- RSS Channel Showcase 6405639
- RSS Channel Showcase 6531366
- RSS Channel Showcase 5598082
- RSS Channel Showcase 9485419
Articles on this Page
- 04/05/16--07:58: _More than 4,000 Geo...
- 04/08/16--08:35: _DoD gives Cerner EH...
- 05/10/16--11:00: _Technology's Impact...
- 04/11/16--08:49: _Chronic care manage...
- 04/12/16--07:41: _Florida Department ...
- 04/14/16--08:49: _CIO LaVerne Council...
- 04/14/16--08:51: _Kaiser Permanente c...
- 04/14/16--21:00: _Top 5 Ways HIPAA Co...
- 04/15/16--08:42: _EHRs may be inadequ...
- 04/18/16--07:32: _MACRA-economics 101...
- 04/18/16--08:24: _Epic awarded $940 m...
- 04/19/16--07:58: _Docs in value-based...
- 04/19/16--08:43: _Decision Resources ...
- 04/20/16--07:21: _Mount Sinai signs o...
- 04/22/16--13:05: _U.S. Coast Guard pu...
- 04/25/16--06:51: _Texas CISO points t...
- 04/25/16--08:50: _Mariann Yeager on H...
- 04/25/16--10:55: _Denise Hines on HIM...
- 04/27/16--07:12: _Geisinger takes gia...
- 04/27/16--07:59: _Population health m...
- 04/08/16--08:35: DoD gives Cerner EHR implementation a name: MHS Genesis
- 05/10/16--11:00: Technology's Impact on Patient Satisfaction
- 04/14/16--08:51: Kaiser Permanente collecting patient data for DNA Research Bank
- 04/14/16--21:00: Top 5 Ways HIPAA Compliant Messaging Improves Your Organization
- 04/18/16--07:32: MACRA-economics 101: Prepare today for tomorrow's outcomes
- 04/18/16--08:24: Epic awarded $940 million in Tata trade secrets case
- 04/25/16--06:51: Texas CISO points to HITRUST and NSA guidance to boost cybersecurity
- 04/25/16--08:50: Mariann Yeager on HIMSS Radio at HIMSS16
- 04/25/16--10:55: Denise Hines on HIMSS Radio at HIMSS16
- 04/27/16--07:59: Population health management demands an effective set of measures
Remember ONC Regional Extension Centers? There were 62 of those federally-funded organizations, better known as RECs, created nationwide in 2009 with a mission of helping primary care physicians move from paper to digital systems.
In 2009, Morehouse School of Medicine was awarded a $21 million from the Office of the National Coordinator for Health Information Technology to become the only REC in Georgia to provide on-the-ground technical assistance for individual and small medical practices.
News out of Atlanta today is that the Georgia center, GA-HITEC, part of the National Center for Primary Care at Morehouse School of Medicine, is closing in on getting the job done. The Georgia REC has reached 100 percent of the eligible primary care providers in the state and 89 percent of its eligible critical access and rural hospitals have achieved Stage 1 meaningful use.
Through the program, it has reached more than 4,000 eligible primary care physicians and 56 critical access and rural hospitals by employing a 10-Step Roadmap to meaningful use. Also, it has assisted members in receiving more than $80 million in incentive payments through the federal EHR incentive programs.
"Through our quest for Health IT interoperability we have provided the Georgia medical community increased patient engagement and improved quality health care through the use of technology," said Dominic Mack, MD, GA-HITEC's principal investigator and newly named director of the National Center for Primary Care at Morehouse School of Medicine, in a news release. He added that the work of the team would result in both better clinical outcomes and improved population health outcomes.
As the national REC program is slated to sunset in late 2016, GA-HITEC continues to develop activities in support of CMS' HIT initiatives, including Stage 2 and Stage 3 meaningful use, health information exchange, clinical practice transformation, along with other value-based reporting efforts.
And, GA-HITEC is not alone. Most RECs plan to stay open, according to the 2014 HIMSS Regional Extension Center Survey.
The Military Health System's massive EHR modernization project has a new name – MHS Genesis – and will begin in earnest at the end of this year, U.S. Department of Defense officials said.
"The meaning of 'genesis' is the origin or process of origin," according to the department, which explained that MHS Genesis represents "the initial stage of the developmental process of building and implementing an electronic health record by organizing the critical medical and business administrative data needed to provide quality and safe medical care."
The project, which MHS is pursuing in partnership with Cerner, Leidos and Accenture, "is replacing a system that has been challenged to keep up with technological and operational advances," according to DoD.
It's a "new beginning," enabling a process for "providing greater population health data, tracking, and alerting capabilities, enabling healthcare professional to more easily monitor beneficiaries' health status and encourage healthy behaviors."
