March 21, 2012
How long have you been banking online? Two years? Ten years?
A recent survey from the Deloitte Center for Health Solutions found that patients are still twice as likely to use the Internet for online banking than for health tasks, even simple ones such as researching treatment options. In addition, the research found that patient engagement through personal health record services remains difficult with only one patient in nine is interested in using PHR services, let alone actually doing it.
Physicians are scoring a somewhat higher but still have a ways to go. The Deloitte survey found 46% of physicians do not use Internet tools to enhance patient care, and only one in five provide patients with the ability to view lab results or schedule appointments online.
While this lack of online patient access to medical information is hardly news, the problem has become a much more significant barrier to cross in the wake of the recent Meaningful Use Stage 2 rules.
A recent story in SearchHealtIT (http://searchhealthit.techtarget.com/news) notes that the new MU2 rules require that more than half of an eligible provider’s (EP) patients receive online access to their medical records within four days of the records becoming available to the physician.
“The kicker, though, is 10% of patients must view, download or transmit their health information. This objective moves from its current place in the stage 1 menu set to a core requirement in stage 2.”
“This requirement also presents a quandary for meaningful use compliance. Essentially, caregivers would have no control over whether patients will view, download or transmit their medical information. If compliance hinges completely on actions outside the caregiver’s hands, there could be backlash among providers who see the core requirement as unfair.”
“Additionally, how will hospitals and physicians be able to prove that 10% of patients were active with their medical information?”
This proposed requirement (the new rules aren’t final yet) is bound to draw a lot of negative comments from physicians who see it as a “bridge too far.” I predict that it will be eased considerably when the final rules are issued later this summer.
March 16, 2012
Two separate surveys from KLAS point out that in the EHR world, biggest isn’t always best.
The first survey by KLAS, the Orem, Utah-based healthcare technology research organization, was reported last week in Health Imaging. KLAS surveyed 104 providers about their attestation experience. The publication reported that
“Some large vendors-like Allscripts, McKesson and Siemens-had successful attesters, but it was a small number compared to the size of their client base. KLAS reported that Meditech is both a success and a struggle for providers. While they have the highest number of successful attesters at 203, the bulk of their attesters came from one large integrated delivery network (IDN).”
While this hardly a secret, it is a fact played down by the big companies and often ignored by the press, which tends to look at simple, gross numbers rather than percentages. The fact is there are a number of smaller EHR vendors with a smaller client base that can boast of having a very significant percentage of their customers achieve attestation.
According to Health Imaging, the survey found the top three investments needed to meet meaningful use Stage 1 attestation were hardware, interfaces and EMR upgrades.
In addition, most providers surveyed reported problems with adopting CPOE and problems lists, reporting quality measures and interfacing.
KLAS, which makes money selling customer survey information, issued another report last week, this one about EHRs serving surgical specialists. As reported in Information Week, the survey found that specialists are less satisfied with their EHRs than primary care doctors.
The survey assessed physician satisfaction with the ambulatory-care products of 18 vendors. Information Week reports that
“Mark Anderson, a health IT consultant in Montgomery, Tex., (said) that specialists like their EHRs less than primary care doctors do because most systems were developed for primary care and lack many of the features and templates that the specialists’ work requires.”
“’Ophthalmologists, for instance, have to take pictures of the eye and do all these eye tests, so they need totally different things in an EHR,’ he said. ‘Oncology is really hard because of the way oncologists do their chemotherapy and the supplies that they have to track.’ As for surgical specialists, he noted that few EHRs have templates designed to document procedures in the ways that surgeons require.”
In fact, several smaller EHR vendors do a very good business selling to specialists who are affiliated with hospitals using Epic, Cerner and GE. Their products are designed for particular specialists, such as orthopedists or oncologists, who find them much easier to use.
March 9, 2012
Many of us are still sorting out the deluge of information, business cards and swag that poured forth at the HIMSS 12 show.
One interesting analysis comes from Andrew R. Watson, MD, Medical Director, Center for Connected Medicine, Pittsburgh, writing in the mHIMSS newsletter.
Dr. Watson notes
“As I reviewed the schedule of educational sessions and toured the exhibit hall, however, two concerns arose.
“The first was how rarely the word ‘patient’ appeared in prominent signage on the booths. I took notes during one of my tours on the floor and was disappointed to see that ‘patient’ and ‘outcomes’ were not among the primary messages vendors were projecting. Concepts that held marquee status, on the other hand, included data, scalability, cost, HIE and meaningful use.”
I agree with Dr. Watson on this point, the concept of “benefits to patients” in terms of better health, lower costs and convenience was notably lacking.
There are two reasons for that.
1. The patient rarely pays for the full cost of his health care. If you went to a car show, all of the displays would be centered on car buyers. No so at HIMSS. Patients are not the direct buyers of the technology on display. They will, however, bear the costs indirectly. Which brings me to the next point.
2. Relatively few of the technologies on display at HIMSS will lead to decreased costs for the consumer in the short-term. Most of them are sold as “improvements to workflow” or “enhancing productivity.” This basically means the physician will see more patients each day. This will lead to busier physicians, but will it reduce the number of unnecessary tests, or decrease length-of-stay? The jury is still out.
What is Dr. Watson’s second concern?
“The second consideration I found myself wondering about revolves around how all of these remarkable companies, drawn together through HIMSS and its annual event, could work together.”
I do not share this concern. For the few who went downstairs to the “basement,” the HealthStory booth in the Interoperability Showcase displayed some excellent examples of collaboration by vendors.
Fortunately, Dr. Farzad Mostashari went down and was pleased with what he saw. His challenge to send a new clinical document electronically across the country in less than an hour was quickly met by two different teams of vendors.
March 2, 2012
The powerful physicians’ lobby is driving the ICD-10 delay, reports HealthLeaders.
The CMS has had an October 2013 deadline for providers to adopted the ICD-10 reporting system since 2009. Only a few organizations paid attention at first, but as the deadline for implementing the complex new system of medical codes has approached, many office-based physicians have gotten alarmed at the time and expense involved. Through the primary physician lobbying organization, the AMA, they have mounted an effective PR and lobbying campaign to delay the deadline.
The article quotes a spokesman for the AMA:
“The timing of the ICD-10 transition could not be worse for physicians as they are spending significant financial and administrative resources implementing electronic health records in their practices, and trying to comply with multiple quality and health information technology programs that include penalties for noncompliance.”
Many on the IT side of the aisle, particularly the techies in HIMSS and AHIMA, argue that many hospitals have spent tens of millions on meeting the 2013 deadline and it is unfair to postpone it so late in the game.
The article notes
“Our stance is, we’re opposed to any kind of delay,” says Sue Bowman, director of Coding Policy and Compliance for the 64,000-member American Health Information Management Association (AHIMA).
“It’s just so ironic to me,” Bowman continues. “We’re all talking about how much we need to cut healthcare costs and improve quality of care. And how we’re not where we want to be with quality. And oh, by the way, we’re not going to bother upgrading our healthcare data. It just doesn’t make any sense.”
The AMA may represents less than half of the 600,000 practicing physicians, but it is still the most powerful physician organization in the country. They have a good, grassroots lobbying organization with thousands of doctors who regularly visit Congressmen and state legislators.
The health insurance industry knows how powerful the AMA is, having tangled with them on many managed care issues. Interestingly, the health insurers have said little about ICD-10, which they probably see as a great tool for cost containment.