OneClickMed Community

By now, it’s apparent EHRs need to grow up. But, as patient-centered business models become increasingly popular, the EHR is also shifting into a vital part of the success of these organizations. 

“The new ‘patient team’ business models, like ACOs, will require that EHRs mature into real-time care coordination and collaboration platforms that can help move organizations … from basic independent care into accountable care,” said Shahid Shah, software IT analyst and author of the blog The Healthcare IT Guy.  

“But care coordination and collaboration aren’t just about adding patient messaging and simple health records sharing— in fact, they must become managers of digital biology and digital chemistry and be able to use that new data to help physicians across patient care teams better comprehend what is happening inside the patient so that they can actually improve health outcomes.”

Shah walked us through what he calls the patient collaboration maturity model and outlines the five stages of EHR maturity and patient collaboration. 

1. Independent care. The first stage of Shah’s model, independent care, is where individuals or separate organizations provide much of the patient care. “This is pretty much where most organizations are today,” he said. “There’s nothing wrong with independent care, but the vast majority of the burden of managing patient collaboration is placed on the patient themselves, which means there’s very little real care collaboration going on.”

2. Connected care. Next, in the connected care phase, organizations begin to share enough information to begin basic patient care collaboration, like sharing patient charts electronically or sending messages about patient care between organizations. “Organizations will start by sharing simple records, but they must design their systems to help move from digital paper into digital biology and chemistry sharing,” said Shah. 

3. Coordinated care. Once an organization begins to benefit from connected care, said Shah, they mature into coordinated care, “where enough patient data is connected, [so that] it will allow multiple organizations to coordinate their care between each other through case tracking and management for simple tasks, such as identifying health risks,” he said. Organizations at the coordinated care maturity level, he continued, start to use their systems to start helping their patients manage their care between firms that might not be legally connected other than as HIPAA business associated or providers. “This is the first maturity level where [patients feel] they aren’t leading their care team but are the center of their care team,” he said.

[See also: ACOs and meaningful use to go hand in hand.] 

4. Integrated care. “Further maturity takes us from coordinated care to integrated care,” said Shah, “where multiple organizations share data and resources between each other, almost as fluidly as if they were a single organization without boundaries.” He added this is where population health management and advanced digital biology starts to “pick up steam,” since coordinated care organizations are no longer concerned with basic records management and digitizing paper and instead start to learn more about what’s going on with their patients. “At this maturity level, the patient starts to feel like they have control over their health, [and that] they have a great team behind them to not just fix existing ailments, but [also] help prevent future problems by modifying behavior.”

5. Accountable care. Lastly, in the “most mature organizations,” said Shah, we see accountable care, which is where there is “such a high level of patient collaboration, that groups of firms become accountable for outcomes and costs together as a team.” At this stage, he said, full information therapy and customized behavior prescriptions are now tracked, in addition to typical clinical treatments. “Accountable organizations take full responsibility for a patient’s care over time,” said Shah.

Follow Michelle McNickle on Twitter, @Michelle_writes

Article source: http://www.healthcareitnews.com/news/5-stages-ehr-maturity-and-patient-collaboration

NEW ORLEANS – The Crescent City Beacon Community will get assistance to strengthen the New Orleans healthcare infrastructure and health IT to improve care coordination and population health in 18 participating practices, including community health centers.

The Primary Care Development Corp. (PCDC)  of New York, which offers practice redesign and training to healthcare providers who treat medically underserved patients, will introduce health IT tools and train clinical and administrative staff for the Beacon partners, which serve 50,000 patients.

[See also: Beacon Communities snag more money for IT]

The training will concentrate on classifying the health risks of patients, creating disease registries, developing care management protocols, using care teams to manage patients with chronic diseases and adopting clinical decision support systems, said Anjum Khurshid, director of the New Orleans Beacon at the Louisiana Public Health Institute.

“Since Hurricane Katrina devastated New Orleans in 2005, the community has made tremendous progress in rebuilding the healthcare infrastructure, including significant investments in health IT and achieving high concentrations of medical home practices,” she said in a Feb. 6 statement.

