- Data Governance. Data is the crux of healthcare improvement. It is critical to establish a data governance council consisting of an interdisciplinary team that is responsible for developing a set of processes that serve as a quality control mechanism for handling information. These mechanisms define lines of responsibility and establish methods to foster the accessibility, completeness, and integrity of data. Strong data governance that can validate the accuracy of the data is critical to instill trust among clinicians. The absence of a data governance structure exposes the risk of clinicians contesting the accuracy and usefulness of the performance information produced by the data, thereby reducing its value to continuous improvement initiatives.
- Health IT Strategy. An organization must develop a health IT and analytics strategy to determine the types of health IT necessary to support the clinical and operational processes of the organization. The most essential component in the development of a successful health IT strategy is to gain consensus from all affected stakeholders. Attempting to implement a strategy without the buy-in from the affected stakeholders will be extremely difficult, if not impossible, because clinicians will not support the efforts and may challenge the types of health IT implemented.
- Systems and Technology Framework. The systems and technology framework of healthcare organizations is very complex. Organizations must inventory the various systems and develop a blueprint to guide system selection, technical and functional builds, consistent standards, and information output. All of these aspects affect clinical operations, and the implications must be considered and risks mitigated. Neglecting this activity will have serious implications on system integration and data aggregation efforts.
- System Integration and Solution Architecture. Healthcare organizations have various technology systems and platforms that were typically implemented at a point in time to serve a specific business need without extensive thought or planning given to system integration. The result of this approach is that these systems are not designed to “speak to each other”. Organizations must build an enterprise architectural approach that allows platform integration of multiple disparate systems, supports system interoperability, and establishes a centralized master data management structure.
- Solutions Search and Selection. Commonly, a systems and technology inventory reveals gaps in the framework, and the organization must embark on a search and selection process to identify a system to fulfill the need(s). It is important to establish a systematic approach to IT system selection so that the evaluation of the systems is comparative. More important, the organization must enlist the help of an interdisciplinary team to evaluate and score the systems based on a pre-defined list of functionality and standards. The process must be executed very methodically, starting with defining the system requirements, developing the evaluation criteria, training the evaluation team, conducting the system demonstrations, reviewing test cases, and selecting the system of choice. In addition, the organization must establish an enterprise approach to system search and selection, which can help minimize ad hoc purchases that can conflict with the overall integration strategy.
- Workflow Redesign. Clinical workflow redesign is integral with any health IT solution implementation. Before even embarking on system selection, an organization must first understand the clinical workflow. This will provide insight to the existing processes and protocols and enable the organization to select a technology solution that will best support clinical operations by incorporating solution sets that promote workflow redesign around functional roles, care model redesign, clinical decision support, and clinical protocols. Failure to consider the clinical implications when selecting a system will lead to an underutilized system and decrease efficiencies.
- Clinical Health IT Optimization. Clinical care optimization is critical to maximize the value of the health IT system. Health IT systems are rarely used to their fullest potential. This underutilization can have negative impacts on many facets of a healthcare organization, including patient safety, quality of care, clinical performance, staff satisfaction, and revenue capture. The organization can improve the functional use of systems and applications through utilization evaluation, reeducation of clinical documentation requirements, and system functionality retraining for clinical staff. Failure to optimize clinical health IT systems leaves the organization vulnerable and at risk for poor coordination of care, fragmented communication, performance penalties, staff turnover, and decreased revenue.
- Integrated Analytics and Reporting Strategy. An integrated analytics strategy is imperative to establish a streamlined approach to developing, managing, updating, and reporting performance measures. Many organizations are faced with various regulatory, accreditation, and quality program reporting requirements. Typically, report writers will build ad hoc reports according to the specifications requested, but report reviews reveal that many of these reports include the same metrics. Organizations must catalogue the performance measures contained in all reports. This accounting should include the details of the measure (e.g., numerator and denominator), discreet data needed to calculate the measure, the source system for the data, the purpose of the measure, the report measure owner (both requester and developer), the user(s) of the information, and the user status (internal or external). This will help the organization to delineate the various reports, identify duplications, and establish consistency across the clinical analytics and reporting requirements.