The DoD wants people to recognize MHS Genesis as “a safe, secure accessible record for patients and healthcare professionals that is easily transferred to external providers, including major medical systems and Department of Veterans Affairs hospitals and clinics,” William M. Roberts, the retired Navy rear admiral who serves as the MHS functional champion.
"When our beneficiaries see this logo or hear the name, they'll know their records will be seamlessly and efficiently shared with their chosen care provider," he said.
The department will begin implementating the new EHR in the Pacific Northwest late this year, followed by multi-year process of installation around the world. Officials said MHS Genesis will be available and accessible throughout all Department of Defense facilities in the U.S. and abroad, whether in hospitals, clinics or ships at sea.
Widespread Health IT adoption over the past decade is transforming the way healthcare organizations and clinicians deliver care. Countless technologies exist, both for the healthcare organization as well as the consumer, to help patients and providers monitor and manage health information. Electronic Health Records (EHRs), medical and mobile devices, health-related apps, patient portals, secure email and telemedicine are just some examples that provide a higher level of convenience and extraordinary access to information. As a result, patients and caregivers are better educated and more involved in the healthcare decision making process, which ultimately helps improve patient satisfaction.
Michael Paul Gimness, MD, is one doctor who's been embracing chronic care management strategies for years – even since before it was incentivized by Medicare.
A physician at Plant City, Florida.-based Family Medical Specialists of Florida, Gimness said the new CMS rules have been a boon to his patients and his practice.
Since the beginning of 2015, the Centers for Medicare and Medicaid Services has reimbursed physicians for CPT code 99490, which covers non-face-to-face consults of at least 20 minutes for patients with multiple chronic conditions. Those might include Alzheimer's disease, arthritis, asthma, atrial fibrillation, cancer, COPD, depression, diabetes, heart disease, hypertension, osteoporosis or others.
With 36 million Medicare patients suffering from two or more of those chronic conditions, the prospect of being reimbursed per patient, per month for coordinating their care has significant implications for population health.
The additional $43? Gravy.
But while the money makes it worthwhile, chronic care management is not without its challenges, Gimness said.
CCM reimbursement requires clinical summaries (demographics, meds, allergies) to be created in certified electronic health records, and the development of patient-centered care plans – made available and able to be exchanged electronically with the patient and with all practice staff.
Just seeing 18 or 20 patients a day isn't the ideal, he said. After all, "you're just taking care of the sick visits when they come in like that. What I was trying to get to at my practice was a population health aspect, where I'm taking care of the entire practice, and I can zero in on the sickest of the sick patients I need to get into chronic care, case management, home health."
Several years ago, Gimness would work to identify those patients on his own, poring over spreadsheets, sometimes with help from his EHR vendor, Allscripts.
"There's really no way for me, as an independent doctor, to really get a population health network onto my system," he said. "I was basically just manually doing it, getting checklists, trying to get everything done that needs to get done for the patients. But in a busy day, you're still missing things, as much as you try."
A while, back, a medical colleague who knew Gimness' pop health proclivities connected him with CareSync, which makes use of care coordination technology and 'round-the-clock nursing services to help providers outsource their CCM initiatives.
Communication with patients was key, he said. Gimness would explain to them: "This is what chronic care management is. I think it would be a benefit to you. Medicare is going to help pay for this. And it's an extension of my office. This RN is going to have access to you 24/7. She is an extension of me. These people who are calling you are an extension of my office staff. They're not physically here, but they're an extension of me."
Impressively, "I only had two people who didn't sign up for it," he said.
In the past year or so he's had "a great buy-in from my patients and also from the staff," he said. "They were glad because that reduced a little of the call volume."
If a patient calls at 2 a.m. CareSync will handle it, he said. "If they have a concern about a medication, that's taken care of; if it's something I need to know about, I get a page."
Gimness offers the example of one of his patients, who has both colorectal and lung cancer, as well as anemia. Since joining the CCM program, his data has flowed much more freely among his many providers and his engagement with his care has improved.
"He's chronically ill, in and out of the hospital. He was going to eight different providers in three different health systems. One of them, I have direct access to through my EHR but the others are just separate silos out there, and I can't get that information. When we set him up, CareSync went out and hit every single provider, got all of them to start sending data in to them."
Now, Gimness said, the patient "comes into his monthly meetings with me and lets me know. He says, 'Hey, did you check the CareSync? I checked it yesterday, and they have all the stuff from my oncologist.' I don't have it yet, but I log onto the CareSync portal and it's there. I can print it off, I can fax it to myself."