This partnership is a chance to create “a national model for regional primary care transformation that demonstrates measurable results for patients, practices and the healthcare system,” she added.

[See also: Health IT 'Beacon Communities' awarded $220 million]

The Crescent City Beacon Community is one of 17 communities selected and funded by the Office of the National Coordinator for Health IT over three years to improve the quality of health services for populations suffering from diabetes, heart and other chronic diseases.

The Louisiana Public Health Institute coordinates the activities in the community with an aim to better manage chronic disease care through patient-centered medical homes and improve transitions of care between hospitals and primary care practices, both of which health IT enables.

The New Orleans beacon community last month launched Txt4health, a mobile health information service designed to help people understand their risk for type 2 diabetes and become more informed about the steps they can take to lead healthy lives. Individuals who sign up for txt4health will receive SMS text messages each week with timely, relevant information to help them improve and manage their health.

The Louisiana Public Institute also said that it will fund 17 of the beacon clinic and hospital partners to develop and put in place quality improvements that may be unique to their circumstances while still linked to the overall beacon interventions and goals.

Local beacon partners include the Interim Louisiana State University Public Hospital, Ochsner Health System, Tulane Medical Center, community health centers and metro New Orleans school-based health centers, Children’s Hospital and Touro Infirmary.

The Crescent City Beacon Community also works with the state’s health information exchange and regional health IT extension center initiatives, both which are ONC programs, and which are led by the Louisiana Healthcare Quality Forum. In addition, BlueCross BlueShield of Louisiana provides an important link to regional quality incentive programs, Khurshid said.

Article source: http://www.healthcareitnews.com/news/new-primary-care-model-making-new-orleans

HAMPSHIRE, UK – A burgeoning market for healthcare peripherals and increasing smartphone processing power will result in the number of patients monitored by mobile networks to rise to 3 million by 2016, according to a new report on the mHealth sector from Juniper Research.

Remote patient monitoring, using the smartphone as a hub, will lower the cost of mHealth services by reducing the need for costly tailored devices, the report notes.

[See also: Pennsylvania hospital strengthens fight against chronic disease]

Cardiac monitoring leads
Juniper found the monitoring of cardiac outpatients is leading the field, as insurance reimbursement in the U.S. market plays a key role. However, in time the management of diabetes and COPD (chronic obstructive pulmonary disorder) and other chronic diseases will play an important role in the remote patient monitoring market.

“Remote patient monitoring will step in to reduce the cost burden of unhealthy lifestyles and aging populations,” report author Anthony Cox said.

However, while remote patient monitoring is already showing both positive medical outcomes and cost savings over outpatient care, more trials would still benefit mHealth in order to further convince the medical establishment of its benefits, he added.

[See also: Medicare to tackle chronic illnesses with home care]

Other key findings include:

• Mobile Healthcare and medical app downloads will reach 44 million in 2012,  rising to 142 million in 2016
• Clarification from the U.S.  FDA (Food and Drug Administration) on which mHealth apps will require FDA approval is still required but is expected to add further impetus to the market.       
• Developing markets continue to benefit from SMS-based education programs and stand to benefit in medium term from app-based healthcare services such as mobile ultrasound that are now being developed        
• Electronic health records have yet to gain significant traction even in developed markets but in the long-term will become an important component of mHealth offerings                    

Article source: http://www.healthcareitnews.com/news/remote-health-monitoring-pegged-3-million-users-2016

WASHINGTON – The Office of Inspector General has provided a laundry list of management and performance challenges facing the Department of Health and Human Services. Many have IT implications, such as improving patient safety, preventing Medicare and Medicaid fraud and ensuring that IT systems and data are secure.

The overriding theme is that the department must strengthen its oversight capacity.

[See also: IT aid to largest Medicare fraud sting in history]

Every year, OIG identifies for HHS the most significant new and emerging challenges the department faces. In reveiwing 2011, OIG identified these top challenges going forward.