- Clinical Informatics and Analytics. In line with the analytics and reporting strategy, an organization must define an approach and process to ensure that solution capabilities enable the collection of discreet clinical data that supports the development of reliable, action-oriented reports. An important component to developing a sound clinical informatics and analytics process is having an interdisciplinary team composed of IT, clinical, and report analyst representatives. This team composition will ensure that the information needed from the clinical team is addressed, the technical team can build it, and that it is structured so that analysts can easily generate the necessary reports.
- Actionable Data Analytics. Once the type of information that is needed for analytical reports is determined and the process by which this information will be captured is defined, an organization needs to determine the most effective way to present the information, to whom the information should be provided, and how frequently in a timely manner. Most important is designing reports that present data in a usable, action-oriented, and meaningful way. The way in which data is presented can make the difference between impactful care management and quality improvement results and futile care coordination efforts.
This morning, the Office of the National Coordinator for Health Information Technology ("ONC") released the first draft of its interoperability roadmap to deliver better care through the exchange and use of health information technology ("IT").
The roadmap lays out the plans for the next three years in order to meet the goals first laid out in ONC’s “Connecting Health and Care for the Nation: A 10-Year Vision to Achieve Health IT Infrastructure,” which was first issued in June 2014.
“Great progress has been made to digitize the care experience, and now it’s time to free up this data so patients and providers can securely access their health information when and where they need it,” HHS Secretary Sylvia M. Burwell said in a statement. “A successful learning system relies on an interoperable health IT system where information can be collected, shared, and used to improve health, facilitate research, and inform clinical outcomes.”
The roadmap will provide guidelines so the majority of individuals and providers can send, receive, find, and use a common set of electronic clinical information across the care continuum and at the nationwide level by the end of 2017.
The report also outlined four important actions for both public and private sector stakeholders to take to enable interoperability of electronic health information in the near term:
- Establish a coordinated governance framework and process for nationwide health IT interoperability
- Improve technical standards and implementation guidance for sharing and using a common clinical data set
- Enhance incentives for sharing electronic health information according to common technical standards, starting with a common clinical data set
- Clarify privacy and security requirements that enable interoperability
The roadmap also provides more detailed near-term actions for each high priority area, a common clinical data set of 19 basic elements, and an updated estimated timeline of select high-level critical actions.
The plan from ONC is open to the public for comment until April 3.
“While we have made great strides as a nation to improve [electronic health record] adoption, we must pivot towards true interoperability based on clear, defined, and enforceable standards,” Russell P. Branzell, FCHIME, CHCIO, president and chief executive officer of the College of Healthcare Information Management Executives, said. “This Roadmap incorporates a tremendous amount of stakeholder input and articulates a clear path towards interoperability. It is a cornerstone in the continuing evolution of federal health IT policymaking.”
Below is an infographic developed by HealthIt.gov which displays the Shared Nationwide Interoperability Roadmap: The Journey to Better Health and Care. The nation relies on Health IT to securely, efficiently and effectively share electronic health information with patient consent to achieve better care, smarter spending and healthier people. Interoperability will transform our health system from a static one to a learning health system that improves individual, community and population health.
To view a full-size version of this infographic, click on the image or click here.
In its annual predictions for the year ahead, our colleagues at The Camden Group, one of the nation’s largest healthcare business advisory firms, released their outlook for 2015. The firm’s experts forecast continued provider consolidation and a drive to providing a better “value proposition” to the consumer and payer. Additionally, there will be a renewed focus on cost management and a steady stream of transactions that consolidate the acute, ambulatory, medical group and post-acute care components of the delivery system. And, keep an eye on the nation’s capital for further developments. The Camden Group takes a look at pain points, the bottom line, politics, opportunities, consolidation and acquisition, as well as insurance trends:
Pain Points: Show Me Where It Hurts
- A few hot areas to watch that could impact hospitals: continuation of sequestration for healthcare expenditures, changes to the 340B drug purchase program and site-neutral payment reforms (e.g., imaging), including hospital-based clinics.
- Inpatient volume will remain soft. Hospitals will continue to struggle as inpatient use stagnates and pressures build to find new ways to reduce expenses, grow revenue and improve access to capital.