That's, in turn, has helped improved his health, he said. "Since we've gotten him involved with CCM, I'll send him to home health. He's been out of the hospital more than he's been in. Now, say that's an aggregate of my entire patient population. If we can lower that by 20 percent, that's a huge win because then we can use those resources for other things, like preventative care."
More than 1,000 patients of the Florida Department of Health Clinics in Palm Beach County could be at risk of identity theft after a recent medical records breach, department officials announced Monday.
Federal investigators brought the situation to the attention of the department in February.
Included in the breach were the names, addresses, social security numbers, medical record numbers and Medicaid identity, which officials determined were the clinic's clients, said Tim O'Connor, public information officer, Florida Department of Health, Palm Beach County.
All patients on the list were either now, or at one time, a patient of one of the seven local clinics within the Florida Department of Health. The list included extensive information about each patient, O’Connor said.
Federal officials are continuing to investigate, but O'Connor said, for now, "We don't know the source of the breach."
Each patient on the list was mailed a notification about the breach, which included methods to review their credit and how to notify law enforcement of any suspicious activity. DOH-Palm Beach is taking it a step further and advising any current or former patients of the Health Centers to review their credit report, as well.
Local authorities will report any incidents to federal officials.
A number of protocols were changed at DOH-Palm Beach a few years ago, O'Connor said. We no longer record SSNs or dates of birth on health records. We've also added additional staff training to prevent these types of incidents.
"The Department of Health takes its role of safeguarding client’s personal information very seriously," officials said. We're "keenly aware of how important this information is to everyone and are fully committed to safeguarding all confidential information."
Patients who received a letter and former or current patients with questions about the breach can call 1-855-438-2778, 8 a.m. to 5 p.m. Monday through Friday.
Veterans Affairs CIO LaVerne Council on Thursday testified that she has recommended a "state-of-the-art, world class" electronic health record to VA Undersecretary for Health David Shulkin, MD, and they will publicly share those intentions this summer.
VistA is "the heartbeat of the patient experience," Council said. "But it doesn’t have everything needed to support the overall veteran experience and clinical management."
The particular software leverages FHIR, has a user interface akin to Facebook and Google, and is available as a cloud service, Council said. Referring to the broader vision as a "digital health platform," Council explained that it will consist of four key elements: clinical management, hospital operations, veteran experience, and predictive analytics.
Council added that the platform VA is considering is currently being evaluated by users and is highly agile and interoperable with the DoD and private sector entities.
"This summer we will unveil what we think the VA should do,” Council said without naming a particular EHR vendor.
During the same Veterans Affairs Subcommittee on Health hearing, Shulkin said the decision VA is facing is whether continuing to modernize the 40-year old VistA EHR will better serve Veterans, healthcare providers and taxpayers than a commercial product.
"We are engaging industry leaders in tech and healthcare as well as domain knowledge," Shulkin said. "As Ms. Council and I have the opportunity to evaluate more options, we gain more insight, we will share this vision with you."
Shulkin added that VistA’s final planned milestone is slated for 2018.
The hearing on Thursday also addressed the VA’s choice of a scheduling system. Last year the VA awarded Epic a $624 million contract to implement its MASS product, which has since been suspended, while the VA is testing its own VSE.
Shulkin said that that wait time crisis was caused by archaic software and held up a posted with the old DOS-based interface next to VSE’s Microsoft Outlook-like UI and, what’s more, added that VSE is available today and will cost $6.4 million to rollout nationwide. Epic’s MASS, on the other hand, would cost taxpayers $150 million just to pilot and that would take months.
[Also: Epic grabs VA software contract]
“We felt the best decision was to roll out VSE, make a decision very quickly whether it meets all the needs of employees, veterans, taxpayers and, if not, we’ll proceed with MASS,” Shulkin said.
Shulkin said the contract with Epic remains open and can be tapped into at any time.
New Hampshire Democratic Rep. Anne Kuster said that the VA needs to be thinking about interoperability with the DoD and wisely spending precious taxpayer dollars because in her district some providers have stopped participating in the VA because they’re not getting paid in a timely manner – while some patients have given up on seeking care at VA facilities because they can’t book or get to appoints.
Noting that interoperability was a topic at the first hearing she attended, Kuster added: "This feels like déjà vu all over again to me."
Kaiser Permanente this week launched a new database that enables researchers to examine participants' DNA in conjunction with environmental and behavioral health.
Kaiser members across eight states and the District and Columbia can participate in the research bank, which aims to spur new diagnoses and treatment plans. The goal, officials say, is to gather data from 500,000 participants across Kaiser's seven regions – creating one of the biggest and most diverse repositories of genetic, environmental, and health data in the world.
To date, more than 220,000 members from four geographic regions have enlisted with KP's biobank initiatives.
