What is HCIT Friction?

wheelThe Truth Is Stranger Than Friction

I just returned from two eye-opening experiences: HIMSS, the largest health IT event in the industry, and AAOS, the country’s largest orthopaedic conference. Of course, I heard about the amazing benefits of many new technological and medical breakthroughs . . . But what really got my attention was hearing some physicians say that when it comes to productivity, they wish they could return to the days of paper charts.

What? Since when do medical professionals want to turn back time on medical technology advancements like productivity solutions? All of those innovations were designed with an important goal in mind: to help doctors have more time to help more patients. However, due to many reasons, the data collection process is getting in between doctors and patients. That friction is rubbing both parties the wrong way—and the need to get beyond that friction was the clear message I took away from both HIMSS and AAOS.

Friction isn’t inherently bad: it is the force that allows our tires to grip the pavement, lets us steer the way we want to go, and enables our brakes to stop us from crashing. However, excess friction hinders movement and wastes energy: that’s what’s happening right now in the world of EHR solutions. What we need are systems that work with—not against—physicians while they perform their very important work. By creating smarter solutions, we can transform friction into traction: positive momentum that takes us where we want to go, faster—in a way that enhances, instead of interferes with, the doctor-patient experience.

In order to really help advance healthcare, the next generation of EHR solutions must do more than just capture data. They must be intelligent technologies that go beyond frictionless, creating the traction to:

  • Operate in the way that best supports each doctor’s work style, so that physicians can concentrate on patients, not iPads
  • Enable seamless data collection during patient interactions, so that doctors are not spending hours recording data later
  • Leverage mobile platforms and predictive technologies that not only keep up with busy specialists but actually help move them forward

Turning meaningless friction into meaningful traction is the driving force behind what we are calling Smart Workflows. Living and practicing in the Information Age, the only way to go is forward—not to reduce the technology involved, but to reduce its intrusiveness by developing software that easily captures required data while actually prioritizing the physician’s role in medicine. That’s something no EHR has ever done—nor any paper chart, for that matter.

To frictionless and beyond!

~ Khal Rai

Top 5 Observations at HIMSS16

HIMSS16

With a conference that draws over 50,000 attendees, 1300+ vendors, 300 educational sessions, and interesting keynote speakers, there is always plenty of food for thought. So much so that it can take a while to really assimilate all the information and process it into key observations.

Our team has just returned from the show, so I just wanted to quickly share our top 5 observations at HIMSS16:

  1. Value-based payments: There was much discussion on the shift to value-based payment. The MACRA/MIPS regulations are expected in the spring, which could mean as early as March or as late as June, with the Final Regulations mandated to be published by November 1. While the goal of MIPS is to simplify life for providers (by rolling up all the various current programs into one streamlined program), it’s a good bet that things will get more complex before they get easier. All of this begs the question: How will physicians be ready to comply beginning on January 1, 2017?
  1. Interoperability: No surprise that everyone was talking about this! This was reinforced when big-name healthcare technology providers promised to use standardized APIs to make access to patient information easier. Interestingly enough, this also ties in with the HHS wanting to expand its oversight of electronic health record vendors. The proposal they released on March 1 would allow the agency to review how certified health IT products interact with other products, with the aim to prevent data blocking, and to review certified HIT vendors if required (and even to take away their certification if necessary!) The comment period for the ONC rule ends on May 2.
  1. Population Health: This is increasingly becoming one of the top buzzwords at this show. More and more people are talking about it, but there does not seem to be a clear definition about what value this brings. After discussions with different attendees and vendors, it was clear how unclear it was: everyone was providing different answers. The term population health is much more widely used than it was back in 2003 when it was defined by Greg Soddart and David Kindig as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” The management element is using the aggregation of patient data to devise actions that improve both clinical and financial outcomes. But what data should be used, especially when it comes to specialty practices? Clearly this is something that needs to be defined to ensure we are getting real value from these solutions.
  1. HHS and CMS: There was an interesting session with Karen DeSalvo (National Coordinator for HIT, Asst. Secretary HHS) and Andy Slavitt (Acting Administrator, CMS) where the barriers to data sharing was discussed, and 3 commitments were announced:
    1. Consumers will be able to easily and securely access their electronic health information and send it wherever and to whomever they want.
    2. Providers will share information for patient care with other providers and will refrain from information blocking.
    3. The government will implement national interoperability standards, policies, and practices and will adopt best practices related to privacy and security.

This further reinforces the 2nd observation in this post about HHS wanting to expand its oversight of electronic health record vendors. This session also brought up an interesting point about data blocking; DeSalvo pointed out that a year ago there were a “host of organizations who denied that blocking even was happening,” and now these same groups are “willing to publicly say that they want to engage in something now they’ve acknowledged info blocking can exist.” Hopefully, these same groups will follow with their pledges. As Slavitt advised, “I strongly encourage you to recognize those that don’t [live up to their pledges]” (FierceHealthIT).

  1. EHR collides with NFL: Denver Broncos quarterback Peyton Manning, the reigning Super Bowl Champ, gave a speech at the show thanking the health IT community. For a man who has gone through 3 potentially career-breaking, neck surgeries, I think it is fair to say he can “fully appreciate the value of information systems to keep hospitals functioning.” A physician joined Manning on stage, discussing the NFL’s EHR system and their portals, allowing players access to their medical details. Manning put it like this: “Football is a game. Revolutionizing healthcare is a mighty endeavor.” He also mentioned that leaders in any field need to evolve to match circumstances (HealthcareIT News).

Of course, HIMMS is a huge show where other topics were discussed too, such as patient engagement and RCM. The points mentioned above were only our key takeaways from it. We want to understand the latest regulations and trends, and how these will impact healthcare specialists. What were your key takeaways?

