Industry Watch

Is your organization still dragging its feet on ICD-10 planning and implementation? Fear not. Help is only a click away. Healthcare Information and Management Systems (HIMSS) and the American Health Information Management Association (AHIMA) have jointly developed and released “ICD-10 Critical Pathway for Getting Started – 2012 and Beyond,” a free, online tool that details the steps that healthcare providers must follow in the next 20 months (February 2012 to October 2013) to meet the ICD-10 coding conversion compliance deadline of October 1, 2013. Follow the timeline in the critical path tool, and you should be good to go.
Access the toolkit in .pdf format at http://tinyurl.com/88g46ss.

Electronic health record (EHR) systems are becoming more common in exam rooms across the U.S., but how is the technology transition being perceived? A survey conducted by GfK Roper for Practice Fusion asked patients about their views on the safety of EHR vs. paper charts, while a separate survey posed the same questions to medical professionals. The results? A majority of physicians reported that EHRs are safer than their paper record counterparts, citing accessibility of data as the top safety benefit.

Information Exchange

Glenn Keet

With financial, clinical and regulatory pressures increasing steadily, and the new and confounding acronyms appearing daily, many hospitals and health systems today are wondering where they should first put their focus – building a robust health information exchange (HIE) or preparing for an accountable care organization (ACO) or other payment reform model?

Each variety of HIE (statewide, regional or private/IDN) has different goals. Privately held HIEs are rooted in the desire to achieve clinical and operational excellence among physicians within a health system, while regional or statewide systems are focused on sharing patient information across providers in a geographic area. We all know that trying to connect these disparate systems can be challenging, and that linking into a larger network requires additional infrastructure investment. But rather than implementing a less robust system that will need to be replaced in two years, the inevitability of some kind of payment reform and shared risk model coming to a town near you means that healthcare organizations need to invest in an HIE that both enables meaningful use now and has the power to support collaborative care models later.

Regardless of whether the shared-risk model adopted in the area is an episode of care, bundled payment, full capitation or per-member per-month model, the functionality that is inherent in a robust, full-featured HIE will be a requirement for any successful ACO. Primary caregivers, specialty physicians, the hospitals, the health plans, employers – any group assuming risk for the healthcare of a set of patients – are going to need to be able to communicate efficiently and electronically about patients and their health data. Moreover, they need to be able to access key analytics on that data so that they can segment their riskiest patients and treat them in ways that make them healthier while controlling costs. They also need to enable real-time decision support and alerts to the caregivers with actionable intelligence to reduce gaps in care.

The reality is that HIEs can be up and running for years before any payment reform model is adopted or implemented, and those healthcare organizations that have HIE experience will be best positioned for the change. With the inevitable shift toward collaborative and accountable care on its way, there is no reason to wait. But providers need to make sure that the HIE system they select is flexible, scalable and “ACO ready,” avoiding the trap of implementing a less robust system to tide them over until the time comes. When ACOs take hold, the last thing organizations will want is to have to make a square HIE peg fit into a round ACO hole.

Both HIEs and ACOs are on the mind of every hospital C-level executive, and faced with these big changes, it can be extremely difficult to know where to start and how to prepare. But regardless of the ACO or collaborative care models that are adopted tomorrow, these systems need a fully functioning HIE today – one that will help them exchange information securely and operate more efficiently now, providing the data and analytics to support continued care and workflow improvements that will be core to models we adopt in the future.

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Glenn Keet is president of Axolotl, part of OptumInsight (formally known as Ingenix).
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ACOs

Commentary on CMS’ Medicare Shared Savings Program: Accountable Care Organizations notice of proposed rulemaking (NPRM) by Justin Barnes, chairman emeritus, Electronic Health Record Association (EHR Association) and vice president of marketing, corporate development and government affairs, Greenway Medical Technologies.

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 who are hospitalized are readmitted within 30 days, and 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 the physician quality reporting system (PQRS), hospital inpatient quality reporting (IQR) and the meaningful-use program – all established initiatives to improve patient care through quality reporting, namely the electronic health record (EHR). It also proposes establishing 65 quality measures, grouped in five categories, that align 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 using EHRs at the point of care to take on greater reward and risk throughout the three-year commitment. Or they can take on smaller rewards in years one and two, and then assume more 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 beginning in 2012, and initially it would allow for reporting of quality measures, followed by proof of performance, much like what transpired with the original meaningful-use proposal. 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. 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.