The Bottom Line: A Need for Surgical Precision
- Revenue reductions will continue to put a squeeze on the bottom line. Growth of public and private health insurance exchanges, sequestration (Medicare), state budget issues (Medicaid) and soft volumes will create challenges for the healthcare system.
- The human factor: With salaries, wages, and benefits typically accounting for 50 to 55 percent of a hospital’s operating expenses, organizations will continue to reduce non-clinical personnel.
- Also on the chopping block: non-core service expenditures, streamlining clinical and nonclinical processes, and refining compliance with group purchasing organizations and vendor relationships.
- Information technology (“IT”) will gobble up a greater portion of capital expenditures. As population health management continues to grow and take hold of the “new approach” to healthcare in the U.S., IT will remain a major investment. The new spend will target: patient registries, analytics using population data, a data warehouse linking data from across the continuum and analytics using payer claims as well as internal data. Lastly, the drive to engage the patient will start with patient portals, wellness outreach, providing patient access to their medical record and, in some cases, telehealth as an element in this space.
Politics: What Happens in D.C. Doesn’t Stay in D.C.
- The Republicans will hold significant influence on a national level with their control of Congress.
- “With Republicans taking control of Congress – yet lacking 60 Senate seats or 67 seats to override a veto – parts of ‘Obamacare’ are going to change,” says Steven T. Valentine, president of The Camden Group. “A full repeal of the Affordable Care Act is highly unlikely; however some parts will be eliminated and others likely watered down. At the end of the day, most health systems and medical groups should continue to move ahead with developing population health management capabilities in response to the need to demonstrate value.”
- President Obama stands ready to veto policies and legislation he does not support and is ready to use his executive order powers to extend his influence.
- The public insurance exchanges may find strong headwinds due to the Republicans carving out some pieces, thereby reducing the population accessing the exchange. The wildcard to watch: the Supreme Court has agreed to hear the debate on issues with the subsidies; expect a decision in June.
- Clinicians have developed and are using new care models and economic incentives to reduce resource consumption. The growth of the Patient-Centered Medical Home, episodes of care management (e.g., co-management and bundled payment arrangements), accountable care organizations (“ACOs”) and clinical integration will all continue to grow and expand.
- Population health will continue to be the focus for many organizations. The growth of ACOs in both numbers and population reflects this trend. Employers will continue to demand better value for their healthcare dollars. Medical groups, hospitals and health systems will be required to invest more resources and money into the infrastructure build-out to manage the populations’ health. As a result, expect to see IT spend that will focus on: EMR interfaces, data warehousing (collection) and analytics. Providers that want to embrace population health will need to adopt a payment model that rewards them for delivering a better “value” to the patient and payer.
- Competition between healthcare providers will focus on capturing a defined population. Figure 1, below, identifies highest priority access points. The trend is that health systems and hospitals are adding hospitals, clinics, health plans, direct contracts with employers, physician practices and ambulatory sites to their continuum of care delivery system/network.Pyramids of success resized 600
- Transparency will grow, albeit ahead of the consumer’s interest in using the information. Numerous websites, states and health plans offer quality and price information. All competitors play by the same rules, and the public sees the same data, because that is all they have. Medicare, Medicaid, health plans and proprietary databases all provide information on quality, satisfaction and cost. Providers will have to dedicate resources to provide a more standardized and reliable data set to offer more accurate and useful information.
- Physician resources: As physicians in the Baby Boomer generation start their long-delayed retirements (their investments have returned, and their practice is at peak value), hospitals and medical groups will identify opportunities to staff clinics, urgent care centers and physician practices with these newly retired physicians willing to work part-time for someone else or on “fill-in” shifts.
Consolidation and Acquisition: Shaking Things Up
- Consolidation will continue at a strong pace and spread. Consolidation of imaging services will accelerate this year. Radiology benefit managers, pricing transparency, higher out-of-pocket co-pays, health plan contracts that redirect business and cut-throat pricing will pressure the profitability of these centers. Additionally, expect consolidation in the postacute care world as referral patterns change and ACOs, clinically integrated networks and health plans alter business and clinical relationships.
- Hospital and physician alignment will continue to be a top priority for hospitals. In the never-ending quest to capture a greater population, health systems and hospitals will continue to acquire medical groups and physician organizations.
