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Articles on this Page
- 10/27/17--10:22: _Cerner revenue up 8...
- 10/27/17--10:51: _Cerner execs say VA...
- 10/31/17--10:50: _Vanderbilt Universi...
- 10/31/17--11:31: _Allscripts to VA: L...
- 11/01/17--08:40: _EHR fatigue has fru...
- 11/01/17--09:04: _Here's why 9 system...
- 12/13/17--09:00: _Lessons Learned fro...
- 11/02/17--07:17: _Meaningful Measures...
- 11/02/17--07:56: _HealthPartners Inst...
- 11/02/17--08:48: _McKesson presses Tr...
- 11/02/17--11:52: _Senators reintroduc...
- 11/02/17--12:14: _Allscripts extends ...
- 11/03/17--07:32: _Why streamlined dat...
- 11/03/17--09:39: _Congress is trying ...
- 11/03/17--10:46: _MACRA final rule ma...
- 11/03/17--12:50: _Epic sued over mill...
- 11/06/17--12:15: _AMIA, OpenNotes par...
- 11/07/17--05:23: _Epic, Cerner, CVS a...
- 11/07/17--08:51: _Tiger Institute joi...
- 11/07/17--11:26: _KLAS picks EHR lead...
- 10/31/17--11:31: Allscripts to VA: Look beyond EHR, fast-track interoperability
- 11/01/17--08:40: EHR fatigue has frustrated doctors looking to cut clinical hours
- 11/01/17--09:04: Here's why 9 systems made planning for EHR go-lives a priority
- 11/02/17--07:17: Meaningful Measures show CMS, ONC commitment to deregulation
- 11/02/17--12:14: Allscripts extends more contracts to Paragon, plans to enhance EHRs
- 11/03/17--07:32: Why streamlined data plus EHR connectivity equals more revenue
- 11/03/17--09:39: Congress is trying to ensure interoperability between VA, DoD
- 11/06/17--12:15: AMIA, OpenNotes partner on patient engagement
- 11/07/17--08:51: Tiger Institute joins Sequoia Project, linking EHRs with SSM Health
Cerner announced that its revenue for the third quarter of 2017 was $1.3 billion, up from $1.2 billion in the same time last year. President Zane Burke specifically pointed to revenue cycle software and services as well as population health as areas where the EHR giant made progress.
Overall, the company posted earnings of $177.4 million, a 4 percent jump compared to the prior year.
Despite the 8 percent revenue increase, however, Cerner reported fewer new bookings in the third quarter, which saw $1.1 billion, down from $1.4 billion last year. That figure was below prior guidance because large deals they expected to close were pushed back.
Burke said the company still has a lot of opportunity in the robust EHR market.
“There are still 2,000 hospitals on a legacy EHR platform,” he said. “While many of these opportunities are smaller, there are still some large opportunities.”
EHR customers exist within the federal government as well. In addition to the U.S. Department of Defense and Veterans Affairs, which Cerner CFO Marc Naughton called the biggest health IT project in history, Cerner considers Coast Guard, Indian Health, state Medicaid programs and the Federal Bureau of Prison as possibilities.
Burke also gave a glimpse into future areas where Cerner will invest.
“There are also several related capabilities we're investing in, such as artificial intelligence that we believe will widen our competitive edge while broadening our revenue opportunity,” Burke said.
Just days after Veterans Affairs Secretary David Shulkin, MD, testified before Congress that the entire EHR modernization project VA presumptively awarded to Cerner will take 7 to 8 years, Cerner executives answered questions about the deal in an earnings call with investors.
“We have not finished anything, but we anticipate that the VA would commit to the broad project,” Cerner President Zane Burke said late Thursday.
CFO Marc Naughton added that “all we know for sure is that it feels good that [the contract] is going to get done,” in the fourth quarter.
That’s not to say nothing has happened yet, of course.
Burke explained that Cerner has “made good progress with the VA on scoping the full work effort.” That includes crafting a plan, contract negotiations that are underway, and determining who will be the prime contractor; Burke said he expects Cerner to play that role.
“We're on the verge of beginning the largest healthcare IT project of all-time with the VA,” Naughton said.
What’s more, the VA project, along with the DoD EHR modernization initiative Cerner already has underway, could mark the beginning of similar arrangements with other federal agencies.
“We believe we are in the early stages of government business beyond DoD and VA,” Burke said. “It includes opportunities like the Federal Bureau of Prison, Coast Guard, Indian Health, and state Medicaid programs.”
Cerner is also looking at non-governmental EHR deals. Indeed, Burke said the 2,000 hospitals are still running legacy electronic health records software comprise a robust replacement market.
“Clients are figuring out they need more information rather than less. They need more data sets from other places,” Burke said. “They need intelligence above all that data to help them drive their operations in a more effective and efficient manner.”
And looking beyond EHR projects Naughton predicted much more is to come.
“The shift to value-based care,” Naughton said, “will represent an even bigger opportunity than the EMR era.”
After two years in the making, Nashville-based Vanderbilt University Medical Center will shift from its McKesson electronic health record to an Epic EHR. McKesson is discontinuing support for certain clinical applications VUMC uses.
Launch day for the Epic system is set for Nov. 2, and VUMC officials have not released the estimated cost of the project.
Executives and staff have dubbed the new system “eStar”. It includes 25 separate customized modules of Epic software designed for VUMC’s specific needs.
EpicLeap, the name given to the two-year project to switch to the new system, affects about 18,000 employees and also VUMC patients who use the “My Health at Vanderbilt,” patient portal. The portal will be replaced with Epic’s “My Chart.”
Executive Chief Nursing Officer Marilyn Dubree said the software switch is paying dividends already.
