The Case for Coordinated Care, or, Why I Want My Veterinarian to be My Primary Care Provider!

Allan Hess

A Personal Journey

As the healthcare industry in its many forms strives to improve population health and care coordination through advanced technologies on a grand scale, we are still aware of and often get to see how our systems can impact individual physician practices and even patients on a personal level.

When my mother became ill last summer, I found out first-hand just how pressing the need is for true data liquidity and the adoption of care coordination solutions on any scale. Could it be that my household pet’s veterinarian offers more advanced systems than my mother’s providers? Or mine?

We decided it was necessary to move Mom from New York to Atlanta so I could oversee her care needs. The challenge quickly became getting her prior medical history – disparate among former primary care, specialist and hospital settings – into the hands of her new providers, which I quickly found out became my responsibility to compile, they said, and not theirs.

I did have legal authority to do so with a proper power of attorney and medical proxy document, so I embarked on the effort to rein in those elements of medical history.

Each of the physicians she’d been seeing, whether for months or for decades, still required that the request for her medical records be done through a paper fax: one fax to each of her doctors to request that the information be sent back to me in a paper format. One exception was the hospital she had been to numerous times for radiology tests, which accepted an email request, and within two days sent back four CDs of medical images.

For that I was very impressed, but not so much with her prior batch of physicians. Those offices took up to six weeks to photocopy and send her medical records to me. When I inquired about the delay, I was told that the office staff was busy and the request was in queue, so six weeks passed for all the papers to arrive by mail. Finally, I was armed and ready to bring four CDs and a six-inch stack of paper to her new physicians. Oh, and along the way, one of the medical offices I legally requested information from actually sent me medical and personal information for two other people, which sadly falls within the realm of a HIPAA violation. At least they did apologize and did not charge me for the photocopying (at 75 cents per page).

Mom’s new primary care physician was excited to tell me that the paper trail would be scanned into their electronic health record, as soon as I faxed it into the office! Very disturbing on many levels, but here’s the real kicker. In January, my dog fell and injured himself. A few days after falling, it was obvious he needed medical treatment, so off we went to his regular veterinarian. A few tests later, and it was recommended that he needed to see a canine orthopedist/therapist. On the way to checkout, without asking, I received a CD containing the just-taken “X rays” so I could bring them to the orthopedist. Nice touch, I thought!

So my dog and I show up for our scheduled appointment just a few days later, go into the exam room and the technician begins asking questions and typing the answers into an EHR. I thought that was interesting, and I was fairly impressed. During the conversation, I forgot to mention a current prescription drug he was on for arthritis. Guess what? This orthopedist had my dog’s entire 11 years of medical records transferred electronically from his primary care vet into this specialist’s EHR system, in digital format. This enabled the vet tech to inquire about the drug I neglected to mention! I was also asked about other aspects of my dog’s medical history to verify the digital record. Pretty impressive, right?

Now I was totally impressed and immediately saddened once I realized that my 11-year-old dog could get more coordinated medical care, with less hassle, than my elderly mother.

It was then that I decided that I wanted my dog’s vet to be my own PCP!, or at least for our providers’ care coordination abilities to catch up with the vet’s.

Allan Hess is director of marketing strategy and brand management at Greenway.

Community Health Centers – A Care Coordination Model on the Forefront of Delivery Reform

Bill Young

Our nation’s healthcare system, and subsequently the healthcare information technology industry, has been increasingly emphasizing the advancement of the growing role – and need – that Community Health Centers (CHC) present as a care coordination and preventive medicine model toward improving population health.

But just what is a CHC? Basically, it is an outpatient healthcare provider that receives a substantial part of its funding from government payers or direct government grants, delegated by federal and state entities (through Medicare and Medicaid) to provide care to the uninsured and underserved. This includes Federally Qualified Health Centers (FQHC), Rural Health Centers (RHC), Indian, migrant and homeless health centers. From a health IT perspective, the challenges of meeting the needs of CHCs revolve around unique reporting and reimbursement requirements that require a robust IT platform to facilitate compliance and promote greater clinical care functionalities as well.

While CHCs make up less than five percent of the ambulatory clinics in the United States, they are at the forefront of technology adoption, care coordination and population health management as a result of their governing agency’s (the Health Resources and Services Administration – HRSA) emphasis on quality improvement in healthcare. They were early participants in chronic disease management registries and population health data management. Through HRSA grants CHCs have formed alliances with regional health information organizations (RHIOs), state primary care associations (PCAs) and Health Center Controlled Networks (HCCN) to use population health management as a tool towards developing and implementing evidence-based medicine to improve healthcare outcomes.

Under the Accountable Care Act, there has been an emphasis on the development of the Accountable Care Organization (ACO) as well as the Patient-Centered Medical Home (PCMH) models. As a percentage of clinics that are either recognized as a PCMH or are seeking recognition, CHCs are generally “ahead of the pack” due to their emphasis on offering all primary care disciplines within one clinic, including pediatrics, OB, dental and behavioral health. They are accustomed to incorporating population health management which encompasses management of chronic disease. As a result, care coordination comes somewhat natural to a CHC thereby making the path to PCMH recognition somewhat easier. When the original regulations governing ACOs were issued, FQHCs were excluded from participating. After considerable discussion, they were expressly included in the final rule when it became clear that they generally possessed many of the characteristics sought by the ACO community and already possessed the infrastructure to make them an effective and efficient ACO provider.

Greenway embraced the CHC healthcare segment and its mission in 2008 by developing the basic clinical and reporting needs into PrimeSUITE for the Primary Plus FQHC in Kentucky. In late 2009, Greenway entered into a software development partnership with CySolutions, a company with more than nine years of experience serving the unique needs of FQHCs in 46 states.  Within six months after signing the agreement, CySolutions had integrated its technology into PrimeSUITE and began deploying that technology to many of its customers as well as new and existing customers of Greenway. In November, 2011, Greenway acquired the developed technology along with customers and key personnel from CySolutions, firmly establishing their presence in this healthcare segment. At this juncture, PrimeSUITE is one of only two solutions in the marketplace that offers a fully-integrated, meaningful use certified, electronic health and dental record.

PCMHs and ACOs provide promise to a healthcare system that seeks improved outcomes through care coordination, patient engagement in their care, the shift from episodic medicine to preventive care with early detection and aggressive management of chronic conditions. Successful achievement of these objectives should result in a reduction of overall lifetime healthcare costs as well as accelerated research to advance disease prevention and cures.

CHCs have long been at the forefront of developing and implementing the basic objectives of the PCMH among a challenging population of underserved and uninsured people, and they serve as a vital role in our national healthcare system, all while leading the way in developing the care model of the future.

Bill Young, former CEO of CySolutions, is a product strategist at Greenway.

Observing Cuba’s Healthcare System, and What the U.S. Can Gain

Justin Barnes

Havana – Fortunate to be among a delegation formed by the Medical Group Management Association (MGMA), and facilitated by the sanctioned Academic Travel Abroad’s (ATA) Professionals Abroad program, I spent a week late in 2011 with MGMA’s Research Program observing  Cuba’s healthcare system on several fronts.

From the Cuban Ministry of Public Health, the Latin America Medical School and the National Center for Medical Sciences Information (InfoMed), we were given an intensive tour of the infrastructure, approach and devotion the country places on the best practices Cuba can achieve.

Of course given its relative isolation and geopolitical history of trade embargo, Cuba is one of the world’s poorest countries overall, and faces health challenges ranging from threatening air quality in its capital city to dietary issues based on high caloric intake, to name just a few that were self evident. Its healthcare system – while providing state-sponsored, free healthcare and free medical school education – is a rudimentary, paper-based system with none of the automation or data sharing we enjoy. (The above-noted InfoMed center, though, does allow computerized research.)

But despite these obstacles, Cuba’s life expectancy is on par with that of the United States at age 78, and its infant mortality rate is actually better, at 4.6 per 1,000 vs. 6.5 per 1,000 in the U.S., all according to the World Health Organization (WHO).

How this is accomplished in a country of 11 million people? Our visit to a “Policlinico” provided a first-hand look at the country’s emphasis on direct, community-based preventive medicine. These interdisciplinary specialty clinics are located throughout the country intermingled with primary care clinics, and also act as teaching centers. We found a strong sense of community overall throughout Cuba that readily translates to healthcare. The family and specialty clinic physician and nurse teams work in concert, and spend much of their day making proactive house calls throughout their communities, where the doctor/patient ratio goal is a commendable 1 to 1,100.