- Medical group consolidation: Of note is the acquisition of medical groups and physician organizations by other medical groups; this trend should accelerate in 2015.
- Academic medical centers will enter more markets to acquire medical groups and clinics and provide more access points to their system.
- Other opportunities: Additionally, we have seen a steady increase in co-management agreements, bundled payments, ACOs and clinically integrated organizations focused on aligning the economic interest of all parties. Expect all of these alignment vehicles to continue to increase and become more sophisticated in their economic incentives, trying to produce greater value.
Insurance Trends: More Marketplace Disruption
- Direct employer contracting and private insurance exchanges will be a small but growing trend, led by the continued growth in high deductible health plans.
- Public insurance exchanges will have little new impact this year compared to last year.
- High deductible PPO products will continue to grow.
- Commercial HMO enrollment will continue its slow decline.
- Medicare Advantage enrollment will continue to grow as the population ages in.
- Employers also will increasingly add value to their healthcare benefits through the addition of wellness programs, healthy lifestyle, education and prevention.
In conclusion, management should focus on these trends and be prepared for some unexpected twists through 2015. Everyone will be looking for better value, and the pressure is on health systems, hospitals and doctors to deliver.
Now that healthcare in America is evolving as rapidly as technology, hospitals are expected to transform their archaic IT systems to meet reform requirements or face significant penalties from the government. Add to the mix a lack of skilled IT workers and an operating system that is already functioning at a loss, and the next few years look very grim. How can hospitals meet the mandates and recover their cumbersome IT systems? This infographic from Innotas outlines what these facilities need to implement to meet a brighter future.
To view a full-size version of this infographic, click here.
The Deloitte Survey of U.S. Physicians provides data-driven insights on physicians’ perceptions of the health care system and their thoughts on health care reform. Research conclusions include their perspectives and attitudes about health care reform, the future of the medical profession, and HIT. As they have done in past years, the Deloitte Center for Health Solutions conducted a survey and compiled the findings in an infographic, below.
The survey polled a nationally representative sample of up to approximately 600 U.S. primary care and specialist physicians to understand their perspectives and attitudes about health care reform, the future of the medical profession, and HIT.
Most U.S. physicians are concerned that the future of the medical profession may be in jeopardy and consider many changes in the market to be a threat. They believe that the performance of the U.S. health care system is suboptimal, but the Affordable Care Act is a good start to addressing issues of access and cost.
- Nine out of 10 physicians are interested in mobile health technology; those who are not tend to be older and have long-established solo practices.
- Users of the technology outnumber non-users in favoring its benefits for accessing clinical information, researching diseases and treatments, and pursuing continuing education.
- Three out of four physicians say EHRs increase costs and do not save time.
To keep you updated with information on the Medicare and Medicaid EHR Incentive Programs, CMS recently added one new FAQ and updated seven FAQs to the CMS FAQ system. We encourage you to stay informed by taking a few minutes to review the new information below.
- For Measure 2 of the Stage 2 Summary of Care objective for the EHR Incentive Programs, may an eligible professional, eligible hospital, or critical access hospital count a transition of care or referral in its numerator for the measure if they electronically create and send a summary of care document using their CEHRT to a third party organization that plays a role in determining the next provider of care and ultimately delivers the summary of care document? Read the answer.
- If my practice does not typically collect information on any of the core, alternate core, and additional clinical quality measures (CQMs) listed in the Final Rule on the Medicare and Medicaid EHR Incentive Programs, do I need to report on CQMs for which I do not have any data? Read the answer.
- Can eligible professionals use CQMs from the alternate core set to meet the requirement of reporting three additional measures for the Medicare and Medicaid EHR Incentive Programs? Read the answer.
- If one of the measures for the core set of CQMs for eligible professionals is not applicable for my patient population, am I excluded from reporting that measure for the Medicare or Medicaid EHR Incentive Programs? Read the answer.
- If none of the core, alternate core, or additional clinical quality measures adopted for the Medicare and Medicaid EHR incentive programs apply, am I exempt from reporting on all CQMs? Read the answer.