• Implementing the Affordable Care Act: The ACA is sprawling and far-reaching. HHS and its partners “must be vigilant in identifying and addressing existing and emerging fraud, waste and abuse risk areas in ACA-related programs.”
• Preventing and detecting Medicare and Medicaid fraud: HHS must strengthen the enrollment system, be attentive to the programs’ vulnerabilities and carefully select its contractors and make sure they have what they need to appropriately handle the job they have been given.
• Identifying and reducing improper payments: HHS needs to continue to monitor its payments systems and prepayment reviews and to develop error rates for additional programs as well as expand its education efforts.
• Patient safety and quality of care: The department should continue to prioritize quality of care and patient safety by implementing more of the quality improvements of the ACA and the goals set by the Partnership for Patients.
• Integrity and security of information systems and data: Protecting the electronically stored personal medical information of patients must be a priority. HHS needs to close security vulnerabilities that could potentially allow unauthorized access to personal data.
• Availability and quality data for effective program oversight: To ensure the availability and completeness of data, HHS needs to address the vulnerabilities of the databases it relies on and then form a process that will ensure the completeness and correctness of the data.
• Oversight of the Centers for Medicare Medicaid program and benefit integrity contractors: HHS must strengthen oversight and monitoring of its contractors.
• Ensuring integrity in Medicare and Medicaid benefits delivered from private plans: HHS must strengthen its oversight of bids and risk adjustment payments, monitor plans’ implementation of integrity safeguards, provision of covered services and compliance with marketing rules.
• Avoiding waste in healthcare pricing methodologies: HHS must put into place a process that makes sure Medicare and Medicaid payments are economical as well as in line with changes taking place in the marketplace.
• Grants management and administration of contract funds: HHS must vigilantly monitor and manage new and continuing grant programs.
• Ensuring the safety of the nation’s food supply: HHS and the Food and Drug Administration need to act quickly to implement the Food Safety Modernization Act to better protect the country’s food supply.
• Oversight of the approval, safety and marketing of drugs and devices: HHS must close vulnerabilities in the FDA’s oversight of drug safety, biologics and medical devices by focusing on reducing off-label promotion and using its authority to sanction those engaged in fraud and abuse.
• Oversight and enforcement of HHS’ ethics programs: HHS should do more to identify and address conflicts of interest among internal and external stakeholders.

Follow HFN associate editor Stephanie Bouchard on Twitter @SBouchardHFN.

[See also: Bipartisan Policy Center calls for more, better health IT]

Article source: http://www.healthcareitnews.com/news/inspector-general-review-highlights-it-challenges-hhs

WASHINGTON – The Office of the Inspector General (OIG) announced Monday it has posted a video and audio podcast on the agency’s self disclosure protocol, the most recent of its video and audio presentations on top healthcare compliance topics.

The new video and audio podcast shows how to disclose and resolve potential fraud issues identified by an organization’s compliance program by using OIG’s Self-Disclosure Protocol. 

The newest step in OIG’s provider compliance training initiative, the free videos and audio podcasts – averaging about four minutes each – cover major healthcare fraud and abuse laws, the basics of healthcare compliance programs, and what to do when a compliance issue arises.

“We know that the overwhelming majority of healthcare providers are working hard to comply with federal laws and regulations,” said Daniel R. Levinson, HHS Inspector General. “These videos are designed to guide them in further enhancing their compliance efforts.”

The protocol videos and audio podcasts will continue to be released at the beginning of each week over a three-month period, OIG officials said.

[See also: OIG to monitor Medicare, Medicaid IT upgrades, incentives.]

The OIG has also made a new compliance training widget available for healthcare providers to add to their website or Facebook page. According to OIG, the compliance training widget is “a sleek graphical image” containing a hyperlink that can be posted to non-OIG websites, allowing visitors easy access to OIG’s provider compliance training materials. 

The OIG encourages Twitter users to use the hashtag #OIGCompliance when tweeting about the new protocoal information online. 

OIG officials said they are also continually updating online the corporate integrity agreement list and enforcement actions. 

[See also: Fraud detection study gets put on the fast track.]

Follow Diana Manos on Twitter @DManos_IT_News.