“The process of preparing for our eStar go live has created amazing teamwork and collaboration on the part of the Medical Center, she said in a statement posted on the VUMC website. “The interdisciplinary problem-solving around setting standards and putting into place new workflows – all of that has been really collaborative. That’s an investment that we made to be ready for go live, but it’s an investment that we will reap benefits from going forward.”
“We’ve long had an innovation agenda that was catalyzed by having access to and ownership of the clinical data and an information model that connected the data to the workflow, and we’ll be preserving that level of access to data and workflow,” added Kevin Johnson, MD, eStar, senior vice president for health information technology.”
For the first several weeks, VUMC will have hundreds of eStar experts on hand to provide one-on-one support on the new technology.
For the first three weeks, the ratio of “at the elbow” support personnel to clinicians will be one-to-four, for other clinical users one-to-six, and for backend office users one-to-eight. There will be 1,386 support personnel working during the day, and another 242 working at night.
A command center, called the EpiCenter, will operate around the clock.
The U.S. Department of Veterans Affairs is heading in the right direction by replacing its legacy EHR with Cerner, but the agency will need to fast-track the power of its new EHR and improve interoperability among other care providers, Allscripts CEO Paul Black wrote in a letter.
VA Secretary David Shulkin, MD, made the decision in June to replace its outdated system with Cerner, which powers the Department of Defense’s EHR. His reason for choosing Cerner was the desperate need to modernize VA’s system, and the agency will be able to lean on lessons learned from DoD’s massive Cerner EHR install.
But to truly impact veteran care, Shulkin will need “a strategy that looks beyond the EHR.”
Black recommended the VA prioritize three capabilities to ensure veterans receive care “that it is just as effective as the care our civilian population receives.” That includes: combine and share data in a meaningful way, discover and manage care for at-risk veterans and enable two-way digital engagement.
Specifically, the VA needs an interoperability tool that will aggregate and harmonize data -- not only from the VA and DoD -- but private providers, especially as the VA’s CHOICE Program has been extended. In fact, a predicted one-third of veterans will receive care from the private providers in the coming years.
The VA will need to create a platform that will present data in a single, comprehensive view that will allow the agency’s healthcare providers to see actionable insights. Black explained this will enable “seamless, API-powered care coordination.”
To Black, it’s these types of tools that will completely modernize the system, and prepare the VA to incorporate precision medicine and mental health data into the EHR at the point-of-care.
Further, the agency will need to provide veterans with a “bidirectional, EHR-agnostic digital access point to their data,” which will include scheduling features, preventative engagement functionality and telehealth. This data can flow back to the EHR and automatically update the patient’s record.
“The VA is headed in the right direction,” Black wrote. “It’s striving for an actionable, community-aware health solution.”
“Its new EHR will be an important first step, but the capabilities that will magnify the power of that new EHR should also be fast-tracked, in parallel to the EHR, to all caring for our nation’s Veterans on existing platforms,” he added.
The burden and bureaucracy of modern medicine, not to mention technological frustrations, inflict a toll on U.S. physicians and appear to be major factors influencing their intentions to reduce clinical work hours or leave the profession, according to new research by experts at the American Medical Association, Mayo Clinic and Stanford University.
The research calls for a comprehensive approach by national policymakers and healthcare providers to address the challenges.
Published in the new issue of Mayo Clinic Proceedings, the findings show roughly one in five physicians intend to reduce clinical work hours in the next year. And about one in 50 physicians intend to leave medicine for a different career entirely in the next two years.
The study’s authors highlight a correlation between the career plans of physicians and the growing problem of burnout, technological dissatisfaction and administrative fatigue among physicians.
Physicians who were burned out, dissatisfied with work-life integration, and dissatisfied with electronic health records were more likely to intend to reduce clinical work in the next 12 months. Burnout is the largest factor influencing physicians who intend to leave medicine in the next two years; mounting obstacles to patients’ care have been contributing to emotional fatigue and loss of enthusiasm and may foreshadow a crisis in the American healthcare system.
Attrition in the physician workforce results in diminished access to care for patients. If just 30 percent of physicians follow through on their intention to leave medicine in the next two years, the study estimates approximately 4,759 physicians would leave the workforce -- a loss roughly equivalent to eliminating the graduating classes of 19 U.S. medical schools in each of the next two years.
“Our findings have profound implications for health care organizations,” the authors wrote. “Replacing physicians is costly to institutions, with one recent analysis suggesting costs of $800,000 or more per physician. In addition, turnover is disruptive to patients, staff and organizational culture.”
To help physicians succeed in their life's work of caring for patients, the AMA has made the prevention of burnout a core priority. Working with partners across healthcare, the AMA is leading a change in medicine that embraces physician well-being as a critical factor in the long-term clinical and economic success of the nation’s healthcare system.
The AMA is also striving to help physicians cope with the challenges of providing quality patient care in a modern environment, arming them with relevant tools, information and resources -- and, in so doing, rekindle a joy in medicine. The STEPS Forward collection of practice improvement strategies helps physicians make changes to their practices, offering free online modules that help physicians and health leaders learn their risk factors for burnout, and adopt medical practice solutions to reignite professional fulfillment and resilience. The modules include Creating the Organizational Foundation for Joy in Medicine, Implementing Team-Based Care, Team Documentation, and EHR In-Basket Restructuring for Improved Efficiency.
There have been several major EHR go-lives that required years of planning resources - financial and staffing - to make it all work. Here are a few orgs that took the leap and the lessons they learned while tackling their projects.
Mount Sinai's EHR go-live
REASON: Mount Sinai Hospital's recent mergers and an aging mainframe prompted the hospital to replace paper charts, integrate records from multiple sources and add a revenue cycle management system.