"One of the ways the Kaiser Permanente Research Bank is unique from other efforts is that in addition to DNA samples, we ask our participants about behavioral and environmental factors," said Sarah Rowell, associate director of the research bank, in a press statement.
"That means we're able to connect this information with data from the patient's electronic medical record, which could allow us to make discoveries that just aren't possible with other research resources," she added.
Researchers may study whether a person's DNA influences how they respond to certain hypertension drugs, or how genetic and environmental factors might influence diabetes and cancer. Second-hand smoke, neighborhood violence, environmental pollution, financial security and access to healthy food are other factors that could be studied.
Participating KP members will be asked to fill out a consent form granting access to their EHR, complete a brief health survey, and provide a blood sample, officials say. Their data will be kept private, secure and confidential, and participation will not affect healthcare coverage or become part of their medical record.
Healthcare organizations have to process data every year, requiring very tight security. Not only do these companies handle protected health information, but they also utilize sensitive information such as social security numbers and financial data.
The diagnoses of 27.3 percent of patients with depression and 27.7 percent of patients with bipolar disorder were missing from their primary care electronic health records, a study published in the Journal of the American Medical Informatics Association has found.
These behavioral health patients had an average of three to eight visits during the year both at the EHR site and outside the site. But despite these high numbers, the data from the encounters were underreported.
In the study, researchers from the Department of Population Medicine at Harvard Medical School studied Harvard Pilgrim Health Care patients at Harvard Vanguard Medical Associates who in 2009, who had a depression or bipolar diagnosis. Researchers studied outpatient care visits and calculated the proportion of these visits not found in the EHR.
"In this research, we found the lack of integration, interoperability and exchange in US healthcare resulted in a major EHR missing roughly half of the clinical information," the authors wrote. "While behavioral healthcare is unique, it's important to emphasize our findings demonstrate the problem of incomplete clinical data in the EHR is not limited to behavioral care."
About half of the outpatient care days from insurance claims could not be matched to clinical contacts recorded in the EHR, the report shows. While this data is true for all areas of care, the extent of missing information was greater for behavioral services than for general outpatient.
Furthermore, 89 percent of acute psychiatric services in hospital-based events were missing from the EHR, and 43 percent of all hospital-based events were missing. In contrast, clinical events found in the EHR could be matched to claims 93 to 98 percent of the time.
The study also found there were also high rates of missing EHR data in general for healthcare, both for inpatient and outpatient care. Areas of specialist care were also grossly underrepresented in primary care EHRs.
"Published reports touting the anticipated benefits of the recent rapid adoption of EHRs should be tempered by frank examinations of EHRs as they currently exist," the authors said. "Individual providers and health system leaders need to be fully cognizant of the information gaps and disconnects that lie behind the screen.
"Features intended to improve care and protect patients from harm may be inadequate in typical fragmented health systems, offering false comfort," they added.
Starting in 2019, Centers for Medicare & Medicaid Services, will change how they pay physicians in a profound way. Unfortunately, the details are complicated and confusing, and many of the particulars have yet to be worked out, which has led many healthcare leaders to glaze over the details and focus on more immediate concerns.
However, disengagement is a strategic mistake because while the Medicare Access & CHIP Reauthorization Act of 2015, or MACRA, details are intricate, the outline is clear. Providers and healthcare organizations must begin now to prepare for advanced value-based care models to maximize the benefits from MACRA.
MACRA's repeal of the Medicare Sustainable Growth Rate, the prior standard set of changes used to implement the physician fee schedule, was an attempt by Congress to control ever-rising medical costs. In SGR's stead, Congress has implemented the MACRA, which consists of the Merit-based Incentive Payment System, or MIPS, and Alternative Payment Models, APMs.
Together, MIPS and APMs establish a new framework that streamlines existing quality reporting programs into one system and, in doing so, fundamentally changes how clinicians get paid.
The MACRA track differential
At its core, MACRA seeks to tie 90 percent of reimbursement to quality by 2018 and gives health care providers two payment tracks or options: The Merit-Based Incentive Payment System, Track 1, and the Alternative Payment Models, Track 2.
Track 1: Merit-Based Incentive Payment System (MIPS)
The MIPS track combines the Physician Quality Reporting System, the Value-based Payment Modifier, and the Medicare electronic health record incentive program into a single consolidated program with the four categories generating a composite performance score. The CPS determines whether a clinician receives a greater or smaller fee or no fee adjustment.
From 2019 to 2025, the base physician fee schedule is frozen, which means clinicians' fees in 2019 are the base rate pay through 2025. In post-inflation terms, that means clinicians will be making less in fee-for-service base rates.
