medical Home, private provider groups

For large ambulatory care providers, buying an electronic health record (EHR) is only one piece of the puzzle. This is especially the case when we look at how health care is transforming. Under many of the new mandates and reform efforts, we begin to recognize that many more components above and beyond a standard EHR will need to be in place to support an ACO, medical homes and other changes coming down the industry pike.

For some time now, there have been many pilots in place for ACOs and medical homes. Some have been able to offset the costs associated with the initial capital investment through CMS grants that have been available; others have established a community base ACO and leverage collective funding, which has allowed several private physician practices to create the infrastructure needed to collaborate on patient care.

As ACOs and medical homes grow in numbers, some of the larger, privately owned physician groups would need to define and prepare their infrastructure and ensure that their business model can adapt to the changing landscape.

Following are some of the changes that will affect the larger private health organizations:

The need for a community based HIE or Registry:

HIE is one of the core components that will be required in order to have a successful ACO or medical homes. This is the engine that will facilitate the exchange of patient health information. So for many organizations, having connectivity and the ability to exchange information is a must have. Unfortunately not all states will be able to provide an operational HIE when some practices will look to engage in ACO’s. This would leave many of the privately owned physician’s group looking to their local health system for similar infrastructure or create their own community based HIE. In Charlotte N.C. for example since there are two large health systems, one of which has taken the initial steps to implement an enterprise wide HIE and maybe on its way to enable future ambulatory practices to connect and exchange health records.

The need to create and fill more health IT (HIT) positions:

For sometime now, many of the mid to large physician owned groups have not required extensive health informatics knowledge as a perquisite for internal IT positions. As some begin to implement EHR and participate in ACOs and become medical homes, they are requiring additional staff with more healthcare specific training. Some of the skills needed in the candidate pool will be: healthcare data analysis, interface and integration experience, EHR experience, EDI, HL7, and an understanding of clinical and administrative workflow.

Establishing community-based collaboration that goes beyond care:

Since some of the reforms call for bundled payments for services and care, many of the physicians will need to work collectively at all different levels. When we discuss ACOs, we focus mostly on the collaborative efforts that physicians will be able to participate in when providing care for their patients. But there will also be additional collective work that will need to happen behind the scene to ensure payments are received, processed and distributed accordingly. CFO, coders, administrators and scheduling staff will need to work together to ensure that the practices are working toward the same goal and ensuring that they are collectively identifying process bottlenecks to better streamline the workflows.

Process reengineering:

For many practices that have continuously reevaluated their processes and improved on them, they will be challenged again to make further modifications. As with the shift toward preventative care, outcome based fee, bundled payment model, organizations will need to quickly adapt to the changes and rework their processes and workflows to ensure sustainability.

mhealth will play a bigger role:

As it stands today, smartphones and mobile devices are as far as IT is concerned are in the hands of very few clinicians. But as telehealth becomes more popular, health organizations will begin to use it to engage patients in their care as well as communicated with them. There are very few services that are covered under telehealth. But with the new ACO model and Medical home, providers now can be reimbursed for both virtual or home visits. In addition, many providers will need to monitor patients outside the practice settings and coach them. Mobile devices will then play a much greater role as they can provide the vehicle to transfer information regarding the patient to their health provider.

It is fair to assume that the only constant in health care is change. Whether it is through new mandates or simply moving toward a more sustainable health care system, many of the upcoming changes will require the organizations to reinvent themselves to navigate through the tough economy and ensure its success.

September 25, 2011  6:03 PM

Text4Health HHS initiative to encourage texting in a healthcare setting

Posted by: RedaChouffani
DHHS, Health and Human Services, healthcare, HHS, mhealth, mobile health, SMS, Text messaging, text4health

On September 19, 2011, the Department of Health and Human Services (HHS) released new recommendations for its mhealth program, Text4Health. As HHS continues to recognize the significant role that smartphones are playing in the industry, and just how the much of the US population uses short text messaging (SMS) to communicate, the following is the list of timely recommendations that the task force officially suggested:

Recommendation 1: Facilitating Health Text Messaging Development. The Task Force recommends that HHS develop and host evidenced-informed health text message libraries to leverage HHS’ rich and scientifically based information.