Read the full story >>
Vanderbilt's EHR go-live
COST: $214 million
REASON: Epic replaces Vanderbilt’s McKesson EHR with 25 separate customized modules of Epic software during a two-year project dubbed “EpicLeap."
Read the full story >>
MidMichigan EHR go-live
COST: $55 Million
REASON: MidMichigan needed to replace multiple vendor systems for registration, scheduling and billing on the same EHR platform.
Read the full story >>
St. Joseph’s Healthcare EHR go-live
REASON: St. Joseph’s Healthcare needed to integrate their EHR and revenue cycle system across its acute, long-term care and ambulatory facilities.
Read the full story >>
Mayo Clinic's EHR go-live
COST: $1.5 billion
REASON: Mayo's multiple sites and 51,000 employees needed to better integrate EHRs and revenue cycle management systems into their workflow to better serve their patients.
Read the full story >>
DoD's USNH EHR go-live
REASON: USNH's Oak Harbor facility deployed the inpatient components of MHS GENESIS with the goal to move to a single EHR to standardize across the military branches.
Read the full story >>
UMass Memorial Health's EHR go-live
COST: $700 million over 10 years
REASON: UMass needed to add more functionality, namely telehealth, into EHR and have one place for all data to analyze it.
Read the full story >>
Tomah Memorial Hospital's EHR go-live
COST: $3 million
REASON: Tomah Memorial Hospital wanted to integrate departments and platforms in order to share patient information between two health systems that were using different EHR vendors.
Read the full story >>
WellSpan's EHR go-live
COST: $188.7 million
REASON: WellSpan wanted to switch their entire system to a new EHR to better connect with patients and improve care coordination.
Read the full story >>
In this presentation, Marc S. Williams, MD, Director, Genomic Medicine Institute, Geisinger Health System will provide an update on work being done to enable the use of genomic data within the EHR.
Dr. Williams leads the EHR integration workgroup of the National Human Genome Research Institute (NHGRI) and he will share work being done by the Electronic Medical Records and Genomics (eMERGE) network, a consortium funded by NHGRI. Established in 2007 to study the feasibility of using EHR data in genomic discovery, eMERGE has studied the implementation of genomic medicine in the clinic. This talk will provide an update on eMERGE activities and summarize the enablers and barriers encountered by the eMERGE network sites that predict the success of implementation.
Two top federal health officials are talking about cutting the regulatory red tape for how physicians are reimbursed, as the final MACRA rule on the physician fee schedule is due out this week.
The Centers for Medicare and Medicaid Services has taken a hard look at MACRA and is reexamining the process for conducting quality measurement across the board, CMS Administrator Seema Verma said at the Health Care Payment Learning and Action Network Fall Summit Oct. 30.
"2017 has been a transitional year for MACRA," Verma said. "We appreciate all of your thoughts and comments on the Year Two Proposed Rule, as we work to make this program less of a burden.
Related to our efforts to minimize burden in the implementation of MACRA, we're reexamining our process for conducting quality measurement across the board."
There are too many measures, Verma said, and they are measuring process, not outcomes.
"That's why we're revising current quality measures across all programs to ensure that measure sets are streamlined, outcomes-based, and meaningful to doctors and patients."
Verma did not specially refer to revisions to MACRA for the physician fee schedule rule expected this week. In fact she gave as examples a review of the hospital star rating program and the new initiative, Meaningful Measures, a streamlined approach for hospital and physician reporting focused on outcomes.
The Office of the National Coordinator for Health Information Technology is working with CMS on a new concept for physician reimbursement that would reduce regulations, said John Fleming, MD, deputy assistant secretary for Health Technology Reform.
Politico reported that Fleming in a recent speech talked about partially reimbursing physicians based on a "weighted average" of past services. This would base payments for the physicians' "evaluation and management services" -- a common reimbursement code -- based on the past average, reducing the need for documentation to hit reimbursement benchmarks.
Fleming clarified that any discussion is merely a concept at this point, and is not part of a decision-making model or MACRA.
"I was addressing a more fundamental part of physician burden under the 21st Century Cures Act to address administrative burden," Fleming said Wednesday.
For instance, EHRs are seen as a big pain point for providers, he said, but the documentation and administrative work are behind the problem.
"If we come out with a better technology, that won't solve the problem," Fleming said.
Verma said patient outcomes should be the focus, and there's no indication that required reporting measures actually improve health outcomes.
Inpatient hospitals report up to 61 quality measures, she said. Of these, 12 are "chart-abstracted," meaning that hospital staff must manually enter the values.
Some family practitioners have to report nearly 30 measures to seven different payers, she said.
The American Hospital Association recently published a report showing that health systems, hospitals, and post-acute care providers must comply with 629 mandatory regulatory requirements, Verma said. Providers spend nearly $39 billion a year solely on the administrative activities and the average-sized hospital dedicates 59 full-time employees to regulatory compliance.
Last week, CMS announced "Patients Over Paperwork," an initiative to go through all of its regulations to reduce burden, according to Verma.
"A case in point is the implementation of the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA as you know it," Verma said. "At this time, the only way to avoid MACRA's extensive reporting requirements is for physicians to take on risk to be part of Advanced Alternative Payment Models – or APMs, which many practices are simply not ready for."
But there are few Advanced APM models available and hardly any for specialists, Verma said.
"We are hearing that doctors are overwhelmed by MACRA's new requirements and confused about the steps that they need to take," she said.
Most physicians are looking at entering the MIPS program, rather than APMs for payment. Performance on 2017 quality scores in the Merit-based Incentive Payment System will be used to determine 2019 payments.