With few exceptions, clinicians must participate in the MIPS incentive program, which means a provider must report quality measures, demonstrate outcomes for quality measures, and demonstrate meaningful use. Depending on performance and the MACRA year, clinicians will receive a 4-9 percent increase or a 4-9 percent decrease in their year-over-year fee-for-service payment.
MIPS is revenue-neutral, which means if one clinician is making more in fees, another is making less. In a sense, Track 1 puts all providers in a race against each other to improve quality, and it raises the stakes for continual year-over-year quality improvement.
Track 2: Alternative Payment Methods (APMs)
The APM track is geared towards advanced accountable care organizations, patient-centered medical homes, and the like, and while CMS has yet to issue a regulation on the details, the legislation makes it clear that only the most advanced forms that expose providers to both upside and downside financial risk will qualify.
Providers who choose the APM track are excluded from MIPS adjustments and will instead receive a lump sum incentive payment equal to 5 percent of the prior year's estimated aggregate expenditures under the fee schedule. The 5 percent incentive payment is in effect from 2019 to 2024. Also, providers can retain savings from improved quality and efficiency of care under the advanced APM program. If organizations provide high quality at a low cost, they get more money. If organizations do poorly, they receive less money.
There are different forms of ACOs. For example, in a one-sided ACO if a clinician does well, he or she receives a bonus, but if the clinician does poorly, there is no fee reduction. In a two-sided ACO, clinicians that do well get higher fees and those that do poorly receive less fees, and the reduced fee is a combination of both quality and cost.
MACRA encourages expansion of the APM options available to physicians, most notably specialists, through Physician Focused Payment Models. From 2026, the fee schedule growth rate will be higher for qualifying APM participants than for other providers.
APMs are a cost-effective model because clinicians are signing up for more efficient care along with more financial risk, and CMS benefits because the overall care costs less. In the best sense, APM provides the tools for clinicians to reap greater rewards for quality care at a lower cost.
Get ready: Prepare with education, analytics and a focus on quality
Providers' quality of care will be measured, and it's going to have a much larger impact than the meaningful use incentive program. Here are tips for how you should prepare:
Educate. Providers need a firm understanding of their population health approach, robust productivity strategy, and an awareness that use of certified EHR technology is written into legislation. Clinicians choosing the MIPS track must recognize that 25 percent of the total adjustment is based on meaningful use. Nothing has changed for eligible hospitals and critical access hospitals, that are still subject to the MU penalty phase. MACRA only changes the Medicare track for eligible providers, so it does not change MU for those who are using the Medicaid track. That being said, now is the time to be proactive, investigate APM methodologies, and join a local ACO or start a patient-centered medical practice to measure and improve quality. Perhaps, most importantly, providers should be aware that the CMS measurement year begins in 2017, and while it won't significantly impact pay until 2019, it will be based on performance in 2017.
Incorporate data & analytics. Annually, the amount of healthcare data grows by 48 percent. Clinicians need to think about how they are acquiring and aggregating the data they need to get the full view and manage the whole patient. ACOs need the analytics capabilities to measure quality at the population level, not just the individual patient level, and the work of assembling and aggregating data takes time. Providers need to start thinking about existing tools – do you have the tools to understand quality metrics? How are you getting the data from the EHR, and is your data platform model flexible (data can be unstructured and granular), scalable, accessible, and transparent (data flow and data quality is visible to you)? How you analyze and aggregate the data will determine what tools can help you evolve your processes. Providers must meet certain requirements that involve quality measures, the use of certified EHR technology and their revenue and payer mix. To achieve value in the short term, providers should establish clarity on your strategy, create a technology roadmap, and recognize that a different set of tools will all be essential to stay profitable.
Preplan and refocus on clinical quality. If not already part of an ACO, providers should put together an application for one of the CMS models. If you already have strong analytics, identify the areas you need to improve. In a value-based environment, the focus must shift to cost structure rather than revenue increases, and a strategy must be in place to lower costs without sacrificing quality. While a variety of details still need to be worked out with the structure of provider pay and a lot of enabling regulation needs to occur, the key is to understand that we are moving toward a more outcomes measurement approach. Unlike Stage 1 and Stage 2 of MU, where providers were measured on whether they updated their processes, CMS is making quality of life and clinical outcomes fundamental, and that's good news for patients and providers alike.
As the industry wades deeper into MACRA and value-based reimbursement, how physicians get paid and whether they'll earn enough to sustain a viable practice will be the primary concerns. My advice is to proceed thoughtfully as you restructure your business to mirror a value-based approach. As the healthcare landscape transforms, your practice needs to change with it. But act swiftly because the effectiveness of any strategy depends on preparation. The ability to shift your focus to the new structure required by value-based reimbursement is essential because you'll be measured based on activity in 2017, and that's right around the corner.