Recommendation 2:  Research and Evaluation. The Task Force recommends that HHS develop further evidence on the effectiveness of health text messaging programs.

Recommendation 3: Partnerships among Federal Government Agencies and Non-Federal Organizations. The Task Force recommends HHS explore and develop partnerships to create, implement and disseminate health text messaging and mobile health (mHealth) programs.  It is further recommended that in FY2012, specific HHS staff persons (e.g., HHS mHealth lead) serve as main points of contacts to represent HHS in discussions of collaborations or partnerships with other stakeholders in the mHealth ecosystem

Recommendation 4: Coordination across HHS. The Task Force recommends that HHS form a mobile health (mHealth) community of practice, initially led by HHS staff in the Office of the Secretary, that meets regularly (e.g., monthly or quarterly) to discuss and coordinate mHealth activities, including health text messaging, across the Department.

Recommendation 5: Integration of Health Text Messaging/mHealth with other HHS Health Information Technology Priorities (e.g., Electronic Health Records, Cloud Computing, Health Games, etc.).  The Task Force recommends that HHS align health text messaging/mHealth activities with other HHS Health IT priorities.

Recommendation 6: Delineating Privacy/Security Issues. The Task Force recommends that HHS conduct further research into the privacy and security risks associated with text messaging of health information and establish guidelines for managing such privacy/security issues. Furthermore, mHealth issues should be discussed within the HHS Inter-Division Health IT Policy and Security Task Force.

Recommendation 7: Regulatory Issues. The Task Force recommends that relevant HHS agencies (FDA, NIH, AHRQ, ONC, etc.) conduct research on future trends of text messaging technologies and establish regulatory guidelines for these interactive systems that can be used in treating, curing, mitigating or preventing diseases or conditions.

As one quick read will tell you, these recommendations are significant. They will enable HHS to establish regulatory guidelines for interactive systems, and with the emerging ACOs and Medical Homes, where personal physicians and care givers will need to have effective ways to communicate with their patients, SMS will allow them to interact and inform patients adequately and efficiently. Privacy and security concerns will still need to be addressed, but this is a first step toward in the right direction.

September 18, 2011  7:49 PM

New proposal for patient and physician national smart card

Posted by: RedaChouffani
Medicare, Medicare fraud and abuse, Patient identifiers, Smart cards

Last week, Senators Mark Kirk (R-Ill.) and Ron Wyden (D-Ore.) and Representatives Jim Gerlach (R-Pa.) and Earl Blumenauer (D-Ore.) introduced a bill that would require the issuance of ‘smart cards’ to all Medicare members. The bill provisions state that it will become law for physician practices and practitioners to have a membership smart card, with the idea being to reduce fraud by having both patients and care givers confirm during the DOS (date of services) via a device that would allow them to scan their cards, having both a pin challenge as well as a biometric method for authorization.

While this would add a few more steps during visits for many physicians, given the volume of dollars lost due to fraud and abuse of CMS reimbursements, the federal government will be able to offset the cost of implementing this technology with the reduced lost dollars due to fraud, estimated at a whopping 60 billion dollars.

But one question still remains: How will physicians react to this requirement if it becomes law? It has a clear significance to CMS, though I could not help but wonder that with today’s technological advancements, smart cards may not be the only feasible identification system available.

With the advancements in facial recognition and the existence of NFC (Near Field Communication), a technology that an estimated 10% of smart phones will have in 2012, I can see how there are other options that can be utilized for other services within the health care settings. Facial recognition can be used in practices to check-in patients as they walk through the door, without the need of having patient’s sign-in. Also, NFC enabled devices can be used to make payments, using many of the e-wallet apps in smartphones, and potentially used in tandem with a CMS app enabling patient check-in and authentication.

Physicians today still have to deal with several other identity systems, including the new required by e-Prescribing for controlled substances, meaning physicians would potentially be dealing with implementing any number different biometric products, requiring both capital investments as well as setup and training.

Whatever will be proposed as far as patient and physician identification goes, it has to be a solution and technology that can be reused, not only promoting adoption, but also collaboration and innovation.

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