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.

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/.

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.

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/.

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.

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/.

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.

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.

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.

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.