A U.S. district court jury in Wisconsin has found in Epic Systems' favor, awarding the EHR giant $940 million in damages in its trade secrets lawsuit against Mumbai-based Tata Consultancy Services. The massive settlement seems likely to be reduced on appeal.
Epic's intellectual property suit against TCS, which is part of the enormous $109 billion Tata Group conglomerate, charged that employees of its American arm had "brazenly" downloaded technical documentation and other trade secrets for software it was helping install in Kaiser Permanente hospitals, using them to help improve its own hospital technology called Med Mantra.
The jury awarded Verona, Wisconsin-based Epic $700 million in punitive damages and $240 million in compensatory damages, according to a Reuters report – which noted that Epic officials declined to comment, but Tata officials immediately announced plans to appeal.
"The jury's verdict on liability and damages was unexpected as the company believes they are unsupported by the evidence presented during the trial," the Tata statement said. "The company did not misuse or derive any benefit from downloaded documents from Epic Systems' user-web portal."
The near-billion-dollar judgment looks likely to be reduced by the presiding judge, who questioned Epic's methodology for calculating damages – pointing out during the trial that it hadn't proved it was impacted to the extent it claimed, and had offered little evidence for how Tata was using Epic’s confidential information.
District Judge William M. Conley wrote that Epic had "swung for the fences" in asserting "far broader use of its confidential information than the facts now support."
Care coordination, quality measurement, patient engagement and population health management strategies are routinely used by physicians with electronic health records who participate in accountable care organizations or patient-centered medical homes, according to a new study published in the American Journal of Managed Care.
Aiming to find out whether doctors using health IT and working within new reimbursement models were actually employing improved care processes, researchers Jennifer King, Vaishali Patel, Eric Jamoom and Catherine DesRoches examined cross-sectional data on office-based physicians from the 2012 National Ambulatory Medical Care Survey Physician Workflow Survey.
"Early indicators suggest strong physician participation in initiatives to support health IT adoption and to reform healthcare payment and delivery," they said. "However, evidence on whether provider participation in these initiatives has translated to better care delivery is just beginning to emerge.
"Although studies prior to HITECH and the ACA found health IT and external reporting or payment incentives to be associated with a higher likelihood of performing these care processes," they added, "they are performed at low rates even when these factors are in place."
[Also: 4 surprising benefits of PCMH]
King et al. examined how ACO and PCMH docs used their EHRs for 14 specific processes in four categories: population management, quality measurement, patient communication and care coordination.
They found that those factors were independently associated with better processes: "Physicians who were using EHRs in combination with participation in ACO or PCMH initiatives had the highest likelihood of routinely performing the care processes."
Indeed, those docs "were between 6 and 22 percentage points more likely to routinely perform the care processes than physicians with EHRs alone."
While fewer than half (44 percent) reported routinely doing quality measurement, substantial majorities of docs said they routinely engage in care coordination (89 percent), patient communication (69 percent), and population management (67 percent).
"Given the cross-sectional nature of this study, these results do not establish a causal relationship between payment reform, EHR use, and these care processes," researchers said. "Nonetheless, this finding is consistent with other research that shows that healthcare providers are most likely to perform these care processes when practicing in a payment environment that incentivizes and supports such care."
Moreover, many U.S. physicians are still "not performing these processes routinely," researchers said. "Our analysis highlights several specific areas – including population management processes that require the aggregation and analysis of individual patient data and communication with patients and other care team members – where additional technology and policy supports may be important to facilitate wider adoption of these activities."
Healthcare analytics company Decision Resources Group is growing its healthcare data trove in a big way, adding claims and electronic health record data for its new Real World Evidence repository, or RWE.
DRG touts the fact that RWE, meant to offering its clients better patient insights and help them do longitudinal analytics, covers 90 percent of the U.S. healthcare system
The company did not release the cost of the data acquired.
Brigham Hyde, senior vice president of analytics and chief data officer at DRG, said the amount of data it now has available for licensing to its clients – all of it de-identified – far surpasses that offered by Truven and other data companies.
"We have four times as many patients as Truven has and six times as many claims, and we have EHR detail," Hyde said.
IBM announced February 18 it would purchase analytics company Truven, adding a massive repository of data to its Watson Health Cloud.
DRG is expanding its expertise to offer its clients more complete and dynamic analyses in the following areas: health economics and outcomes research, epidemiology validation, patient-level forecasting and market sizing, patient-level compliance and real-time network influence.
The RWE data asset comes from multiple data providers in the U.S. and includes patient, healthcare professional and payer-level analysis.