Article source: http://www.healthcareitnews.com/news/oig-issues-fraud-self-disclosure-info-online

CHARLOTTE, NC – The Premier healthcare alliance has joined with Verisk Health, which develops risk assessment and decision analytics technology, to offer data to hospitals and health systems meant to help better measure the health of their communities and develop new care models.

The initiative combines Premier’s clinical, financial and operational comparative database – billed as the largest compilation of inpatient data in the country, with nearly 20 percent of all U.S. hospital discharges – with Verisk Health’s risk-based analytics, used by more than 450 healthcare organizations.

As a result, officials say, providers will have access to a more complete picture of patients and a better understanding of outcomes and total cost of care, including care provided outside the hospital setting.

“To appropriately take responsibility for the health of a population, providers need a complete look at the cost and effectiveness of all care provided,” said Keith J. Figlioli, senior vice president of healthcare informatics for Premier, a provider owned performance improvement alliance of more than 2,500 U.S. hospitals and 81,000-plus other healthcare sites.

[See also: Premier develops industry IT standards for ACOs.]

“Today most hospitals are only able to measure the procedures they perform,” he added. “All other aspects of a patient’s health – including primary care, post-acute rehabilitation and the patient’s return to health – remain a mystery. Combining data from inpatient and outpatient settings with claims data will help produce actionable information that supports care interventions to help ensure patients receive the most effective and informed treatments possible.”

This Premier–Verisk Health initiative will also enable providers to more effectively support emerging care-delivery models through health reform. For example, as hospitals and health systems participating in accountable care organizations (ACOs) are reimbursed based on performance and total cost management, they will need to collaborate with payers to efficiently and cost-effectively deliver improved outcomes, as well as exchange population-level data. This initiative will equip the ACOs with the tools necessary to better understand both performance and costs.

“By combining the significant capabilities of these two companies, providers can design and implement quality-based programs and interventions to drive cost-effective care at both the patient and population levels,” said Mike Coyne, CEO of Verisk Health. “These data-driven, risk-management initiatives are a crucial first step toward improving the national well-being and reducing costs associated with gaps in care, uncoordinated service delivery, and preventable procedures, readmissions and emergency department visits.”

[See also: Analytics and the future of healthcare.]

Officials say an example of the benefits of this combined offering can be explained in a common scenario: If a person with diabetes goes into insulin shock today, a hospital can only measure the cost and the outcome of that emergency care. But insulin shock is inherently a poor outcome that should not happen. By combining these solutions, providers should be able to spot patients who fail to file claims for prescription medicines – all too often the cause of insulin shock – and take steps to prevent a worsened condition that leads to a more expensive hospital stay.

Even if hospital care is required, claims data will help hospitals ensure that the post-discharge plans are followed effectively, and intervene if the appropriate medical care hasn’t been sought to avoid a preventable readmission.

Health system members of Premier’s Partnership for Care Transformation (PACT) will participate in a series of short-term performance improvement initiatives that will use the data and tools to determine the total cost and efficiencies of care for a defined population. PACT members will share their learnings and experiences to help the alliance further build and define the capabilities that will be required for new delivery models. Based on this initial work, Premier and Verisk Health anticipate developing new analytic offerings targeting the emerging needs of integrated delivery systems.

Article source: http://www.healthcareitnews.com/news/premier-verisk-health-offer-hospitals-data-care-improvement

HOUSTON – Greater Houston Healthconnect, formerly known as Greater Houston Health Information Exchange, has named James Langabeer president and CEO, Langabeer will lead the organization’s overall strategy and direction and examine new growth opportunities.

“Jim is an extraordinary leader with a wide range of experience in healthcare, technology and business development,” said Gilbert A. Herrera, chair of the board at Healthconnect. “He brings with him the kind of skills that will allow Healthconnect to support better outcomes for all patients, and to continue the momentum that has built over the past year under Kay Carr’s leadership.”

[See also: Blue KC goes for new master patient index]

Langabeer was formerly on the faculty and director of the Center for Emergency Research at the University of Texas Health Science Center, School of Public Health, where he led a large research center focused on quality improvement in healthcare for strokes, cardiovascular and emergency medicine. He also has held leadership positions at the University of Texas MD Anderson Cancer Center and the University of Texas Medical Branch.