Physicians not participating in MIPS, or APMs, will see their compensation frozen over the next few years, according to Tim Gronniger, senior vice president of Development and Strategy for Caravan Health, who is a former deputy chief of staff at the CMS.
HealthPartners Institute is embarking on the next phase of its ongoing high blood pressure study, dubbed Hyperlink, with a $6 million grant from the Patient-Centered Outcomes Research Institute.
The hospital said it will use the new PCORI funding to build expand the study to more patients.
In the new research phase, HealthPartners will work with telemedicine and remote patient monitoring vendor AMC Health to track patients’ blood pressure from home and directly link to pharmacists or nurse practitioners.
As part of the program, AMC Health will give patients in-home devices that patients will use to measure their blood pressure several times a week.
Those devices will automatically send vitals data through AMC Health’s CareConsole clinical platform into the HealthPartners Epic electronic health records system. The technology will also enable pharmacists to review, analyze and act upon home blood pressure readings to manage patients’ hypertension.
Hyperlink telehealth is in addition to regular doctor visits, which will determine if remote patient monitoring can improve a patient’s health and decrease blood pressure more than traditional clinic-based care.
“Over 85 million adults have high blood pressure – that’s one in every three adults in the U.S.,” said Karen Margolis, MD, with HealthPartners. “Only about half of people with high blood pressure have their condition under control.”
McKesson is calling on the Trump Administration to implement a number of recommendations to help combat the opioid crisis.
In a letter to New Jersey Gov. Chris Christie, the chair of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, McKesson Senior Vice president of Public Affairs Pete Slone laid out some crucial health IT -- and policy needs to begin the fight against the addiction crisis.
One major recommendation is for the commission to support a National Patient Safety Network able to identify patients with prescription histories that reveal a higher risk of opioid abuse or misuse than the average patient.
The platform would complement statewide prescription drug monitoring programs, which are designed to assist law enforcement to identify doctor shoppers and aren’t included in a physician’s EHR workflow. Further, PDMPs lack real-time data, which are critical to providers looking to verify a patient’s prescribing history.
McKesson’s idea is to bring that data into the pharmacist’s workflow, with real-time flags -- in the same manner they see insurance information and copay amount. When pharmacists see a red flag, they can voluntarily provide that information to the state’s PDMP and call the prescriber to verify the legitimacy of the script.
The National Council for Prescription Drug Programs first created the idea, and McKesson has been working with a coalition to make the tool a reality.
Also included in its recommendations is that all state require e-prescribing, fully leverage data analytics to identify at-risk patients and improve information sharing among PDMPs.
But Sloane feels that a key element is missing from really making an impact on the opioid crisis: input from pharmacists.
“Our country’s opioid epidemic is the public health crisis of our time. We must make it a priority to harness the full breadth of all our clinical capabilities… Pharmacists are uniquely positioned to have a comprehensive view of a patient’s health status,” Sloane wrote.
“Given our country’s impending physician shortage crisis and the availability of highly skilled, medically trained pharmacists that are ready and able to help now, we encourage the administration to consider policies that make it easier for pharmacists to provide MAT and other clinical services to individuals suffering from opioid addiction,” he said.
A group of United States Senators on Thursday put forth legislation intended to reduce the burden that using EHRs and attesting to the meaningful use incentive program put on doctors.
“Our bill ensures that unnecessary regulatory burdens do not continue to negatively affect providers’ ability to leverage technology to improve patient care,” said Senator John Thune, R-South Dakota. “With such strong and continued support for this legislation, I’m hopeful it will lead to swift and meaningful action in the Senate.”
Along with Thune, Sens. Lamar Alexander, R-Tennessee, Mike Enzi, R-Wyoming, Pat Roberts, R-Kansas, Richard Burr, R-North Carolina, and Bill Cassidy, R-Louisiana, signed the original EHR Regulatory Relief Act in June 2016 and reintroduced it on Thursday.
Alexander, chairman of the Senate Committee on Health, Education, Labor and Pensions, cited American Medical Association data that doctors spend two hours in the EHR and desk work for every hour they treat patients. “I encourage the Senate to pass this bill to take a step towards getting our electronic health records system out of the ditch,” Alexander said.
The five-page bill calls for “a 90-day period for the determination of whether a MIPS eligible professional or eligible hospital is a meaningful EHR user and to remove the all-or-nothing approach to meaningful use, and for other purposes.”
The proposal would grant hospitals “any continuous 90-day period” for EHR reporting for fiscal 2019 and subsequent years.
“The Secretary shall determine that an eligible hospital is a meaningful EHR user for the EHR reporting period for such fiscal years using a methodology specified by the Secretary through rulemaking based on performance with respect to objectives and measures established by the Secretary that are met by an eligible hospital,” the bill states. “Such methodology shall allow an eligible hospital to be a meaningful EHR user if they achieve 70 percent (or a portion between 50 and 70 percent) of such measures or if they achieve a composite score (as determined by the Secretary through rulemaking) based on such measures.”
The EHR Regulatory Relief Act also extends flexibility for providers seeking hardship exemptions for the 2017 EHR reporting period and payment adjustments for 2019.
“The use of electronic health records has the potential to revolutionize patient care,” Enzi said. “But if we want electronic health records to work for providers and patients, we have to provide relief from unrealistic and burdensome requirements and build flexibility within the program.”
Allscripts announced this week that four more hospitals have extended their Paragon EHR agreements with the company in the third quarter of 2017, following its acquisition of McKesson's Enterprise Information Solutions unit in August.
The Southern California-based KPC Group hospitals will innovate with Paragon, OneContent and other tools by selecting remote hosting and adding additional years of maintenance through a bundled offering, according to Allscripts.