We also found a healthcare culture that takes pride in avoiding ER visits and hospital admissions, though much of that is born of necessity. Cuba’s acute care system, facilities and devices are not as advanced as ours or those of many developed nations, re-emphasizing the need for ambulatory preventive medicine. The country’s trade embargoes also limits drug imports, which has led to an aggressive biotechnology program emphasizing widely given vaccines that also speak to preventive medicine.

What we can learn from Cuba about managing healthcare at the local level, and combining that model with our technology and data sharing – along with the will to succeed seen in Cuba since this Family Doctors Program was established in the 1980s – can help make our healthcare delivery more efficient and effective, which we are seeing at hand with growing care coordination goals.

And if house calls may not be realistic in this country, the patient-centered medical home, for example, is a good and growing analogy.

The Next Time

Eric Grunden

Best Practices for Changing out a Failed EHR System

If you are anything like me, you find yourself daydreaming from time to time, when you should really be focusing on the task at hand or that project due at work.  It is human nature for us to “zone out” every once in a while and allow our mind to wonder into a land of “what ifs.” Yes, I’m as guilty as the next guy and often catch myself thinking about the beach vacation I would love to be on, or car I would like to have next, or what retirement life will be like, or what it would be like to go to the Super Bowl, or wondering why McDonald’s doesn’t sell hot dogs, or what I would change if I was the President (of the United States – not Greenway-it’s in good hands).

And if you are lucky enough to be married you can really amp up the “dreams” by co-dreaming with your spouse.  For my wife and me it usually revolves around our “next home.” For Nicole (my wife) our “next” home will have more closet space, larger breakfast area, an island in the kitchen, no formal living room or sitting area, more storage space in the attic and/or garage, a larger guest bathroom, a larger master bathroom, a larger walk-in closet in the master bedroom and a basement.  As for me, I’m a little less complicated – just a large basement with a movie theater room and a place for a golf simulator/trainer.

Yes, “the next time” conversations are a lot of fun to have, but can they translate into reality when the time comes – when you are actually ready to pull the trigger and make the move?  Which brings me to the subject of this post…

A recent KLAS report, Ambulatory EMR: Win Rates, Replacements, and Provider Loyalty, stated that 35 percent of providers are looking to replace their existing EHRs.  Additionally, it was reported that more than 40 percent of groups with more than 100 physicians were changing EHR systems. The industry is identifying this trend as “rip and replace.” So it seems that many practices today are starting to pull the trigger on “the next” EHR solution. Apparently there are needs, service requirements and functionality not being met by some of the solutions on the market today.

Most practices state that their reason for moving to a new solution was either due to lack of needed functionality, lack of product flexibility, issues with customer support and/or implementation/integration failures.

For customers who have made the decision to “rip and replace,” there is always a mixed bag of emotions that accompany it.  Of course there is excitement in moving to a solution that will address the needs/desires, but there is also always some trepidation because of the move from the known to the unknown – better said – CHANGE is never easy.  Many practices assume it is as easy as installing the new software and copying the data from their existing EHR to the new one.  And yes, that is definitely part of the process, but there is much more to consider and plan for with the move.  Here are some of the things we walk our customers through:

1. Project Planning – you don’t often get too many complaints for “over communicating”, so putting a plan in place that includes regular communication and updates to the staff AND patients is key.
2. Data Migration – what data will be transferred from the legacy system and in what format?  The goal is to capture as much discreet data as possible to ensure the continuity of the medical record and clinical reporting.
3. Training, Training, Training – Get your staff plenty of training, and then get them more.
4. Be flexible and expect obstacles – have a backup plan and communicate that plan throughout the practice.
5. Map out the workflow before you go-live – even consider running a mock clinic or test before go-live.  The providers should be intimately involved with designing the templates and mapping out the workflows within the clinic.  This will help to ensure full physician adoption. Bottom line – have the physicians invested their time!
6. Monitoring – once the onsite support and training team leaves make sure you have a dedicated team from the vendor to “watch over” your progress.  This will identify gaps in knowledge, suggest workflow improvements and act as an insurance policy for the billing department.

So if you are dreaming about your next EHR solution it is important to know exactly what you want from it before pulling the trigger.  And once you do make the decision to “rip and replace” make sure you have a good partner with a good plan and plenty of experience in doing these transitions.

Happy New Year & Happy “Daydreaming”!

Thanks and God Bless,

E

Follow me on twitter @EGrunden

To learn more about replacing your EMR/EHR, visit http://www.greenwaymedical.com/solutions/replacing-your-emr-ehr/.

Physicians Hold Accountable Keys to Care Leadership

Justin Barnes

Despite what has been voiced or viewed by critics of Shared Savings as a complicated mold physicians must fit into, or even a harkening to managed care, accountable care can instead be a gateway for healthcare providers to determine their own futures, and emerge as increasingly trusted leaders in their communities.

As the concept and trend toward preventive, care coordination delivery reform built on quality reporting incentives and health information  technology takes multiple shapes -  be it the CMS program, private payer, employer, health system or public-private combinations – there are defined steps physicians and practices can take to navigate the landscape to become an “ACO ready” practice suitable to these entities.

Built around the necessity of sharing discrete data, it’s important for physicians to take a leadership role in assessing technology capabilities needed for success. EHRs with interoperable solutions, e-prescribing, lab data capture and patient communication functions are needed foundations.

Physicians and practices should immediately begin proactively engaging peers, hospital and health system leaders and all types of payers to not only determine care coordination specs and strategies, but toward the pivotal reality of not being left  out of an emerging program. Primary care and specialists practices must understand their value to these programs, but also realize the size of the rosters being proposed around them.

As these programs grow, there is a growing understanding by payers that a technologically sound and progressive practice is the key to success, and the level of confidence payers are looking for.

The 2011 Employer Driven Accountable Care Organizations Survey Report (Aon Hewitt, Polakoff/Boland) focused on that very sector, which is becoming a large player in accountable care program formation. It found that of more than 600 companies asked, the highest combined confidence level (53%) of an ACO-run structure was a physician-led ACO combined with a health plan, over that of a hospital-led program (48%). Also encouraging from the survey was that quality of care, cited by 82% of respondents, was the most important goal of an ACO.

Practices and medical groups should take this to heart, for it is their physicians who are best positioned to lead the way on the understanding of the inter-workings, workflows and care plans that best lead to preventive, coordinated care. And that will translate into properly focused payment structures.

Justin Barnes is co-chair of the Accountable Care Community of Practice (ACCoP), and a vice president at Greenway Medical Technologies, Inc.

‘Tis the Season…To Tackle Industry Challenges

Eric Grunden

“It’s the most wonderful time of the year, with kids jingle belling and everyone telling you to be of good cheer, It’s the most wonderful time of the year”.

Yes, I think for most of us, that is one of our favorite Christmas songs (originally by Andy Williams, but done by hundreds of other artists through the years).  And it is that time of year again!  Time to deck the halls, wish everyone season’s greetings, pray for peace on earth, exclaim joy to the world and say good tidings to you.  It’s time for Santa and gift giving and card sending and candy making and family traditions.  And most importantly it’s time for remembering and celebrating the true reason for the season.

It is time to give thanks and reflect on the past year, and without a doubt, I am truly blessed.  I’m blessed with a wonderful loving family, good health and to work for a great organization with people that are the best in the business.  It is also time to wish others peace and joy, good tidings and prayers; which brings me to the reason for this post.

This is supposed to be a stress-free, happy and exciting time, but I’m not sure that is the case for physician practices today.  We are in a very turbulent time for the industry.  There is 5010, the year-end attestation for Meaningful Use funds, the coming of ICD-10 and the threat of major Medicare reimbursement cuts.  I would classify those as anything but “exciting” and “joyful”.

I have many friends that are physicians, and of course I know many more that are our customers, and each and every one of them went into medicine because they wanted to make a difference.  They wanted to serve.  They wanted to help people.  I think you will agree with me when I say, it is often a challenge for physicians to focus on the medicine, and care of patients, in today’s world.

What other industry or profession are you required to basically learn a foreign language in order to get paid?  Physicians must know CPTs, ICD9s, modifiers, HCPCs in order to bill for their services.  There is also HIPAA, understanding EOBs and the constant fight with insurance companies to prove that you, not only provided the service, but you provided the right service.  Add to all that sick, tired, impatient, nervous, anxious and scared patients.  Sound like the perfect job?