“We are confident Healthconnect will benefit from Jim’s strategic vision, in light of his deep ties to Houston’s healthcare community and his demonstrated understanding of the pivotal role that health information sharing organizations like Healthconnect will play in the future of healthcare,” said Herrera.
 
Previously, Langabeer was the executive vice president for an information technology and consulting firm in Cambridge, Mass., leading the development of the firm, which was later acquired by Oracle.

“Great things will happen in the region as we deploy health information technology to connect institutions and providers,” said Langabeer. “Integration will streamline care, reduce duplication of services, and improve overall patient care – helping us tackle the most pressing problems in the region by providing better, more timely information. Greater Houston Healthconnect is partnering with nearly all hospitals, physicians, and other stakeholders to catapult Houston to national prominence in this area.”

[See also: 5 keys to getting your HIE capabilities up and running]

Healthconnect became operational in under a year, a rapid progression as compared with the traditional long start-up times normally associated with many other HIEs around the country, Healthconnect officials said, adding that it reflects a groundswell of community and provider support. Healthconnect has garnered letters of interest from 60 hospitals and more than 5,300 physicians in the region.

Article source: http://www.healthcareitnews.com/news/greater-houston-hie-changes-name-hires-new-leader

Minnesota is home to the Mayo Clinic – a world-renowned institution for medical care, research and education, employing more than 3,700 of the smartest physicians and scientists and scientists in the world and caring for patients from across the globe.

It is also home to congresswoman and former GOP presidential candidate Michele Bachmann – a person whose healthcare expertise includes calling the Affordable Care Act the “the crown jewel of socialism,” and charging that Democrats’ efforts at health reform are tantamount to “reaching down the throat and ripping the guts out of freedom.” But that’s a topic for another story.

Truly, the North Star State is a land of contrasts. From the thriving Twin Cities of Minneapolis and St. Paul, to remote, frozen outposts like International Falls, the so-called “Icebox of the Nation,” Minnesota – often ranked as the healthiest state – covers a huge geographic and demographic area and has many different healthcare needs. It is also an early leader when it comes to deploying healthcare IT to meet those needs.

Leading up to the Minnesota caucus on Feb. 7, Healthcare IT News Managing Editor Mike Miliard spoke to Marty LaVenture, director of the Office of Health Information Technology and the Center for Health Informatics and e-Health in the Minnesota Department of Health, about the Gopher State’s healthcare needs – and how they’re addressed by its health IT infrastructure.

Q: Can you talk a bit about healthcare – and healthcare information technology – in Minnesota?
A: The environment related to health IT is one that has a strong history of collaboration between the public and private sectors, starting with 2004, with the establishment of the Minnesota eHealth Initiative – a public-private effort chartered by the legislature to bring together, under the Commissioner of Health, a cross-section of the healthcare and public and private sectors to work together on the successful adoption of electronic health records and other technologies.

There’s a very high adoption rate in clinical ambulatory settings in Minnesota – one of the highest in the nation, with around 72 percent of ambulatory clinics having adopted EHRs. And more than 90 percent of hospitals have adopted electronic health records.

Lower but, importantly, growing, is the second key element: the actual effective use of the systems and their environments: things like clinical decision support and e-prescribing are other factors that lead to use of that tool effectively to improve individual care and care of the entire community. Progress is moving there.

A third factor is a number of opportunities for continued improvement related to the exchange of health information, and the factors associated with that.

[See also: Minnesota awards grants to providers for interoperable EHRs.]

Q: How do you grade the extent of Minnesota’s HIE deployment?
A: Minnesota has chosen to support an open market strategy for secure health information exchange that allows for the private sector innovation and initiative. It uses a model for limited government oversight to assure fair practices and compliance with state privacy protections.