"As healthcare continues its shift from volume to value, DRG's RWE repository enables academic grade analysis of the cost centers of healthcare in the U.S., as well as the behaviors and outcomes of treatment and coverage decisions," Hyde said.
The repository covers 240 million unique U.S. patients with more than five years of historical data, and has 3.2 billion medical and pharmacy claims, enabling closer analysis of cost and outcomes data, according to DRG.
Hyde said DRG would leverage its nearly 400 analysts worldwide to provide customers with disease specific insights. For example, the repository has strong coverage of Type 2 diabetes, along with payment details, lab values and clinical progress of patients.
DRG also is using the RWE repository to make available custom and interactive analytic dashboards and analytics to enable clients to answer important business questions quickly.
In a separate announcement today, DRG said the board of directors appointed Jonathan Sandler CEO. Sandler also serves as DRG chairman of the board.
New York's Mount Sinai Health System is joining other high-profile health systems across the nation in embracing OpenNotes, an initiative that gives patients access to their care provider's notes in their medical records.
The notes are available for the first time in the health system's online electronic health record portal, called MyMountSinaiChart. Users can now read details of their office visit from the convenience of their personal computer, tablet or smartphone.
MyMountSinaiChart, launched in 2012, also enables patients to communicate with their doctor, access test results, request prescription refills and manage appointments.
The goal of OpenNotes is to improve transparency, communication and trust between patients and physicians – and it's working, Mount Sinai officials say.
"When patients can access their physicians' notes, they can better understand their medical issues and treatment plan as active partners in their care," said Sandra Myerson, chief patient experience officer at the Joseph F. Cullman, Jr. Institute for Patient Experience at Mount Sinai.
"This can ultimately lead to improved patient engagement, patient empowerment, and communication between patient and physician."
"Patients expect and deserve to have full access to their medical records and the Mount Sinai Health System is committed to meeting this expectation," Jeremy Boal, MD, chief medical officer at Mount Sinai Health Systems, said in a statement.
Four Mount Sinai physicians in various clinical practices conducted the initial OpenNotes pilot beginning in December 2015.
The United States Coast Guard has terminated its electronic health record contract with Epic, it was confirmed today.
Officials uncovered various irregularities, which drove the final decision to terminate the contract, Lieutenant Commander Dave French, the Coast Guard's chief of media relations, told Healthcare IT News. These irregularities are currently under review.
In 2010, the Coast Guard awarded a $14 million contract to Epic to design its commercial off-the-shelf EHR product.
In the following years, the initiative expanded into a broader re-engineering project known as the Integrated Health Information System, or IHiS.
That expansion increased the cost and technical complexity of the project, said French.
"In 2015 the Coast Guard determined there were significant risks associated with continuing the IHiS project and decided not to exercise further contract options," he said.
"The decision was driven by concerns about the project's ability to deliver a viable product in a reasonable period of time and at a reasonable cost. As a result of the analysis that led to the discontinuation of the project, various irregularities were uncovered, which are currently being reviewed."
Officials are in the process of reviewing and closing out contracts and settling outstanding invoices and potential claims, he said.
The Coast Guard will restart its search for another EHR system and thoroughly evaluate its options for potential alternatives. There's currently no projected timeline for the deployment of the new system.
Paper-based records will be used in the interim, without interruption of service to members and dependents.
"The Coast Guard is committed to ensuring proper management and oversight of the acquisition process for a new EHR system," said French.
There are day-to-day blocking and tackling tactics that every healthcare organization should be doing right now to reasonably address the current security threat landscape.
And there is guidance in the industry that can help organizations of all shapes and sizes protect themselves from cyber criminals and other miscreants.
"There is proven work that information security professionals have traditionally done, and we need to get these basics right, we need to be performing these functions," said Sanjeev Sah, chief information security officer and director of IS risk and controls at Texas Children's Hospital, where he recently completed work on a three-year strategic plan for security.
To help address security basics, Sah points to the Common Security Framework from the Health Information Trust Alliance, better known as HITRUST, and to the CIS Critical Security Controls developed by the National Security Agency, the U.S. Department of Energy and U.S. law enforcement organizations.
"Every CIO and CISO should consider focusing on critical controls and using a programmatic approach to achieve effective security," said Sah, who uses HITRUST Common Security Framework to "guide our programs and prioritize our approach to security. And then there is the CIS Critical Security Controls, which give you a prioritized approach in terms of implementing technical safeguards that may give you the best opportunity to protect the organization, especially if you are starting fresh."
At Texas Children's Hospital, for example, Sah ensures security technologies send alerts that clearly delineate what security and IT staff should be paying attention to, perhaps a potential advanced threat buried among hundreds of thousands of threats that merits the attention of the security team so staff can take meaningful action based on the level of the threat.