So here’s my Christmas wish and prayer – that doctors can get a break, take a breath and have a stress free holiday season.  I know it can’t be easy doing what they do every day; working the long hours so you and I can be cared for and healthy.  And for that I say “Thank you” from all of us at Greenway.  I also promise that we will continue to work with you, and for you, in order to make life a little easier.  We will work on your behalf in Washington, to innovate and provide better solutions and provide the best service in the business.

Again, from all of us at Greenway Medical, Merry Christmas!

Thanks and God Bless,

E

Follow me on twitter @EGrunden

To learn more about Greenway’s Client Services or what Greenway Client Services can mean to you click here http://www.greenwaymedical.com/service/client-services/.

Consumer-Engaged Healthcare: The Next Step

Greg Shilling

Approximately 70 percent of Americans utilize the Internet to research health-related information, according to a recent study conducted by Manhattan Research. This same study also noted that tens of millions of people – and growing very rapidly – turn to Facebook friends and other social media for peer support, self diagnosis and suggestions for dealing with common health problems. Yet these same consumers-as-patients don’t fully leverage similar technologies when interacting with their caregivers, nor do they actively participate in their personal health maintenance through these technologies. No, patients predominately use these health portals simply as information sources.

A group of healthcare industry leaders recently met at the HealthWeb Leadership Forum, hosted by Healthline, to ask the question, “How do we get patients to engage in and lead their personal health management through these healthcare portals?” Improvements in population health are certainly recognized through informing patients, but true and ongoing health improvements require patient action. What is it that will get patients to access a healthcare portal, engage in the health message provided and most importantly, take action?

Historically, EHR providers have approached this challenge through the development of PHRs (Personal Health Records), implemented through physician practices and health networks, asort of an “inside – out” approach to patient adoption. If as a patient, you want to maintain a copy of your personal medical record, or if you want to electronically communicate with your physician to schedule an appointment or request a prescription refill, you can certainly do so through a physician’s patient portal. But, where do you go if you would like to proactively (novel concept) engage in your health management; perhaps develop a lifestyle plan, such as a fitness plan, ideas for changing your diet, ways to avoid migraine headaches, etc., customized specifically for you based on insight from your personal and family medical history?

Perhaps a more friendly “outside – in” approach is more effective? Perhaps more of a consumer approach is more appropriate toward changing patient habits. As you perhaps query the Internet about weight loss, lowering cholesterol levels, headaches or managing arthritic pain, to name a few, what if you are led to an interactive site with easy-to-find and understandable advice, peer-based encouragement to take action, tools to help start a new lifestyle program, reminders sent to your smartphone encouraging or “guilting” you into following your lifestyle plan, interaction with online, peer-based support groups, access to medical resources (caregivers, trainers, products, etc.) and perhaps some financial insight estimating your payment responsibilities should you seek care. ( Let’s be real here, we need to remove any perceived obstacle preventing the consumer/patient to take action and cost is certainly a perceived obstacle.)
More than just information and advice, but rather tools, reminders, motivation and resources that we have become accustomed to expect as consumers and customers.

The good news is that there are a group of companies that agree, and are working to develop and promote healthcare consumer portals that engage patients in their healthcare, and not just serve as a healthcare information portal. Companies like Healthy Circles, Healthline, ShareCare, Patients Like Me and Walgreens all get it: lead the consumer/patient to take action. These companies are both technologists and marketers. Technology provides the platform, but marketing and a strong business model are the factors to their success. Technology has never been the issue; engaging patients to take action in managing their health is the real challenge, which must be supported by a business model more consumer-focused.

As EHR companies embrace this approach, exciting things happen. Consumers are engaged and then as patients become aligned with a personalized care network. Lifestyle changes and interests are integrated with patient information, lab test results, medical history, and vice versa. Personal health records that historically acted as an electronic repository of patient information can now lead patients to proactively and privately choose a personalized lifestyle and healthcare plan. As some friends of mine like to say, “There is a way to well” … and it starts with prompting healthcare consumers to take action.

Greg Shilling is vice president of corporate strategy at Greenway.

Superhero Super-Users

Eric Grunden

As you may or may not know, I am the proud father of two great boys – Jack & Chase (aka Thunder & Lightning).  If you are a parent of a boy between the ages of six and 12, you will definitely understand what I mean when I say, “Superheroes are alive and well.”  This past summer I invested a considerable amount of money in the local movie theaters seeing some instant classics such as Thor, X-Men: First Class, The Green Lantern and Captain America. (You might even consider Transformers: Dark of the Moon too).  Now, don’t get me wrong, I am still a kid at heart and love a good superhero popcorn flick as much as the next guy, but my boys take it to a new level.  You can count on a reenactment of one of the epic battle scenes to play out every night right there in our den; and of course, the hero ALWAYS wins.  We have all the shirts, Happy Meal toys, stickers, theme songs, Lego creations and PJs associated with each and every hero.  And my wife and I love every minute – it is truly one of life’s greatest joys being a parent.

With all of this summer’s superhero attention, it has somehow made its way into some of our customers’ offices.  As you can see from the pictures below, they too, have caught superhero fever! And yes, before you all email me at once, I realize Darth Vader is NOT a hero in the truest since of the word, but you get my point.

So what does any of this have to do with service or implementing mission critical software you ask?  That’s easy – all practices need a superhero super-user!

Let me put it another way; for a business to invest thousands of dollars in software, hardware and services, and then NOT invest in making one of their employees a super-user is a mistake.  No matter how much training you invest in or how much ongoing support you contract for, you still need a “go-to person” for the day-to-day operations.  Now they don’t necessarily need to be faster than a speeding bullet! More powerful than a locomotive! Able to leap tall buildings in a single bound! But they should have some “super-human” characteristics.  To name a few: determination, courage, dedication, selflessness, perseverance and loyalty.  All of these traits are needed to lead a practice through the transition of an electronic health record. They will need determination to make the project a success, have the courage to face staff members who resist the change, persevere through the challenges with the project team and remain loyal to the business through it all.

Those that take on this role are superheroes in my book!

So if you are in the midst of implementing any mission critical solution – call on your superheroes!

Thanks and God Bless,

E

Follow me on twitter @EGrunden

To learn more about Greenway’s Client Services or what Greenway Client Services can mean to you click here http://www.greenwaymedical.com/service/client-services/.

Finding Community Solutions

Autumn Cowart

I’ve just returned to Greenway from the National Association of Community Health Centers (NACHC) conference in Las Vegas, where executives from FQHC, RHC and community health centers nationwide gathered to discuss and learn ways to more effectively advance patient care and advance their own needs while meeting the ever-changing guidelines of the UDS (Uniform Data System.)

For this 2011 Financial, Operations Management/Information Technology (FOM/IT) event, the theme was “Real Solutions for Real Change in Health Care.” With limits to budgets, decreasing revenues and rapid changes in the healthcare industry, CHCs are facing many challenges. In order for these entities to continue to thrive, their leaders have to continuously seek new ways to operate more effectively and efficiently.

In my capacity as a conference and trade show coordinator, we utilized our booth space to demonstrate and explain just how Greenway is providing new efficiencies in the integration of EHR, practice management and interoperability to help CHCs meet federal reporting and payment requirements and serve their largely uninsured and underinsured patients, which is the mission of these comprehensive care centers, which often provide primary and specialty care, pharmacy and even dental services.

We are growing in this space to meet the demand for innovations to this patient population safety net due to our recent assets acquisition of CySolutions. We were received well at the conference and I met a lot of very interesting people, one of my favorite aspects of my job.

Opening a Cloud on Evidence and Learning

Jason Colquitt

Is the Learning Healthcare System an academic vision that will never see the light of day? I was fortunate enough to hear Dr. Charles Freidman, former chief scientific officer for the Office of the National Coordinator for Health Information Technology (ONC), recently speak on this topic. I got a brief moment afterward at lunch to personally hear his passion.  He stated the Learning Healthcare System was his life work. Although I did not know it by name, this concept was what I have been envisioning for some time.

The Institute of Medicine has done a nice job outlining the definition around evidence-based medicine, research and other goals, but my definition of the Learning Health System reads like this. A system which drives value for everyone and leaves no one out. Patient-centric communication is a key component to this system. It strives to continuously improve itself. It is data driven, sees that data as good for all, and available for all types of outcomes analysis. The system itself is self-aware and drives point of care knowledge.  Health information technology at large and EHRs are core dependencies. Last is the engagement of the scientific community and allowing access to these rich data sets to feed back into the system.