- If the denominators for all three of the core CQM are zero, do I have to report on the additional CQMs for eligible professionals under the Medicare and Medicaid EHR Incentive Programs? Read the answer.
- For the Medicare and Medicaid EHR Incentive Programs, if the certified EHR technology possessed by an eligible professional generates zero denominators for all CQMs in the additional set that it can calculate, is the eligible professional responsible for determining whether they have zero denominators or data for any remaining CQMs in the additional set that their certified EHR technology is not capable of calculating? Read the answer.
- I am an eligible professional who has successfully attested for the Medicare EHR Incentive Program, so why haven't I received my incentive payment yet? Read the answer.
Make sure to visit the Medicare and Medicaid EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.
AMA Speaks Out In Favor of EMR Overhaul.
The Wall Street Journal (9/16, Beck, Subscription Publication) reports, under the headline “AMA Urges Overhaul Of Electronic Medical Records,” that the AMA is backing physicians’ concerns that the current electronic medical records options are not user friendly and get in the way of patient care. AMA president-elect Steven J. Stack, MD, told the Journal that current EMR technology “is not supporting the quality of care we need it to.”
Dr. Stack criticized the Federal Meaningful User program, managed by HHS, and its requirements for the issues doctors have with EMR technology. Dr. Jacob Reider, currently the deputy national coordinator for health IT at HHS, said the agency welcomes the AMA’s feedback and noted that the agency is prioritizing usability. Dr. Reider was joined by other industry representatives in telling the Journal that usability was a priority for them but that improvement would be gradual and take a few years.
Health IT Stakeholders Lobby for 90-day Meaningful Use Reporting Period in 2015
When CMS issued a final rule in early September granting providers the flexibility in meaningful use attestation the agency had originally proposed back in May and finalizing the extension of stage 2 through 2016 for providers that started attesting in 2011 or 2012.
The rule finalizes the proposed attestation flexibility for providers that were unable to implement 2014 CEHRT in time to successfully attest due to vendor delays. These providers will be able to use 2011 Edition CEHRT or a combination of 2011 and 2014 Edition to attest to either stage 1 or stage 2. They will also be able to attest to meaningful use under the 2013 reporting year definition and use 2013's clinical quality measures.
The rule was generally welcomed by provider organizations and other stakeholders, with one notable point of contention — the final rule keeps the 2015 reporting period at a full 365 days rather than the 90-day period industry members had urged.
This week, 17 industry organizations wrote a letter to HHS Secretary Sylvia Burwell to again request the reporting period be shortened to 90 days. The organizations' main concern is that many of the providers who weren't able to implement 2014 Edition CEHRT in time to attest this year won't be ready to do so in the next 15 days, when the 2015 reporting period starts.
"For roughly 3,800 hospitals, the final rule requires implementation of 2014 Edition CEHRT configured for stage 2 measures and objectives by Oct. 1, 2014," according to the letter. "More than 237,000 eligible professionals will need to be similarly positioned by Jan. 1, 2015. This is in addition to the 1,200 hospitals and 290,000 EPs who also must have 2014 Edition CEHRT implemented before the beginning of their reporting year at stage 1."
However, current meaningful use attestation numbers suggest the vast majority of these providers will not be ready. Just 143 hospitals have met stage 2 thus far, or about 4 percent of the hospitals that will be required to begin stage 2 reporting next month, according to the letter.
Reducing the attestation period to 90 days, and thereby giving hospitals until July 1, 2015 (and eligible professionals until Oct. 1, 2015) to start the reporting period, would "help hundreds of thousands of providers meet stage 2 requirements in an effective and safe manner," according to the letter. "This will reinforce investments made to date and it will ensure continued momentum towards the goals of stage 3, including enhanced care coordination and interoperability."
The letter's 17 signatory organizations include the American Academy of Family Physicians, American College of Physicians, the American College of Physician Executives, America's Essential Hospitals, American Hospital Association, American Medical Association, Association of American Medical Colleges, Association of Medical Directors of Information Systems, Catholic Health Association of the U.S., Children's Hospital Association, College of Healthcare Information Management Executives, Federation of American Hospitals, HIMSS, Medical Group Management Association, National Rural Health Association and Premier healthcare alliance.