Based in Orange, Riverside and San Bernardino Counties, the KPC Group comprises not just acute care hospitals but independent physicians associations, medical groups and other ancillary facilities.
Allscripts says its investments will help the Paragon sites deliver better quality care for patients and establish a stable infrastructure for continuous improvements across those organizations, helping them move IT operations to a secure data environment and enabling them to focus on technology optimization.
Bundled agreements include remote hosting capabilities, maintenance, upgrades and services for the Allscripts application suite, including Paragon, OneContent and other associated tools, officials said, including help with Stage 3 meaningful use and assistance with migration from on-premise data centers to cloud hosting.
In a recent interview, Rich Berner, senior vice president for health systems and population health solutions management, said most of the Paragon customers he's visited since late summer were glad to be new Allscripts customers – and that Allscripts was committed to doing well by its new Paragon clients.
"We made this acquisition as a growth investment, so we're going to continue to invest in their solutions," said Berner. "And the client is excited about some of the new solutions coming in."
As proof, he pointed to an October Black Book report that polled 1,200 McKesson Paragon clients and found that a whopping 96 percent of execs there said they're optimistic about how the Allscripts acquisition will improve Paragon clients' processes and technologies.
Around the same time, however, a report from KLAS said the 'clock is ticking' for Allscripts to make good on the promised innovations for a Paragon client base that had previously been grappling with uncertainty.
Berner said Allscripts is doing just that. "We're going to continue to invest in Paragon for those smaller hospitals who are looking for a fully integrated inpatient/outpatient/clinical revenue cycle solution," he said.
"The nearest term thing is to finish out the ambulatory offering," he said. "The Paragon clients have been wanting integrated inpatient and ambulatory, so next year we're going to continue finishing the investment that was already underway, which is delivering the total ambulatory solution so Paragon clients can continue having inpatient and outpatient on the same platform. They already have inpatient-outpatient revenue cycle but the clinicals piece is what they want.
"We'll also continue to focus on how do we make the EHR easier to use for the clinician and give them the information they need at the point of care," he added.
"One of the other reasons that this merger is good for them is that they will have access to, and an even greater level of tighter integration with CareInMotion, our population health management suite," said Berner.
"We pride ourselves and believe the differentiating strength is that all four pillars of CareInMotion are EHR agnostic – from data aggregation/normalization to the analytics, care coordination to patient engagement. So now Paragon and the rest of the client base coming over will have access to those population health management tools with an even tighter level of integration than they had prior to the acquisition."
The acquisition will also be good for Allscripts' existing Sunrise customers, he said. Before the McKesson deal it had been working on developing a simpler, lighter-weight version of that EHR for the small hospital market. With Paragon, Allscripts now has one – allowing it to refocus some of those resources back to its larger Sunrise clients.
But Berner said the three-month-old acquisition will be good for all of Allscripts' customers, whether existing Sunrise hospitals or new Paragon clients.
"The mission we've been on since Paul took over is to create open connected communities of health," he said. "We want to do that to help our clients improve the health of the patients and populations they serve."
Such a large expansion of its client base, coupled with sizable investments in innovation, will help "accelerate the connection of a greater number of communities," said Berner. "We know today how everyone is struggling with the sharing of information. This acquisition helps us solve some of those interoperability and care integration problems that have been plaguing the industry."
Hospitals and health systems are constantly looking for ways to boost revenue, and a few sound strategies have emerged including streamlining EHR data and simply increasing the number of patients a physician sees in a given day. To bring it all together, however, often requires a bit more technology.
David Conejo, CEO of Rehobath McKinley Christian Healthcare Services in Gallup, New Mexico, found what he was looking for when he stumbled upon Zoeticx, a developer of medical software that bridges the gap between medical quality and patient care.
The way Conejo sees it, seeking out the efficiencies wrought by this technological approach was slow-going. Years ago, he said, with Medicare and Medicaid, there was an attempt to simultaneously expand services and control costs. His hospital followed suit, expanding its services and at the same time trying to access as many people as possible. There was just one problem: As the delivery of healthcare services goes up, so too does the cost.
A number of different avenues emerged in an effort to reduce those costs. Home health. Urgent care centers. Non-medical transportation. Accountable care organizations. All had a positive impact on costs, but the question then became: How do you put all of those elements into one system so there can be some consistency?
That’s where an integrated EHR solution comes in. Zoeticx’s ProVision Wellness platform is a cloud application that streamlines data integration for Annual Wellness Visits covered by the Centers for Medicare and Medicaid Services and private payers. The idea is that hospital systems and other healthcare facilities can essentially create new revenue centers through reimbursements by government and private payers.
Conejo swears by it largely because it integrates with any EHR system without data duplication, so keeping systems in sync is as automated process. It allows for the management of support tracking for wellness visits, provides a physical assessments guide through preventative exams, and maps out the risk factors for potential diseases for patient follow-up visits. The workflow efficiencies aren’t too shabby, either.
“Let’s say I come in for an annual visit and the staff says, ‘We need to get Mr. Conejo onto the wellness program because we need to get more people involved in this,’” said Conejo. “They then ask me questions: ‘Do you regularly monitor your blood sugars?’ ‘Well, 90 percent of the time.’ ‘OK, we’re going to put instructions for you to do this twice a day, and give you the tools to report back. And because of your age, we’re going to make sure there’s no cancer, and we’re going to do a heart checkup. And lastly, we’re going to review your meds.’ And I think, ‘This is quite the program.’”