"A healthcare organization must ensure its posture is appropriate from a network security perspective and from an end-point security perspective," Sah said. "For example, an organization should handle critical systems and applications with a higher level of protection from a network perspective. And when it comes to end-points, an organization should ensure there are proper safeguards such as whitelisting and black-listing and encryption technology, actually employed on every device deployed. Basic measures go a long way in enabling people to do the right work, focused on the threats that require immediate and appropriate responses."
And then there is the human factor: The single most important factor here is education – and not just once in awhile, as traditionally has been done, but on an on-demand basis as threats emerge, Sah said.
Sign up for the Healthcare IT News Privacy & Security Update newsletter.
"Taking a proactive approach to educate employees about ransomware and the steps they can take to avoid that threat from taking a foothold in your network would be very helpful," he said.
"If a person does not click on a malicious message and download the malware that comes with it, that would prevent a threat from going any further. Beyond all the technical safeguards at play, education and awareness to effect change in user behavior is the paramount foundational step that must take place."
Geisinger Health System has enlisted 100,000 people for its genomic study and did so more quickly than expected. Attracting so many volunteers over two years has prompted program executives to raise the bar to 250,000 or more participants.
The study called MyCode Community Health Initiative launched in January 2014 in collaboration with the Regeneron Genetics Center. It is the largest study in the United States with electronic health records linked to large-scale DNA sequencing data.
Health system officials credit the success to Geisinger patients' "stability" in the region.
"The families in our core markets are multi-generational and the population is incredibly stable, meaning they don't move away from the area, Geisinger President and CEO David T. Feinberg, MD, said in a statement. 'When we ask to look into their genome, they tell us 'yes' based on trust and respect."
The information gleaned from the MyCode study will contribute to a broad range of research aimed at understanding, preventing or improving treatments for disease.
"Our ultimate goal is to help improve healthcare by finding ways to diagnose medical conditions earlier or before they appear and also find new treatments or medications to manage these diseases," said Geisinger Chief Scientific Officer David H. Ledbetter.
"MyCode is not only one of the world's largest genomic studies, it's also the most comprehensive with medical record data going back to 1996. Combining DNA sequence data with 20 years' worth of medical records is groundbreaking," Ledbetter explained.
Geisinger is returning results to patients who are at risk for 27 conditions, for example Lynch syndrome, which can result in a higher than normal chance of developing colorectal cancer, endometrial cancer, and various other types of aggressive cancers at a young age, or familial hypercholesterolemia, which can cause heart attack and death at an early age.
By and large, population health measurement efforts are poorly developed and uncoordinated – and without effective measurement, success will remain elusive.
Without population health measurement, in other words, there can be no population health management.
Part of the problem is different people mean different things when they say "population health," said Michael A. Stoto, professor of health systems administration and population health at Georgetown University.
"For some, population health is using predictive analytics to identify groups of people who need intensive care, and thus measures are required to see how their care is being managed," he explained.
"For others, population health is hospitals and ACOs identifying groups of beneficiaries and members whose care you are trying to manage, and that's a related but somewhat different set of measures," he added. "And for still others, population health means the population in a geographic area. All of these legitimately are called population health, and they all need measures that in some ways overlap but in other ways need to be distinguished."
Learn more at the upcoming HIMSS and Healthcare IT News Pop Health Forum 2016, May 19-20, 2016 in Boston. Register here
So healthcare and related organizations undertaking population health must agree on what population health is, harmonizing on goals and measures, Stoto said.
"Imagine a hospital and a community both decide reducing obesity is a priority," Stoto said. "What are they going to do about it? Hospitals can offer weight loss clinics, physicians and other providers at the hospital can counsel patients about physical activities and diet, the community can do work through its parks and recreation department, and so on. Then you need performance measures to see whether the hospital, providers and the community are doing these things. All of these things can be measured."
The hospital, the local health department and other organizations share responsibility for the obesity problem. Measures indicate how well the group is doing meeting population health goals; organizations harmonize in the way they define and work on obesity and measure progress, Stoto said.
"There are standard measures for obesity, physical activity and diet, for example, available from organizations such as the CDC, and hospitals and other providers can use these same measures for their population health programs," Stoto said. "So if those are the problems we are trying to address, what are we doing about it? This is where you need process measures. For example, how many people are using the programs a hospital provides? Track the use of these things. Track physical activities of kids in school."
The key is to study through a "driver diagram," Stoto added.
"What are the outcomes we want to achieve?" he asked. "What are the steps needed to achieve those outcomes? Who is going to do these things? And how do we measure what they are doing?"