My introduction to healthcare was on the delivery side through the lens of an EHR technologist. I have since also seen through the lens of HIT interoperability as well generating meaningful quality measurements out of the EHR.  I have been enlightened over the years by sitting on federal and regional panels, workgroups, and boards. Over the last few years my focus has shifted into the broad landscape of leveraging healthcare data within the life sciences. This journey in my career embodies a life cycle of researching new therapies and interventions through clinical research, treating patients, reviewing outcomes, predicting patterns, and seeing changes in care driven from the aforementioned steps.

Terms like personalized medicine and predictive analytics come to mind as mega terms we are now hearing around this cycle. Are these steps core to a Learning Healthcare System?  How do we change or build connectivity across the different siloed aspects of this chain?

I understand construction principles as I was the general contractor on my current home which was no small feat.  In this process you learn your foundation is core. This leads me to my latest passion and work that I believe is pouring the foundation for a revolutionary platform called PrimeDATACLOUD. This is a platform by which we enable clinical research. This is a platform by which we empower our providers who together treat millions of patients. This is a platform by which we can make patient data available longitudinally. This is a platform by which we enable outcomes and quality related analysis.  This is a platform by which we provide business intelligence tools. This is a platform by which we leverage data for predictive and decision support. And lastly, this is a platform which can be federated into other systems or platforms.

I started out this blog with a question about the attainability of a Learning Healthcare System. I answer my own question with a question: if a system provides value for everyone in its value chain why would that momentum not propel it into existence? While ultimately we would like to see this as a national model, I think this must be a community-led crusade to the top. I personally talk to and see many providers trying to figure out what is the first step toward a smarter healthcare system.  I think PrimeDATACLOUD is that first step. PrimeDATACLOUD is and will continue to enable patients, providers, payers, public health, and life sciences to listen, react, and change. Starting in communities like New York City, Carrollton, GA and Austin, TX, these PrimeDATACLOUD sites and communities will mature and multiply.

High-Tech’s Killer App? Service

Tee Green

Technology companies are always striving to innovate, right? It’s a core tenet of any successful technology company.  In many sectors it has even become a survival instinct and a survival tactic.

But the really smart companies understand that a focus on innovation has to include customer service. That is the way to thrive, and the evidence is all around us that there are successful, and not so successful, ways to approach and innovate how you provide customer service that will truly benefit your bottom line.

While calling for and identifying the trending of “social customer relationship management tools,” a study by Accenture found that companies are struggling to figure it out, finding that while 60 percent of high-tech companies believed that reducing a given product’s costs positively impacted customer service, the customers reported no real improvements. Do you always buy the cheapest?

Where did they go wrong? Here’s a clue.

A different study by IDC Manufacturing conducted a broad survey of 125 high-tech companies published last November. One question went this way: “What were your company’s top 3 business priorities over the past two years?”

The top answer was cost containment, at 45 percent. Next was improving margins, 20 percent. Third was improving customer service, 10 percent. Ten percent. “Other” was just a few doors down at five percent.

We know that online customer service strategies are evolving rapidly, which in my view is a great thing as long as we don’t leave the customer behind. Of these strategies, did you know that if you place a Q.R., a Quick Response code, on your product or service, customers with a smartphone app can use the code to download additional company information, like how to access your customer service?

And if you pursue online customer service, see how you’re doing. The Customer Respect Group in Ipswich, Massachusetts can evaluate your website performance through its Customer Respect Index. Could be an eye-opening experience.

Here’s one online customer service message from one of the world’s biggest high-tech companies: “Enter your information in the field below and click to send an email … we’ll use the information you’ve provided to address your inquiry. We can’t promise a personal reply to each email, but will contact you only if we require more information.”

As a customer I’m not sure what I would make of that. Will they contact me ever? I think I would feel like an other.

In his book Flip the Funnel: How to Use Existing Customers to Gain New Ones (2010, John Wiley & Sons), author Joseph Jaffe puts it this way: “Service is the new currency of selling.”

Greenway Medical Technologies, Inc. has received its industry’s highest customer service award for five consecutive years, and has been awarded 11 total in multiple categories since 2004.

Dispatch from the National Beacon Community meeting

Tone S.

by Tone Southerland

I spent the last two days at the national Beacon Community meeting in Salt Lake City entitled “Meaningful Use of EHRs and Other Technologies to Achieve Measurable Improvements in Health and Care Quality.”

Part of the purpose of this meeting was to bring together EHR solution providers and Beacon Community leaders to discuss the advancement of health IT and care coordination. The breakout sessions were effectively orchestrated by encouraging open discussion on topics such as data extraction and normalization, creating effective feedback loops and collecting/integrating patient reported information.

Begun by the Office of the National Coordinator for Health Information Technology (ONC), Beacon communities are health systems showing advanced use and integration of EHRs and data sharing interoperability programs. There are 17 regional Beacon communities in the country today, supported by ONC funding. Greenway has been involved in their advancement and connecting providers to these communities for some time, and it’s an important project seeking further integration with similar programs to continue to advance patient care.

One of these merging initiatives is including Beacons within the recently created REC Community of Practice (CoP). This is a huge step in the right direction as the charters given to both Regional Extension Centers and Beacons often intersect. Through this CoP we will be able to further explore some key innovation areas.

Data extraction and normalization is the process of moving data from EHR systems to Beacon Community systems. In some cases Beacons have partnered with Health Information Exchanges (HIEs), in other cases they have built their own solutions to collect and process EHR data directly. Data extraction is further broken down into two parts: data modeling and terminology mapping. Data modeling is ensuring that disparate systems agree on the structure of data. Terminology mapping addresses issues of crosswalks between different vocabularies, which is significantly more challenging because vocabularies do not always have one to one maps and they also may represent different aspects of a particular data element. For example, NDC codes to the manufacturer whereas RxNorm codes to the dose form so there might exist multiple NDC codes to a single RxNorm code.

Achieving standardization of Clinical Decision Support (CDS) among EHR providers and Beacons is a significantly more challenging goal, but it is doable if we can align appropriately and look to utilize existing standards to address this. The key to success here is the separation of content and transport, meaning that how questions are asked and how answers are processed is separate from the questions and answers themselves. Such an approach will facilitate rapid implementation across both population demographics as well as medical disciplines. This has been addressed in both IHE and HL7 and standards are available, the challenge will be in implementing these standards before the Beacon grants expire in 18 or so months.

Lastly we need to continue to pursue a fail fast approach uncovering issues sooner rather than later. In the software development world we call this an iterative or agile approach. The sooner issues are found the sooner they can be incorporated back into the development process and addressed appropriately.

I applaud the Robert Wood Johnson Foundation for sponsoring this event as well as Beacon Community leaders and fellow Electronic Health Record Association (EHR Association) members for traveling across time zones, (on a time-change weekend no less) in interest of increasing collaboration between groups to ultimately achieve better patient care.

The Alphabet Soup of Health IT Standards

Tone S.

by Tone Southerland

As both a developer and implementer of healthcare IT standards the past several years, I have had the opportunity to build up quite a vocabulary of acronyms.

From talking to people within my company about what C32 actually stands for (It’s Component 32 per the Health Information Technology Standards Panel reference, with the organization better known as HITSP, or “HITSPY.”) to discussing clinical workflows and which interoperability standards are appropriate for which workflows, I am presented with the opportunity to mingle with both standards geeks and non-geeks alike. This variety of conversation requires that I maintain quite a vocabulary of acronyms and translations. A conversation with a fellow standards geek at Greenway might go something like this:

“Hey Todd, did you get the issues worked out with building the PCC XPHR document so that we can send it to the HIE via an XDS ITI-41 transaction? We’ll also need to run it through the NIST validator to ensure that it conforms to HITSP C32, C80 and C83 in addition to the underlying standards of CCD and CDA. And I still need to work with Miguel to ensure that the XDS pipeline will make a call out to the ATNA ARR using the TCP option. We will also need to review the WCF code that handles the TLS connection. Also, do you have any idea as to whether there is a use case to send this over RFD? After that we’ll need to look at the mappers for APS, XDS-MS and IC, and check to make sure the new CVX codes are in place for immunizations.”