The program enters the relevant data about the patient but, in addition, it includes “everything else that Medicare would recommend for me to have apart from my checkup. So when I come in, they say, ‘We’re going to do the A1C, check your meds, etc., but under the program they also say, ‘We need to look at your blockage and whether it’s increasing. We’re going to take a look at your bone structure. We’re going to take a look at your muscle strength -- the more muscle you have, the better you metabolize sugar.’”
Patient monitoring at the hospital has improved. That’s good news for a facility that now has to think of patients as consumers and all of the market considerations that entails. But it’s also a nice arrow to have in the quiver considering the industry-wide dip in inpatient activity that has taken place.
“We’re seeing a lot more outpatients, and that offsets the decline in inpatient business,” said Cohejo. “So we’ve been doing more preventative work than diagnostic and treatment work.”
Business is growing, with full or near-full compliance. And with its ACO in startup mode, RMCHS is getting a bonus check for $80,000 from Medicare for containing costs, in addition to the new revenues that have been generated.
“A dollar investment in preventative care saves $6 in acute care, so the more you anticipate, the better the whole cost structure,” said Conejo.
The fact that more patients can be seen is an added bonus. When the doctor comes in, they already have the requisite information about meds, compliance and other important factors. That doesn’t sound like much, said Conejo, but if a physician saves 10 minutes per patient, at 18 patients a day that;’s an extra 180 minutes. More minutes, more patients.
“Our residents will greatly benefit from this,” he said.
The House Committee on Veterans Affairs introduced legislation today that would strengthen congressional oversight of the U.S. Department of Veterans Affairs’ transition from its legacy VistA EHR to the Cerner platform.
Introduced by committee Chairman Rep. Phil Roe, R-Tennessee, and ranking member Rep. Tim Walz, R-Minnesota, the bill is designed to ensure “seamless interoperability” between the U.S. Department of Defense and the U.S. Department of Veterans Affairs.
However, to accomplish its goal, Congress will require “additional tools to carry out effective oversight of this challenging undertaking.”
“It’s now incredibly important to make sure the modernization process is as seamless as possible,” Walz said in a statement. “This bill will ensure that Congress has the authority it needs to oversee the process and hold VA accountable every step of the way.”
The congressmen and co-sponsors expressed continued support of the VA’s desire to modernize its system, along with the VA’s decision to choose the same EHR as the DoD.
But to co-sponsor Rep. Jack Bergman, R-Michigan, the bill will help to alleviate concerns, as it’s “no secret that VA has a poor track record of keeping Congress informed regarding its modernization efforts.”
The proposed bill will require the VA provide Congress access to the agency’s key implementation and planning documentation. Further, the agency will need to report to Congress with any major cost increase, loss of health data, delay or privacy breach.
“It’s well known that large IT modernization projects, particularly those in the government, often encounter significant problems,” said Bergman.
A similar bill was introduced in the Senate by Sens. Jon Tester (D-Montana) and Richard Blumenthal (D-Connecticut) on Thursday.
The legislation would require a one-time comprehensive report on timelines, cost projections, risk management plans and a plan to ensure the new EHR works with non-VA providers. The VA would also need to provide quarterly updates on the project’s implementation --- including changes to the initial plan.
As part of the Veterans’ Electronic Health Record Modernization Oversight Act of 2017, the agency is required to provide Congress with key planning and implementation documents for the Cerner project, as well as copies of contracts to verify the project’s status and how funds are being spent.
VA Secretary David Shulkin, MD, announced its plan to implement Cerner for its new EHR in June. Just last month, Shulkin said the agency said it will soon sign the contract with Cerner. He estimated the project would take seven to eight years to complete, with the first roll-out in just 18 months after the contract is signed.
As the Quality Payment Program enters its second year, the Centers for Medicare and Medicaid Services issued its 1,653-page final rule on Nov. 2, with an array of implications for the ways physician practices use information technology in 2018.
Among the biggest provisions is to allow doctors to use either 2014 or 2015 Edition certified electronic health record technology in Year 2 of the program – but gives a 10 percent bonus to those practices that make the leap to using only 2015 edition CEHRT.
CMS also included an interim final rule allowing for a hardship exception aimed at small practices and clinicians whose EHR use has been impacted by "extreme and uncontrollable circumstances" such as the recent hurricanes Harvey, Irma and Maria.
For three of the four components of the Merit-Based Incentive Payment System, meanwhile, it will maintain a 90-day reporting window: advancing care information, improvement activities and cost.
But CMS will require a full-year performance period for the quality component of MIPS. This, even as CMS recently announced its intention, with its "Meaningful Measures" initiative, to reassess just how many of those measures providers should have to report on.
That didn't sit well with some groups, such as the Medical Group Management Association, whose SVP for Government Affairs Anders Gilberg tweeted: "Deeply disappointed the final #QPP reg takes quality reporting requirement from 90 to 365 days in 2018 - not #patientsoverpaperwork."
[Also: Meaningful Measures show CMS, ONC commitment to deregulation]
CMS says it's trying to strike a balance between overly rigid regulations for providers and the need to promote innovation for better quality, delivered more efficiently.
"During my visits with clinicians across the country, I’ve heard many concerns about the impact burdensome regulations have on their ability to care for patients," said CMS Administrator Seema Verma.
"These rules move the agency in a new direction and begin to ease that burden by strengthening the patient-doctor relationship, empowering patients to realize the value of their care over volume of tests, and encouraging innovation and competition within the American healthcare system," she said.
But while physicians should enjoy some added flexibility for their practices' use of IT, hospitals struggling with meaningful use would also enjoy some relief, said Tom Nickels, executive vice president, American Hospital Association.