EHRs

Northrop Grumman has introduced a mobile application that lets U.S. military veterans access the personal electronic health records stored in their MyHealtheVet account on a mobile device. Called “VA-214,” the app was developed to support the U.S. Department of Veterans Affairs’ Blue Button Web portal. The “blue button” concept centers around the goal of pushing a single button to access and download all health-related information needed.
VA-214 is available on both Apple’s iOS and Google’s Android platform. The app’s developers say that it gives veterans “ready access to personal health information for better understanding of their medical history and [the ability] to partner more effectively with health providers.” The app is accessible to all MyHealtheVet accounts – about 1 million veterans total – and is available for download at www.northropgrumman.com/apps.

EHRs

A growing number of healthcare organizations are turning to Xerox Corporation for technology and consulting services in support of electronic health records (EHRs). In the past year alone, more than 50 clients hired Xerox to advise them on everything from securing meaningful-use funding to building health information exchanges (HIEs). Healthcare providers and states are also working with Xerox to comply with regulations put forth under the HITECH Act and American Recovery and Reinvestment Act.

On the electronic medical record (EMR) front, ACS, A Xerox Company, consults with hospitals like Botsford Hospital in Farmington Hills, Mich., and Cooper University Hospital (CUH) in Camden, N.J., on EMR solutions to get the most from meaningful-use stimulus funding. ACS is leading implementation strategies for McKesson’s Paragon solution at Botsford and Epic’s EMR clinical information system at CUH.
When it comes to HIEs, Wyoming is one of several states that ACS is helping to implement a Web-based EHR/HIE system. Working with the Wyoming Department of Health, ACS is helping to integrate the solution with the state’s Medicaid Management Information System (MMIS), other EHR systems, designated laboratories and the state’s immunization registry.

And as for state-level registries (SLRs), five states are currently working with ACS to establish SLRs, which allow providers that participate in Medicaid programs to apply for and receive meaningful-use federal funding via a secure Web site. To learn more about ACS solutions, go to: www.acs-inc.com.

EHR Beat

By Arthur Gasch

September and October saw three significant medical conferences: the new Digital Medical Office of the Future in Las Vegas, the 2010 AHIMA conference in Orlando and the Health Summit West in San Francisco.

HITECH definitely has the attention of integrated delivery networks, but individual physicians were underrepresented. Those with whom we spoke cited several factors keeping them on the EMR sidelines: a pending cut in CMS reimbursement; confusion about meaningful use and CCHIT certification; and concerns about HIPAA 5010, ICD-10 adoption and where they fit into accountable care organization structures and the Medical Home Initiative.

Many of the 100,000 practices that HITECH has targeted are waiting to see if any new changes will be coming. This has caused the EMR market to contract and new revenues to dry up for smaller vendors, but it has blessed about 10 vendors with new sales to pursue. By the end of the Health Summit West conference, 40 EHR products had been certified as ONC-compliant, but only about 18 of these companies have been selected by a regional extension center (REC), so their potential ROI is questionable. EMR developers are folding and merging rapidly, causing group practices to wonder if the vendor they pick today has the ability to survive tomorrow.

Ingenix, a company known for its position in medical coding, is buying into the market, recently acquiring A-Life, Picis, Axolotl, ENS and Executive Health Resources. Likewise, Allscripts has acquired Eclipsys, and GE has acquired MedPlexus (which now becomes Centricity Advance, extending Centricity down into the smaller group practice setting). More acquisitions will occur in the next six months.

Regrettably, the ONC has taken a shotgun approach, launching all aspects of many programs at once, rather than in a slower, more logical sequence. Nothing is actually ready to go yet. The announcement of the last two regional extension centers (RECs) was made in early October; some RECs are getting organized, while others are up and open for business. The ONC educational initiatives are in progress, but ideally market education should have preceded the REC initiative. RECs are taking diverse approaches to the task of creating the next 100,000 meaningful users. We get the feeling that all of these different approaches are going to vary in their success, and that the waters of EMR adoption are going to be deeper than some of the organizations expect. The grants only run for two years before falling off, and that doesn’t leave much time, which is a big part of the problem.

A persistent theme at all three of these conferences was the scope of technology change that smaller group practices and hospitals face in the widespread adoption of EMR technology. There were certainly encouraging success stories, but failure and dissatisfaction with EMR rates are also running high (at 30 and 60 percent, respectively), so EMR adoption is so far achieving a very mixed result. Some have expressed their concerns to the ONC, formerly or informally, and have found their concerns falling on deaf ears. We didn’t find that many were convinced the objective would be met on time, and many were concerned that if the government spends the money and fails, or continues to distort and disrupt the EMR market, that it could do more harm than good because it could drive 300-plus EMR vendors out of the market. When two companies merge, not all products remain on the market with active development; some are acquired for their market share only. The state of the EMR market right now is supercharged, turbulent and a Wild West scenario.

Gasch is author of “Successfully Choosing Your EMR” and founder of Medical Strategic Planning. Contact him at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or 732-219-5090.