Why do we even use acronyms? For starters they are catchy, fun to remember, and for the unaware they make us sound like we know a different language. On a more serious note, they actually help us to be more efficient workers. By shortening lengthy, hard to pronounce words to a few letters our minds are free to focus on higher priority tasks. While it is certainly more convenient to say ATM instead of automated teller machine or TV instead of television, it becomes almost required to use acronyms in the world of a software engineer. Similar to speed-reading where one comprehends groups of words instead of individual words, the use of acronyms allows engineers to achieve their goals faster. In the case of the speed reader the goal is reaching the end of the book. In the case of the software engineer it is delivery of a viable solution to the customer.

Below is an image of the word counts for the above quoted conversation both with and without acronyms used. In the acronym free version there are 53 additional words, 523 additional characters and seven additional lines. In percentages, that translates to 37 percent more words, 73 percent more characters and 70 percent more lines – that is a LOT of extra baggage! Think if this blog post was 37 percent longer. That means that if it took you two minutes to read this post with acronyms it would take an additional 44 seconds without the use of acronyms. This may not seem like a lot as a single instance and it is a rather short blog post, but when compounded over time seconds turn into minutes and minutes into hours. With the pace at which we move in today’s quickly changing healthcare IT landscape, these minutes and hours become extremely valuable.

Acronyms offer at a minimum added convenience in daily life and also increase our efficiency in professional life by freeing up our minds to focus on the important tasks at hand. As creators of software and services solutions, acronyms ultimately help us to innovate, create and deliver viable solutions for our customers.

Tone Southerland is a senior interoperability developer at Greenway. 

Moments of Truth & Bucket lists

Eric Grunden

I think it goes without saying that most people have their “Life To-Do list”, also known as their “bucket list”. These are the events, activities, places, people and things we want to experience before we “kick the bucket” – a premise made even more widely known by the 2007 movie “The Bucket List” with Jack Nicholson and Morgan Freeman.

I, too, have my list (although not a complete list, since I add to it every day). Here are some of my “things to do”:

• Learn to speak Spanish fluently

• Take my mom to Australia

• Drive the Pacific Coast Highway in a convertible with my wife

• Work in a winery or brewery for at least a month

• Play golf at St. Andrews with my sons

• Stay in an over-the-water bungalow in Bora Bora with my wife

• Test drive a Lamborghini (too much trouble to own one)

• Watch the Texas Tech Red Raiders in the BCS National Championship game

• Go to the Super Bowl and World Series

• Attend a movie premier

You’ll notice that the last bullet is “marked off”, and yes, I have attended a movie premier – recently as a matter of fact.

I always thought my movie premier would be in Los Angeles at an action film starring Bruce Willis, Will Smith, Tom Cruise and Angelina Jolie – or maybe even the premier of “Star Wars” episode 7 or 8.  Never would I have imagined I would be marking off #10 on my list by attending an animated kids movie in Dallas, TX, but nonetheless, it is officially accomplished.

Yes, my wife and I had the honor of attending the “Puss in Boots” movie premier at the Gaylord Texan, hosted by DreamWorks Animation and Gaylord Entertainment.  The event was wonderful!  It surpassed our expectations by 1,000%, and will be something neither of us ever forget (see picture with Antonio Banderas below).

Puss in Boots Premier

In the spirit of full disclosure, Greenway has been in partnership with Gaylord Hotels since 2009, and we conduct the majority of our customer events at one of its properties.  We didn’t enter into that relationship lightly, but rather after an exhaustive review of many options and providers.

The main thing that drew us to the Gaylord team was their corporate culture and focus on the customer – something Greenway believes to the core.  I think it’s safe to say that both organizations give much more than “lip service” to customer care and truly care about the customer experience…something both companies refer to as “Moments of Truth”.

If you follow my tweets and blogs, you’re familiar with the term Moment of Truth because I’ve written about it before.  An “M.O.T” can be either positive or negative, but either way it will change the course of the relationship with the customer.  The result can be the much-wanted “Customer for Life” or the much-feared “Future Customer Killer”.

Customers can recognize service that feels manufactured and insincere; they know when employees don’t really care and are only doing a job.  True service isn’t forced; it isn’t manufactured and is 100% sincere – even awe-inspiring!  To deliver a Moment of Truth experience for customers, it has to exceed their expectations and be something they will never forget – something they will compare other experiences against.

I guess that’s really what we’re all looking for within our “bucket list” experiences.  But I think it’s a shame that we’ve had to resort to a special list in order to be truly wowed.  Just my opinion, but maybe we should start expecting those “Moments of Truth” more often…

Thanks and God Bless,

E

Follow me on Twitter @EGrunden

To learn more about Greenway’s Client Services or what Greenway Client Services can mean to you click here http://www.greenwaymedical.com/service/client-services/.

Selecting the Right EHR…The First Time Around

Justin Barnes

Part 2: The EHR Selection Criteria and Checklists

As relayed in Part 1 of this EHR selection series, there are mounting arguments for you and your practice to embark upon EHR adoption. Once you have determined the time is right to begin the process, it’s important to conduct a measured evaluation:

• Seek site visits and references only from practices where more than 70 percent of care providers use the EHR solution daily.

• And of those EHRs that are in use widely, make sure they are being used at the point of care with patients.

• Seek like practices, specialties and workflows using the solution in the above manner.

• In accordance with specialty considerations, seek a solution’s ability for customization.

• Also during site visits, seek demonstrations where the exact software and version you are considering is in use.

• Usability is extremely important, so ensure you look for a system that can be flexible to your specific workflows.

• Examine the EHR provider’s long-term business plan, ensuring that a five-year or more outlook is in place providing a strategy and vision that is inclusive of your own growth and technological goals.

• Review independent assessments of EHR providers and technology in the areas of training, installation, go-live monitoring and support, service and certification:

• - KLAS Research. The above-noted KLAS conducts a range of customer-driven evaluations and awards based on more than two dozen criteria such as sales and contracting, implementation and training, functionality and upgrades, service and support, again as ranked by healthcare providers and administrators. (www.klasresearch.com).

• - Certification Commission for Healthcare Information Technology (www.cchit.org). A long-time independent certification entity in comprehensive and specialty functionality, which also evaluates usability, CCHIT is also a certification entity specific to EHR meaningful use criteria.

• - Industry membership organizations such as the Medical Group Management Association (www.mgma.com) and the Health Information Management Systems Society (www.himss.org) also provide independent assessments in selection priorities and recommendations.

If the meaningful use incentives program and its provisions for up to $44,000 per eligible provider in the Medicare pathway and up to $63,750 in the Medicaid pathway is a motivating factor, then also begin with some foundational review:

• Assign a meaningful use assessment leader within your practice or facility.

• Make sure the EHRs you are researching are certified for meaningful use Stage 1.

• Use the core and menu criteria from Stage 1 as a checklist for a system’s functionality.

• Ensure that the meaningful use Final Rule data exchange language standards of CCD and CCR data are in place.

• Critically assess the knowledge base of the EHR provider as to future meaningful use readiness for Stages 2 & 3.

• Seek an EHR solution that includes a Meaningful Use Dashboard to easily track allowable and quality measures met.

• Ensure the product you are being demonstrated during the Sales process is the exact, Certified product you will be purchasing and installing.

Keep in mind there is still time to take advantage of the program. You can start quality measure reporting and attestation by Oct. 1, 2012 and still receive maximum incentives in the Medicare pathway, and by 2016 to maintain maximum funding in the Medicaid pathway, if you start the process today. I do not recommend you wait anywhere near that long to implement a Certified EHR because of unforeseen hurdles that occur in life that could cause you to miss your maximum incentive allotment but that timeline is good to know.

And there are tangible reasons to find confidence in the long-term availability of incentives, which are drawn from the Medicare Trust Funds held by the U.S. Treasury, and are therefore not subject to annual Congressional budget appropriations. The EHR adoption incentives are flowing today and they are all front-loaded so you can achieve well up to half or more of the total incentive allotment in just the first two years.

But whatever your motivation for implementing an EHR, the process can and arguably should be time consuming, but does not have to be intimidating. On your side is a wealth of EHR adoptions available for clinical, workflow, usability and ROI outcomes evaluation.

Once you make the right EHR selection for your practice, you will realize returns well beyond the incentives, and will be providing your patients with the most advanced care possible while helping to create a smarter, more sustainable healthcare system in America and globally.