"While we applaud CMS for providing much-needed relief from unrealistic and unfunded mandates for EHR capabilities for clinicians, we are disappointed the agency has yet to provide similar relief for hospitals," he said in a statement. "We also urge CMS to provide additional avenues for clinicians to earn incentives for partnering with hospitals to provide better quality, more efficient care through advanced alternative payment models."
More support for telehealth, delay in appropriate-use criteria
Two areas AHA did find to like in the QPP rule and its accompanying 2018 Physician Fee Schedule were new payment options for telemedicine and a delay until 2020 for the requirement that physicians consult with software that tells them whether the imaging tests they order are appropriate and grounded in evidence.
"AHA is pleased that CMS implemented a further delay in implementation, until Jan. 1, 2020, of appropriate use criteria for advanced diagnostic imaging to allow providers sufficient time to understand and implement the program’s requirements," said Nickels.
"We are also supportive of the agency’s policies to make payment for new telehealth services, although we urge a more expansive approach toward telehealth coverage," he said.
CMS plans to increase access to Medicare telehealth services – especially for patients in rural or underserved areas – by paying for more such consults and making it easier for providers to bill for them.
The QPP Final Rule adds a series of new billing codes that reimburse virtual visits for risk assessments and care planning under CMS' chronic care management program.
The American Medical Group Association was another of many organizations who thought the change was overdue.
"Telehealth is a tool that benefits both providers and patients, and it’s a becoming an increasingly effective way to enhance the patient experience," said Jerry Penso, MD, AMGA's president and CEO. "Consultations, remote patient monitoring, and patient self-management all are aided through telehealth."
The MACRA rule will also enable greater use of remote patient monitoring tools and encourage physicians to do more with patient-generated health data.
"We believe that the use of digital technologies that provide either one-way or two-way data between MIPS eligible clinicians and patients is valuable, including for the purposes of promoting patient self-management, enabling remote monitoring, and detecting early indicators of treatment failure," said CMS officials.
"We believe MIPS eligible clinicians will use health IT including providing patients access to health information and educational resources as well as incorporating PGHD for this activity to include standardized data capture and incorporating patient-generated health data."
Healthcare IT giant Epic Systems has been hit with a False Claims Act suit that alleges the company’s billing system double bills the government for anesthesia services.
According to the suit that was made public Thursday, the alleged glitch in the system has resulted in hundreds of millions of dollars of overbilling.
Epic refutes the allegations.
“The Department of Justice did its own expert review and decided not to move forward,” Epic spokeswoman Meghan Roh said in a statement. “The plaintiff’s assertions represent a fundamental misunderstanding of how claims software works.”
But that will not be the end of the case. “The seal has been lifted and the defenders are going to be served,” said Linesch Firm Associate Attorney Daniela Carrión.
The suit was first filed in 2015. It remained sealed until Thursday, giving lawyers the green light to proceed.
Geraldine Petrowski, who worked at WakeMed Health in Raleigh, North Carolina, between 2008 and 2014, filed the complaint that claims that Epic’s billing software defaults to charging for both the applicable “base units” for anesthesia provided on a procedure as well as the actual time taken for the procedure, resulting in payers being overcharged for anesthesia.
“This unlawful billing protocol has resulted in the presentation of hundreds of millions of dollars in fraudulent bills for anesthesia services being submitted to Medicare and Medicaid as false claims,” Petrowski said in the complaint.
She also seeks to bolster her case, alleging that MD Anderson Cancer Center billed for seven hours of anesthesia for a prostate removal that took less than five hours.
Petrowski served as hospital liaison for the WakeMed’s rollout of Epic’s software, when she came across the anesthesia billing issues, developing “major concerns” about incorrect billing, she said in the complaint.
She worked as a compliance review specialist at from September 2008 to September 2012 and then as the supervisor of physicians’ coding through May 2014. In 2015, was the liaison for the hospital’s Epic go-live.
The American Medical Informatics Association and OpenNotes will collaborate to expand the access and control that patients and families have over their own health data.
OpenNotes, which co-director Tom Delbanco, MD, described as a movement rather than a software program, started in 2010 at Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Pennsylvania and Harborview Medical Center in Seattle. The movement has since expanded to more than 20 hospitals and enabled nearly 20 million patients to see what their doctors wrote about them in the EHR.
AMIA and OpenNotes described the partnership, announced at AMIA's 2017 Annual Symposium, as a collaboration that seeks to enlist more hospitals and doctors to empower even greater numbers of patients with “access to, and control of, their personal health information.”
"It is clear this is the direction the industry should be heading," said AMIA President and CEO Douglas Fridsma, MD. OpenNotes Executive Director Catherine DesRoches added that making health records more transparent can be “a remarkably powerful way to effect change."
Many AMIA members, in fact, already take part in OpenNotes, and officials said the informatics community is essential to the continued expansion of this effort.
"Providing patients access to their physician's notes improves communication and trust, patient safety, and perhaps even patient outcomes," said Thomas Payne, MD, AMIA board chair and medical director of IT Services at the University of Washington's UW Medicine.
Surescripts, six EHR vendors, CVS Health and Express Scripts revealed a new joint effort on Tuesday to deliver data about prescription benefits and pricing to clinicians at the point of care.
The goal is to advance shared decision-making among doctors and patients by enabling prescribers to see a specific patient’s health insurance coverage and how much a given drug will cost. From there, Surescripts said the prior authorization will be completed with the EHR workflow and the prescription sent to the pharmacy.
Electronic health record makers — Allscripts, Cerner, GE, Epic, Practice Fusion and Aprima — will integrate such benefit and price information about specific individuals and suggest therapeutic alternatives when appropriate. In addition to CVS, Express Scripts is also participating.
Taken together, the EHR makers and pharmacy benefit managers comprise 53 percent of U.S. doctors and nearly 66 percent of patients.