ONC: Half of Patients Given Online EMR Access Use It
In 2013, about three in 10 patients were offered online access to their medical record. About half of those patients offered access logged on at least once, according to a news brief from the ONC.
The ONC surveyed 661 patients with online EMR access. Of those patients, 21 percent viewed their record once or twice, 15 percent viewed it three to five times and 10 percent viewed it more than six times. Fifty-four percent did not access their record at all.
Of those who accessed their medical record online, 60 percent said it was "very useful."
The brief comes at a time when hospitals and health systems are struggling to meet the view/download/transmit requirement of meaningful use stage 2, many worrying about low participation among their patient populations. This brief indicates patients may be more receptive to accessing their records online than providers think, according to an ONC blog post.
The last day to begin a 2014 reporting period for first-year Medicare eligible professionals is October 3rd.
Here are a few key points eligible professionals who have not yet started participation in the Medicare EHR Incentive Program should know.
- October 3rd is the last day to start the 90-day reporting period in 2014 for the Medicare EHR Incentive Program.
- If you start participation by October 3, you will have the opportunity to receive an incentive for 2014, and if you continue to achieve meaningful use, can earn incentive payments for 2015 and 2016 participation.
- If you wait and start participation in 2015, you will not be eligible to receive incentive payments, but can avoid payment adjustments.
- You will not avoid the payment adjustment in 2015, as you will not be able to attest to 90 days of data by October 1, 2014.
- If you applied for a 2015 hardship exception by July 1, 2014, you may avoid the payment adjustment.
- If you attest to 2014 data by February 28, 2015, you will avoid the 2016 payment adjustment.
Medicare eligible professionals must attest to demonstrating meaningful use every year to receive an incentive and avoid a payment adjustment.
For More Information
To learn more about other eHealth events and National Health IT Week, visit the CMS Events page on the eHealth website. For more information about the EHR Incentive Programs, visit the CMS EHR website.
It could be said that data is the fuel and HIT systems are the pipeline for managing Population Health. Building the data infrastructure for a population health program is a complex undertaking with considerable upfront investment. Provider organizations must build a strategy, manage their cost structures, and understand the accountable care functions and IT systems that are necessary to make ACOs, CINs, and other population health initiatives function properly.
This infographic by Logicalis examines the rapid change affecting the healthcare IT field--and provides some valuable statistics regarding:
- Mobile Communications
- Use of Analytics for Care Improvement
- Patient Access & Engagement
To view a full-size version of this infographic, please click here.
If you are an eligible professional participating in the EHR Incentive Programs, you will be required to meet Patient Electronic Access measures. Patients’ access to their EHRs can help them make more informed decisions about their health care and improve efficiencies in health care delivery.
In order to meet 2014 Stage 1 requirements, you must provide more than 50% of your unique patients with timely access to their health information within four business days of the information being available to you. If you are in Stage 2, you must also demonstrate that more than 5% of your unique patients view online, download, or transmit to a third party their health information.
New CMS Guidance for Calculating Patient Electronic Access Across Multiple Providers
If you are an eligible professional, new CMS guidance may help you meet the Patient Electronic Access objective.
Stage 2 Measure #2: Eligible Professionals in the Same Group Practice
Eligible professionals in group practices are able to share credit to meet the patient electronic access threshold if they each saw the patient during the same EHR reporting period and they are using the same certified EHR technology. The patient can only be counted in the numerator by all of these eligible professionals if the patient views, downloads, or transmits their health information online.
Stage 2 Measure #2: Providers with the Same Patient
If multiple eligible providers who see the same patient and contribute information to an online personal health record (PHR) during the same EHR reporting period, all of the eligible providers can count the patient to meet requirement if the patient accesses any of the information in the PHR. In other words, a patient does not need to access the specific information an eligible provider contributed, in order for them to count the patient to meet their threshold.
Stage 1 and Stage 2 Measure #1: Providers with Patients who Opt-Out
A patient can choose not to access their health information, or “opt-out.” Patients cannot be removed from the denominator for opting out of receiving access. If a patient opts out, a provider may count them in the numerator if they have been given all the information necessary to opt back in without requiring any follow up action from the provider, including, but not limited to, a user ID and password, information on the patient website, and how to create an account.