This tipping point is not a tripping point, but by definition a point at which what is previously rare becomes common, and therefore an opportunity to balance the scales of practice and patient needs.

Accountable Care Best Practices White Paper: What Healthcare Providers Need to Know

Justin Barnes

As you and your healthcare organization, like much of the industry, anticipates the CMS Shared Savings/Accountable Care Organization Final Rule due any day now, it’s important to know that the programmatic details of the Final Rule – while important – will not change the best practice strategies, elements and steps that physician practices need to be considering and acting upon now to meet the future of accountable and coordinated care.

Linked here is a comprehensive white paper that details what is already trending in accountable care formation in terms of multiple and commercial payers, the new interest by employers, patient engagement tools and the necessary elements of technology. The paper also provides an early look at how one practice is approaching participation in an Accountable Care Organization.

Selecting the Right EHR…the First Time Around

Justin Barnes

Part 1: The Case for Electronic Health Records

If we are at or approaching a technological tipping point in the history of healthcare, then it has never been more important for physician practices to select the right electronic health record (EHR) – and there are tangible reasons to believe so:

• A survey of 400 providers by KLAS found that 35 percent are replacing existing systems, including one third of small practices within that number and 43 percent with 100 physicians or more (“Ambulatory EMR: Win Rates, Replacements, and Provider Loyalty,” Feb. 23).

• The industry is regularly updated with financial analyses forecasting growth in the EHR market, such as the June, 2011 report from Market sand Markets expecting the U.S. EHR market to reach approximately $6 billion by 2015, up from about $2.2 billion in 2009.

• And patients are increasingly becoming discerning consumers of healthcare and desiring more from technology, meaning they also will be seeking best practices. A recent Dell survey, for example, found 74 percent of patients share the expectation that EHRs should be able to link providers, healthcare institutions, labs and other facilities.

Taken together, as the implementation impact of the meaningful use initiative increasingly becomes evident, it is equally important to approach EHR selection as a starting point or a foundational aspect of long-term business strategy to navigate the future of healthcare and certainly accountable care, payment reform and new payer models yet to come.

So as meaningful use stages progress, PQRS and other quality reporting programs evolve, ICD10, HIPAA 5010 and accountable care take hold, there are foundational criteria for selecting the right EHR solution that can set the right course even before the research begins or an RFP is sent out the door.

At the outset:

• Bring all parties in your practice together into the discussion. Physicians, practice administrators, physician assistants, nurses, medical assistants, billers, schedulers and other staff important to your institution should be heard.
• Assess practice goals that you want to achieve by adopting an EHR:

- Meaningful use incentives capture?

- Improved internal workflows and practice efficiency?

- Improved patient communication, engagement and satisfaction rates?

- The ability to better exchange data with referring physicians and other health facilities?

- The ability to exchange data with immunization registries and public health agencies?

- The ability to participate in clinical trials and research?

- A system that integrates clinical, financial and administrative tasks for operational simplicity?

- A premise-based or hosted solution?

- How best to position the practice for the future of accountable care and reimbursement model variances?

- All of the above?

It’s also important to ask yourself questions before they are asked of you. For example, do you have an equipped, in-house IT staff or do you require increased levels of support by your EHR solution provider? If you are replacing a system as many are, was it due to insufficient technology – the interfacing of legacy EMR and practice management systems, for example – or that the right system for your needs was not fully investigated on the front end during your last purchase?

Once you have an internal game plan underway, it’s time to start the external process:

Coming Next, Part 2: The Selection Criteria and Checklists

Live from National Health IT Week: One Voice, One Vision

Martina Clark

Justin Barnes

National Health IT Week commenced on September 11, 2011, and nearly 2,000 healthcare professionals and leaders descended upon Capitol Hill to discuss the future of the industry. Monday’s events began on Capitol Hill with the Institute for e-Health Policy Congressional Panel entitled “Implications of HIT for Patient Safety & Quality”. Greenway Medical Technologies was among the participants, and a very informative panel discussion was led by Justin Barnes, Vice President of Marketing, Industry and Government Affairs.  Among the topics of discussion were patient safety and quality as well as what needs to be accomplished from a legislative standpoint to address these issues.

U.S. Senator Kent Conrad (R-ND) also addressed the group to explain the necessary impact telehealth has on the patient safety and quality of his constituents’ care.  North Dakota and several parts of the nation are composed of rural areas, and many citizens must drive 100 miles or more to receive services. Healthcare professionals must take action to improve upon these inefficiencies and truly adopt interoperable technology at the core of their practice which will allow constituents access to better care coordination, leading to increased positive outcomes.

Tuesday began with the Capitol Hill National Health IT Week Press Conference at the House triangle. Among the speakers at this event was Congressman Phil Gingrey, M.D. of Georgia’s 11th District, a strong proponent for the adoption of health information technology who expressed the need for the EHR incentive program as a motivator for healthcare professionals to take necessary steps which will transform healthcare by improving population health and safety. Later that afternoon, Dr. Gingrey released public comments further noting his support, urging other Congressional members to follow suit and protect the EHR adoption funds through the Super Committee negotiation currently underway.

Several other Members of Congress spoke in support of health IT adoption and then that led straight into Justin Barnes’ statement at the podium as he announced the initiatives behind the Accountable Care Community of Practice (ACCoP). The Community of Practice is a consortium of healthcare IT leaders committed to collaborating on issues of mutual concern for the benefit of providers that are developing or planning to develop an ACO or accountable care strategy.

Are We All Accountable?

Shared Savings, Shared Responsibilities.

By Justin Barnes

Anticipated for publication as far back as December, and with a prescribed start date of Jan. 1, 2012, what is now the most far-reaching, and maybe the most hopeful, healthcare delivery and cost containment proposal in decades arrived on the eve of April Fools’ Day.

But it’s no joke that among some 47 million U.S. Medicare patients, one in five that are hospitalized are readmitted within 30 days, and that most suffer from more than one chronic ailment, contributing to annual healthcare costs approaching $2.5 trillion.

The proposed Shared Savings Program forming Accountable Care Organizations (ACOs) seeks voluntary three-year commitments from primary care and/or multi-specialty physician groups, hospitals, home health services, rehabilitation centers and other institutions to form communities of health committed to serving at least 5,000 patients for an initial three-year period.

Essentially the ACO model takes a logical approach by building upon existing Physician Quality Reporting System (PQRS), Hospital Inpatient Quality Reporting (IQR) and of course the burgeoning meaningful use program, established initiatives of improved patient care through quality reporting and provider incentives based on care coordination through innovative technology, namely the electronic health record (EHR).

To that end the proposal’s establishment of a range of 65 quality measures grouped within five categories is another aspect of alignment with meaningful use.

The proposal also offers risk and reward choices so that ACO participants can find their own levels of confidence, allowing care providers already utilizing EHRs at the point of care to take on greater reward and risk throughout the three-year commitment, or take on smaller rewards in years one and two, and take on the risk of below-benchmark penalties only in year three.

Though ambitious in its current scope, the proposal hints at the ability for rolling start dates only beginning in 2012, and would allow simply for the reporting of quality measures initially, followed by proof of performance, much like the original meaningful use proposal emerged through its commentary phase as a manageable Final Rule. I expect that the provision that 50 percent of primary care ACO providers be meaningful EHR users by year two will incur much commentary between now and June 6.

I hope that providers closely study the success their peers have had with PQRS and meaningful use to date – where in the latter program some $40-$50 million in CMS incentives have ready been issued in year one – and understand that Shared Savings is a quality reporting system with a delivery, reporting, coordination and health IT structure that is already in place and has been shown to succeed in several arenas.

Opening a Portal on Federal Health IT Policymakers

Site Visit By Federal Health Community Highlights Patient Communication
By Tee Green

It’s easy to portray ONC and CMS as cumbersome government agencies invoking rules on how care providers practice medicine and EHR software providers write code, and that notion is out there. We know a little bit better at Greenway since our leadership has been involved for several years in the collaborations toward EHR meaningful use standards and a range of quality reporting initiatives.

So when Greenway was asked to host more than a dozen members of the Federal Health Community at a customer practice during the HIMSS11 annual conference – which included ONC and CMS officials, and those from the FDA, CDC and the HHS Office of Civil Rights among others – we knew we could provide a real-world example of the collaboration between an EHR provider and a physician practice they could take back to their colleagues.