Tuesday’s public announcement comes after a yearlong pilot that generated 3.75 million transactions in which benefits and pricing info was delivered to prescribers, the company said.
The participants have committed to delivering this service, which incorporates Surescripts Real-Time Prescription Benefit, Prior Authorization and e-Prescribing technologies, by 2018, the company said.
“As early as next year, any doctor using EHRs from Epic, Allscripts, Cerner, GE Healthcare, Practice Fusion and Aprima, who are meeting with patients whose pharmacy benefits are managed by CVS or ESI, will be able to have these critical conversations with their patients,” a Surescripts spokesperson said.
In a big advance for interoperability in mid-Missouri, the Tiger Institute Health Alliance HIE has linked up the Sequoia Project eHealth Exchange.
The HIE, which includes University of Missouri Health Care, Capital Region Medical Center and other area clinics and post-acute care providers, can now more easily share records with sprawling SSM Health, which comprises 20 hospitals and more than five dozen ambulatory sites in Missouri, Illinois, Oklahoma and Wisconsin.
The Tiger Institute for Health Innovation was launched in 2009 as a unique public-private partnership between University of Missouri and Kansas City-based Cerner, with a full-court-press on health IT adoption and optimization. The Sequoia Project has its roots in the former Nationwide Health Information Network, which was established by the Office of the National Coordinator for Health IT and later taken private.
Since SSM Health is a member of the Sequoia Project's eHealth Exchange, data can now be seamlessly and securely shared among its providers and members of the Tiger Institute Health Alliance, officials say.
"If we have patients from Jefferson City, St. Louis or other SSM Health sites visit our health system, we now can see a history of the care they’ve received," said Thomas Selva, MD, pediatrician and chief medical information officer at MU Health Care, in a statement. "This helps us provide the most appropriate, safe and streamlined care for these patients."
"The newly established interoperability with MU Health Care and other member providers enable our physicians and other caregivers to obtain a complete view of the health history of our patients," added Richard Vaughn, MD, CMIO for SSM Health.
"As a result, we can make faster and better care decisions, avoid duplicating expensive tests, and ensure that patients who’ve previously received care at MU Health Care and other member facilities receive the safest and best care possible."
SSM Health has embarked on several interoperability-related projects in recent years, such as a data exchange agreement with the U.S. Department of Defense and its implementation of the Surescripts National Record Locator Service.
"Interoperability is not just a buzzword at SSM Health," said Vaughn. "It’s becoming a way of life and a key method to help us continually create a better patient experience and provide better care."
A new report from KLAS rating EHRs vendors from across the entire continuum of care is shining a light on some of the niche vendors catering to the ambulatory care, acute care, home care, long-term care, behavioral health and urgent care markets.
The report, “Continuum of Care: A Comprehensive Look at EMRs in a Connected Continuum,” looked at both enterprise and single-setting EHR vendors to determine which platforms best positioned to help customers successfully adapt in each care setting.
In the home care arena, KLAS points to Thornberry and Homecare Homebase as leaders.
“An aging population is putting pressure on home care agencies to grow and prove they are a good fit for narrow networks,” the report said. “Today, most agencies make standalone HIT decisions, and single-setting solutions Thornberry and Homecare Homebase stand out for meeting customers’ needs.”
Thornberry’s customers are smaller and rave to KLAS about Thornberry’s high-touch relationships and go-forward vision. Homecare Homebase offers a robust solution, KLAS said, that can scale to the largest of agencies.
Long-term care also is increasing in importance as health systems focus on reducing readmissions and more quickly discharging patients to less costly settings. Here, KLAS points to MatrixCare as the clear leader in a crowded field.
“Most long-term care providers are not part of a health system and generally opt for non-enterprise solutions,” the report said. “MatrixCare’s acquisition of AOD has generated customer optimism around the future roadmap thanks to strong executive leadership (on top of steady support). These changes have positioned MatrixCare as the top-performing vendor, outpacing PointClickCare and CPSI (American HealthTech).”
In the smaller urgent care field, KLAS said that Practice Velocity comes out on top.
“Urgent care is the setting least impacted by the evolution toward the continuum, with revenue driven more by convenience than value-based care contracts,” the report explained. “Health systems most often leverage their enterprise ambulatory care or emergency department solution for urgent care. Among urgent care-specific solutions, Practice Velocity outperforms DocuTap thanks to strong relationships and development.”
On the behavioral health front, KLAS said that it will begin digging in deeper in 2018 because many providers feel behavioral health is a key for providing better care and controlling costs since behavioral health issues present as comorbidities with a number of chronic diseases.
“Netsmart has the largest market share, with solutions for private practice and psychiatric hospitals,” the report said. “Other key vendors with mindshare include Cerner, Core Solutions, Credible and Qualifacts. Meditech, like Cerner, has released an integrated offering; Epic’s is slated for 2018.”
The acute and ambulatory care settings continue to be the hub for health system EHR decisions, the results of which will impact decisions in other care settings. Here KLAS said Epic and Cerner are the leaders.
“Large health systems evaluating acute and ambulatory care platforms continue to most frequently select Epic for the physician usability and strong departmental functionality,” the report said. “Cerner is also widely considered for the comprehensive functionality. Health systems frequently weigh the revenue cycle as part of this decision, often tipping things strongly in Epic’s favor.”
Large health systems infrequently select Allscripts and Meditech today – Allscripts’ smaller breadth of functionality and Meditech’s previous lack of an integrated ambulatory platform have often been deal breakers, KLAS added.
Ultimately, the report concluded that healthcare data needs to move from disconnected silos to a smooth, connected ecosystem if the industry expects to successfully shift to value-based care.