It’s chosen that model. It lags behind in adoption and use, in terms of the proportion of clinics and hospitals that are reporting exchange activities. It’s higher among those [providers] that exchange standard transactions within the health system, but a little lower outside of, say, your own affiliated partners. So those [organizations] that are not affiliated are a little bit further behind.

ePrescribing is moving rapidly. There is a requirement in Minnesota to use e-prescribing, and more than 68 percent of the clinics report using it as their method of preparing prescriptions. About 40 percent or so of the hospitals are involved in e-prescribing with outside prescriptions, and certainly within their own organization they’re using CPOE as a method for ordering medications as well. Most of the pharmacies in Minnesota – more than 90 percent – are actively engaged in e-prescribing. So there’s a lot of progress, but a long way to go, as well.

(continued on next page)

Article source: http://www.healthcareitnews.com/news/minnesota-healthy-appreciation-hit

In the letter sent Thursday to Department of Health and Humans Services Secretary Kathleen Sebelius., AMA CEO James Madara, MD urged HHS “to make good on its commitment to improve the regulatory climate for physicians.”

Article source: http://www.healthcareitnews.com/news/ama-ahima-odds-icd-10

WASHINGTON – Health information exchange will ramp up significantly in 2012 because the necessary elements of interoperability will be in place, ONC chief Farzad Mostashari, told the Health IT Policy Committee at a meeting Feb. 1.

The health information exchange strategy means finally bringing together the standards, identity authentication certificates, governance for rules of the road, and the availability of directories or digital provider phone books.

[See also: Mostashari: Meaningful use to reach new heights]

These will enable providers to exchange information whether through a simple transaction for a referral or sharing a test with another provider or a more complex query for patient data.

More work will need to be done, “but I think we really do have the pieces coming together for a big win on interoperability in exchange in 2012,” Mostashari told the panel.

Health information exchange will be a critical part of the meaningful use of electronic health records as it moves to Stage 2 in order to coordinate care  and to share data to demonstrate improved patient outcomes.

[See also: Bipartisan Policy Center calls for more, better health IT]

Mostashari cited the success of health IT vendor Epic Systems in conducting exchanges. Epic CEO Judy Faulkner, also a policy committee member, said the vendor has already exchanged 800,000 documents from Hawaii to California, the state of Washington to New York, California to Ohio, and is also planning to exchange overseas.

“We are told all the time that it saves lives,” she said. For example, a patient showed up for the first time as she was about to give birth, and through exchange the provider got her record, which showed that she had had a C-section scar that could burst if they hadn’t seen that, Faulkner said.

With the standards and other requirements in place, exchanging with other vendors is “almost equally as simple” as exchanging among Epic customers, she said.

State HIEs make progress

State health information exchanges funded by the Office of the National Coordinator for Health IT are showing som progress as they begin to bring together multiple exchange networks and models within a state, said Claudia Williams, ONC’s state HIE program director.

The program aims to drive exchange in the state by reducing costs, filling in gaps and assuring a common baseline of trust and interoperability. That means building on existing market activities and focusing on meaningful use. “This is a reality-based approach because resources are important and scarce,” she said.

For example, Delaware offered a time-limited free sign-up period, which attracted 500 providers for its directed exchange services to meet meaningful use requirements to share a care summary when a patient is referred and immunization reporting.

In California, the Cal eConnect HIE Expansion Program funds community based initiatives, such as Redwood MedNet to help provider EHRs connect to labs and share hospital discharge and provider care summaries.

ONC also reported that more than 35 vendors have installed the Direct Project secure messaging protocols in their products, while 40 state HIEs are including Direct services in their plans. Four of the state HIEs have already put it into practice, said Dr. Doug Fridsma, director of ONC’s Office of Standards and Interoperability.

As of January, 22 federal agencies and other large organizations are participating inthe Nationwide Health Information Network(NwHIN)  for more comprehensive patient data sharing, he said.

Some exchanges are preparing for NwHIN production. The Alaska HIE and the Medical University of South Carolina are in conformance testing, while the Quality Health Network has moved forward to interoperability testing. 

Last month, the Health and Human Services Department lifted the restrictions that NwHIN Exchange participants must be a federal contractor or grantee. “This is tremendously important” for keeping the momentum going, Fridsma said.

Article source: http://www.healthcareitnews.com/news/mostashari-expects-big-year-ahead-data-exchange