But I don’t know if we were ready for the level of inquisitiveness and the desire to understand how reality can translate to rules we encountered. In a little less than 90 minutes, Dr. Matthew Mervis of OB&GYN Specialists in Orlando – and one of his patients – took 49 pointed questions. (Yes, we counted.) And of particular interest to the group was the site’s use of Greenway’s online patient portal PrimePATIENT, and its integration with the PrimeSUITE EHR.

This is a practice that in 2010 processed 8,000 appointment requests, 3,000 Ask A Doctor queries and relayed 1,200 lab results through the portal back to its patient population. With these and other EHR efficiencies, OB&GYN Specialists has been able to impact ROI by eliminating the need for eight staff members formerly taking patient phone calls or manually checking in patients, processing accounts or clerking paper charts.

We know that consumerism is as much a part of healthcare’s future as is technology as patients come to expect better care and service. Patient empowerment and communication avenues are central goals of achieving meaningful use, and essential components of accountable care as mobile patient data is securely shared within a community’s hospitals, public health and ambulatory sites.

Relaying lab results to patients through an online portal is the end result of efficiencies. Exchanging that data with external labs to bring it into the EHR for provider assessment before relaying to patients was a particular line of inquiry by these policymakers who sought answers for lab interfacing and monitoring with physician practice EHRs.

Jodi Daniel, director of the ONC’s Office of Policy and Planning, surprised us with this statement: “Labs tell us they can’t do that.” We explained to the audience that Greenway doesn’t necessarily expect labs to be able to. We build it for them, and the practices, through our PrimeEXCHANGE functionality.

Adam Greene, senior health IT and privacy advisor to the HHS Office of Civil Rights, asked about PrimePATIENT’s authentication and patient messaging security. Seth Foldy, the CDC’s director of Public Health Informatics and Technology Program, took data exchange a step further by asking Dr. Mervis if the practice had selected or has the ability to exchange with a public health option. The answer: historical interface with Florida Shots. Dr. Mervis also assured Daniel that through Ask A Doctor templating he has more time to spend with patients who come into the office versus answering online questions all day.

Dr. Mervis’ patient assured the group that she has no fears about data security compared to the efficiencies she’s found, and that the patient portal’s availability was a selling point in her selection of a practice for her medical care…now that’s consumerism. And far from finding the portal impersonal, it allows her to focus on her care during office visits, she said. “I’m more worried about my banking information than my medical information.”

The bottom line was that through this short but intensive visit, I was solidified in my understanding that policymakers need and welcome input into how their actions can and should fine tune the creation of a smarter, more sustainable healthcare system, and that Greenway provides its customers with the ability to do so.

Respectfully,
Tee

How Specialist Provisions Expand Meaningful Use

Program Flexibility Allows for Expanded Participation and Maximum Funding

By Justin Barnes

Now that meaningful use registration is underway, and year-one Medicaid funds have begun to flow, it is time for providers in ambulatory practices pursuing the 90-day Medicare reporting period for 2011 to determine the core and menu criteria each will pursue.

Based on patient population and more so the CMS provision for scope of practice, the meaningful use EHR adoption incentive program allows for a range of criteria exclusions and flexibility, especially for medical specialists, while still satisfying meaningful use reporting and the receipt of maximum funds.

When crafting the Final Rule, CMS understood that chiropractors, for example, write few prescriptions and do not partake in immunization registries. Other exclusions prevail based on criteria and quality measure reporting pertaining to patient age ranges, or those requiring the intake of vital signs, which fall outside the scope of psychiatrists, for example.

This not only led to the flexibility of eligible professionals (EPs) being able to select from five of 10 menu items overall, but even extra exclusions from the range of quality measures or thresholds within chosen menu sets likely to pertain to specialists. In fact seven of 10 menu items allow for such exclusions that would pertain to specialists. The menu provision to incorporate lab tests into an EHR, patient reminders for those over the age of 65 or age 5 and younger, criteria and quality measures pertaining to patient transfers or care transition, and the aforementioned immunization registries are all examples.

Even quality measure reporting exclusions within the core set of criteria exist. Five core criteria, such as for EPs who write fewer than 100 prescriptions during a reporting period, for example, are allowed.

As CMS guidance language states, “An eligible professional (EP) is not excluded from reporting core clinical quality measures. However, zero is an acceptable value to report for the denominator of a clinical quality measure if there is no apparent population within the EHR to whom that clinical quality measure applies.”

The same goes for quality measures within the menu set, meaning EPs can submit a zero denominator for a quality measure within a chosen menu item.  Care providers should carefully review these provisions and understand that specialists are by no means inhibited from meeting meaningful use and receiving incentive funds per eligible professional.

The existence of exclusions should be seen as an expansion of the overall goal of this year’s debut of meaningful use, one that understands that the improvement of patient outcomes is not being limited by criteria exclusions, but that the playing field is being leveled so that specialty medicine can be included in this national initiative.

The advent of meaningful use and primarily the Stage 1 criteria through 2011 and 2012 is a long-term, foundational approach to the improvement of the nation’s healthcare system. As further meaningful use stages evolve and become interactive with accountable care and other quality reporting initiatives, the overriding goal is for every healthcare provider, practice and institution to experience the benefits and advancements of care delivery through successful adoption of certified EHRs and other healthcare information technologies.

The Congressional Shift and Health IT

Why to Trust in Current and Future Meaningful Use Funding

By Justin Barnes

Following the shift to a Republican majority in the U.S. House of Representatives, the pre- and post-election focus of GOP leaders on repealing all or parts of the Patient Protection and Affordable Care Act (PPACA) have led to much discussion and media attention on whether the few true health IT aspects of the Act are in jeopardy, and has even extended speculation – and in some cases confusion – as to whether physician and hospital incentive funds within the government’s previous Meaningful Use initiative are also a target.

There are several foundational elements – and one major point of Meaningful Use funding – that should allay concerns for current and future funding for the adoption of certified electronic health records (EHRs).

Fundamentally it’s important to note that the Health Information Technology for Economic and Clinical Health (HITECH) Act, from which the Meaningful Use program and its funding originates within the American Recovery and Reinvestment Act (ARRA) of 2009, is an entirely different statute than PPACA.

Bipartisan support for the tenets and the spirit of HITECH dates back at least seven years, and it is also noteworthy that the Office of the National Coordinator for Health Information Technology (ONC), which administers Meaningful Use, was created by the Bush administration and a Republican Congress.

Politics aside though, the reason that Meaningful Use funds are secure is because they are drawn from the Medicare Trust Funds held by the U.S. Treasury, and are therefore not subject to annual Congressional budget appropriations or oversight.

In other words, the funding is grounded in law, and has inherent flexibility to encompass the number of ambulatory practices and hospitals seeking Meaningful Use incentives capture. The incentive payments are procured through the Centers for Medicare and Medicaid Services (CMS).

There are, though, health IT provisions within PPACA that merit attention, primarily the planned creation of Accountable Care programs meant to leverage health IT to improve patient safety and promote wellness through best practices and evidence-based medicine.

These aspects of the reform statute, however, have not come under specific concern, and those that have, such as the 1099 provision calling for small businesses to expand IRS reporting of the purchasing of goods and services, has come under the most scrutiny. Meantime, aspects such as eliminating pre-existing conditions toward obtaining insurance have also been largely a bipartisan pursuit. Other aspects coming under scrutiny do not “kick in” until 2014, and overall it is arguable that PPACA is at its heart insurance reform rather than a statute based upon health IT provisions.

Bringing politics back into the discussion, the U.S. Senate and of course the White House remain in Democratic quarters, lessening a broad impact on any of the healthcare Acts being discussed. The White House has signaled a willingness to modify some non-health IT aspects of PPACA, which could lead to a stronger and more secure statute going forward. And following my own time spent in Washington, D.C. just after the elections, there is also a sentiment not to discourage America’s physicians and hospitals already adopting EHRs as well as those planning to do so in time for 2011 Meaningful Use incentives.

The November elections also brought a record of up to 28 new governors to statehouses throughout America, which in theory could impact some state Medicaid processes and procedures concerning the implementation of HITECH plans. But here also the funding, like that for state Health Information Exchange programs, for example, has already begun arriving in state coffers, and there is no fear today of any disruption.

If there are future revisions to PPACA, the consensus is that its health IT provisions are secure, and the goal is that Accountable Care and related aspects will remain intact because they, along with Meaningful Use, play a credible and crucial role in the creation of a smarter, more fiscally sound healthcare system less given to waste, fraud and abuse.

What is clear is that current Meaningful Use funds and those for Stage 2, 3 and beyond remain a safe choice for physicians and hospitals.

Justin Barnes is vice president of marketing, corporate development and government affairs for Greenway Medical Technologies, Inc., and chairman emeritus of the national Electronic Health Record Association (EHRA).

A Meaningful Beginning

As  healthcare professionals briefly pause to assess October’s advent of the Meaningful Use incentives trigger, and whether we acknowledge, critique or celebrate the milestone, it’s more important to realize that what Meaningful Use has accomplished is the fulfillment of much of its promise as only the beginning, or the foundation, of a truly advanced and sustainable healthcare system.

Consider that little more than a year ago, Meaningful Use was a relatively esoteric term that has gone on to capture the imagination and the daily reality of healthcare providers on the front lines.

There are tangible reasons to believe it:

-          A September survey by the Health Information and Management Systems Society (HIMSS) found that fully 77 percent of the health IT professionals asked said their organization plans to pursue the incentives, that 76 percent have done a cost analysis and 45 percent believe they will be able to demonstrate Meaningful Use for 90 consecutive days during 2011.

-          Even more encouraging is a survey by the healthcare technology and research firm CapSite, from its 2010 Ambulatory EHR and Practice Management Study, finding that among 2,000 practices surveyed, the most important reason driving EHR purchases is the goal of making them more efficient, and not just the HITECH incentives.

This shows that it’s important to look beyond the incentives to the modifications in workflows leading to the change process of best practices that are at hand. The incentives remain available for the next several years as October marks the beginning phase for hospitals, followed in January, 2011 for eligible professionals in ambulatory settings.

As that time goes by, trust that existing programs will extend and that new programs will commence, all aimed at a sustainable future of efficiency, time and cost savings, decreased errors and other clinical aspects leading to improved outcomes at the point of care backed by quality reporting.

For example, as the current Stage 1 menu set objectives become core elements of Stage 2 targeted for 2013, the ability to report claims and eligibility is also planned for inclusion, meaning that as PQRI and other incentives continue, the impact of Accountable Care Organizations (ACOs) and other payer models will find their place in Meaningful Use or quality reporting measures meant to further standardize and incentivize healthcare delivery.

Also to be determined are the timeframes between future Meaningful Use stages and the effects that will have on the functionality upgrades on ICD coding and the effects of health reform, for example, which also need to be coordinated.

Together, the meaningful beginning we find ourselves addressing today is meant to continue to grow the increasingly meaningful and integrated and sustainable future of tomorrow.

Encourage Customer-to-Customer Interaction

I apologize for the delay since my last post, but to say it’s been hectic lately would be an understatement. Don’t get me wrong – it is a great time to be at Greenway, but there is a lot going on.

On that note, we just concluded the largest PrimeLeader event in history!  For those of you unaware of what PrimeLeader is – well, it is only the best National Users Conference on the planet.  We had 1300 attendees converge on Atlanta  for four days of in-depth training, interaction with other customers and fun. It was truly a great event and great opportunity for customers to share their experience with Greenway as well as other customers. Which brings me to my topic for this post…

It probably goes without saying that all software companies spend significant amounts of time and money developing tools and strategies around delivering customer support. The quickest way to slow down sales, reduce bottom lines and tarnish a good reputation is to provide poor customer service. The old rule of thumb was that one unhappy customer would tell ten people about their experience. But in the world we live in now, with Facebook, MySpace, Twitter, texting, chats and instant email one unhappy customer could potentially reach hundreds or even thousands of people. So how is one to do it? How are companies today able to keep up with the growing demands of customers?

It starts with a commitment, and ultimately the commitment to do the right thing. Beyond that you can apply resources, cutting edge technology, learning systems and FAQs all in support of the customer’s needs, but there is “another level” companies should strive for – providing opportunities for customers to help each other.

It is a little concerning to companies to provide online communities and user groups. It does allow for customers to “vent” or share poor experiences. But if done with the right mindset and intentions, it can truly be beneficial. Customers helping customers by answering questions, providing advice and sharing experiences not only can reduce the load on a customer support desk, but can also provide great insight to what is working and not working within the organization. Additionally, customers often take feedback and ideas better from someone actually in their same position than they do from the vendor.

As a vendor we are committed to understanding our customers’ “experiences,” and want to create as many opportunities for customers to provide those experiences to us as possible. That can be done through National User Conferences, customer support desks or even online communities. So no matter what your job requires or what system you use – try and be a good neighbor and help another user when opportunity presents itself.

Thanks and God Bless,

E

To learn more about Greenway’s Client Services or what Greenway Client Services can mean to you click here http://www.greenwaymedical.com/service/client-services/.

Next Steps: Making EHR Meaningful Use a Reality

Right now there are hundreds, even thousands, of Greenway customers using a certified electronic health record (EHRs) with the functionality and product strategy capabilities to meet the objectives and requirements of the EHR Meaningful Use Final Rule released July 13.

Now armed with a definitive checklist of the requirements, eligible professionals (EPs) in ambulatory settings and those within eligible hospitals can evaluate automation needs and address patient demographics and population to determine whether the Medicare incentive pathway offering up to $44,000 per provider, or the Medicaid pathway offering up to $63,750 per provider, is the optimal choice.

Even for providers already accomplishing integrated, automated workflows and of course for those considering their implementation choices – and there is time to do so – and given the nearly 1,100 pages of regulation, there are some important fundamentals to understand that speak to timeframes, EHR reporting requirements and certification toward making EHR/EMR Meaningful Use a reality.

Foremost to keep in mind is that as of January 1, 2011, organizations seeking the EHR adoption incentives must register with the Centers for Medicare and Medicaid Services (CMS) for either pathway.

Also keep in mind that:

            The Final Rule is comprised of two documents. The 864-page CMS rule speaks to the automated functions and in some cases thresholds EPs and eligible hospitals must meet, while the more than 228-page rule by the Office of the National Coordinator for Health Information Technology (ONC) addresses the companion functionality EHRs must meet and enable.

            The rules largely speak to EHR Meaningful Use Stage One requirements, which are the reporting standards for 2011 and 2012. But, at the same time, EHR Meaningful Use Stage Two is also addressed. The core set of 15 requirements speak to Stage One. The menu set of 10 requirements allow providers to select five for Stage One, and then defer five to Stage Two. That way EPs and hospitals can begin to establish attainable Stage Two requirements based on patient and clinical needs.

In regards to the scaling up of functionality stages – and up to possibly five are planned over time – and therefore the sophistication of EHRs that translate into enhanced patient outcomes and population health, there does still need to be legislative and regulatory attention to the timeframes between stages and the ability for EPs and hospitals to adjust, concerns that organizations like the Electronic Health Record Association will be addressing.

But let’s not get too far ahead of ourselves.

What’s also important right now is to also keep in mind that both the Medicare and the Medicaid pathways require just a 90-day continuous reporting period within the first calendar year of EHR/ EMR Meaningful Use incentive capture to attain that year’s maximum incentive.

That means equipped EPs or those seeking implementation in the ambulatory care setting can begin as of January 1, 2011 and receive incentives payments as early as May of 2011. Or those needing more time to implement can begin as late as October, 2011 and still receive the maximum first-year incentive.

In terms of EHR certification – and EHRs must be certified by ONC Authorized Testing & Certification Bodies (ONC-ATCBs) for providers using them to qualify for Meaningful Use – ONC began the process of identifying certification bodies on July 1, knowing that entities must be approved and test scripts finalized and then of course EHRs certified in time.

Do not be shy about pressing your EHR solution provider to address the core and menu sets of requirements, and to detail their current certification level and plans to address Meaningful Use certification.

During the release of the Final Rule, officials from the federal Department of Health and Human Services (HHS) also noted the intent to construct an EHR implementation surveillance structure to also gauge the timing and success of implementation if any adjustments are needed to the Meaningful Use Rule in the future.

Additionally HHS took steps on July 8 to fortify the security and privacy of patient records, another high-profile step to empower and bring patients into the process.

Taken as a whole, and with regards to the balance between the importance of EHR adoption and the presenting of attainable Stage One goals that ONC and CMS clearly understood following some 2000 public comments that greeted the original proposals, the foundations and even the cornerstones are in place to make EHR Meaningful Use a reality for providers and patients nationwide.