The End of MU… Oh, Never Mind!

chameleon-315pxAccording to a recent speech by Andy Slavitt, Acting Administrator of CMS, “The Meaningful Use program as it has existed will now be effectively over.” Not surprisingly, the media picked up this news—particularly the word “now”—and ran with it, gleefully proclaiming the “End of MU in 2016,” “CIOs Celebrate End of MU,” “MU on Deathwatch,” etc. It was easy to believe that Slavitt was predicting the demise of MU to be imminent since the stated topic of his talk was “policy areas that will affect the healthcare sector in 2016.” However, in Tuesday’s CMS Blog, Slavitt—writing with Karen DeSalvo—walked his statement back a bit. That said, this is still quite significant news: CMS has formally acknowledged what Slavitt himself referred to as the frustration and burden that physicians have been dealing with since the start of MU.

The key phrase in his statement about MU is “as it has existed.” MU is to be, in Slavitt’s words, “replaced with something better”—i.e., a new and improved version of itself. It is not going away. We already knew that MU had been identified as an integral part of a new program called MIPS under MACRA, the regulations for which are still being written by CMS. MACRA, the legislation that replaces the Medicare Fee Schedule’s SGR calculation, becomes effective in 2017, with a new schedule of payment adjustments (a.k.a. incentives and penalties) beginning in 2019.

Slavitt’s “announcement” was clouded by uncertainty, but was greeted, nevertheless, with great jubilation and high expectations, some of which were dashed by the clarifications published in the subsequent CMS Blog. In his speech, Slavitt had provided little insight into exactly how MU will be restructured. It begged the questions: Will the changes to the requirements be radical enough to be perceived by physicians as “something better?” What will become of the Stage 3 Rule, which is currently undergoing finalization and is due to go into effect in no later than 2018? And, will the MU penalties scheduled for 2017 and 2018 remain in effect or be eliminated? The CMS Blog answered some of these questions, to the disillusionment of many providers:

  • The current law requires that we continue to measure the meaningful use of ONC Certified Health Information Technology under the existing set of standards.
  • We encourage you to look for the MACRA regulations this year; in the meantime, our existing regulations—including meaningful use Stage 3—are still in effect.

Despite the myriad details yet to be determined, what we do know about the future is that physicians will increasingly be rewarded for quality over quantity of care. Therefore, a critical component of the new government programs will be the demonstration and reporting of improved patient outcomes (most likely in PQRS fashion). We can also be confident that MACRA (and any new version of MU it contains) will demand heightened interoperability and patient engagement, and physicians will have to meet requirements that support these goals.

The question of timing notwithstanding, should you be excited about this announcement? I would suggest cautiously so. We are optimistic that the anticipated changes will bring some relief from the unnecessary administrative burdens with which physicians have been struggling and let them get back to focusing on the practice of medicine. But unless concomitant changes are forthcoming on ONC’s side to streamline the excessive EHR certification requirements on the books for 2017/2018, EHR developers and vendors will still not have the necessary time or freedom to focus on innovations that would deliver the efficiencies and clinical benefits that would be of maximum value to physicians and their patients.

As always, SRS will keep you up to date on all developments in this area as they are revealed over the next few months. Please feel free to contact Lynn Scheps, Vice President, Government Affairs, if you have any questions.

Have It Your Way

Dr. Armstrong's Starbucks CupHalf-Caf, Half-Sweet, Non-Fat, No-Foam… and a Latte EHR Choices for the New Year

In 1974, Burger King changed the face of the fast food world when they rolled out their first “Have It Your Way” commercial. This slogan represented a completely new way of thinking among burger chains: one that revolved around the customer’s needs. “Hold the pickle. Hold the lettuce. Special orders don’t upset us.” Basically, BK was asking their clients to tell them what they wanted—rather than feeling bad for requesting something special.

More than 40 years later, Starbucks has grown an international empire known for serving up exactly what the individual wants. So my question is, in an age when we can satisfy specialized needs for the average Joe, why would we feel that a one-size-fits-all EHR is right for specialist physicians?

The answer is simple: it’s not. HIT solutions created to satisfy the biggest economic verticals—primary and inpatient care—cannot provide optimum productivity for specialist practices. They simply aren’t designed for it. That’s why, according to periodic AMA surveys, 2014 satisfaction rates fell to a staggering low of 34%. Specialists are especially dissatisfied, using HIT solutions that were simply built for someone else—solutions built to serve the masses rather than highly focused specialist practices.

These high-volume, extremely efficient businesses don’t run better by using an EHR focused on capturing maximum data instead of the right data. Specialists are finding that rather than providing greater productivity, generic systems create friction and get in the way of their patient interactions. Outside influences such as government regulations further dictate the development of one-size-fits-no-specialist “solutions” that are based on meeting unnecessarily cumbersome and challenging MU and PQRS requirements.

The good news is, the New Year brings innovative new HIT tools tailored for specialist practices. It starts with taking a new look at what an EHR really is: the hub where all other technologies connect. Just as specialists have a narrow focus, so does a specialist’s EHR. Given the robust ecosystem of different medical technologies needed to deliver the entirety of modern medicine, it’s a challenge for any single vendor to excel at everything. Focused tools provide physicians with the right means to expertly address each protocol.

To tweak Burger King’s famous tagline, it’s time to “practice your way.” Start by asking questions in four key areas:

  1. Evaluate the physician-patient experience. Would your patients be better served by a physician-centric model that allows you to practice the art of specialty medicine your way?
  2. Compare your legacy-model EHR against newer alternatives. Is your current solution optimized for your specialty, or do you find yourself creating workarounds?
  3. Prepare for frictionless data exchange. Does your specialty care really benefit from collecting more data than you need as you work toward a more seamless data exchange and fulfillment of government requirements?
  4. Future-proof your specialty practice. Is your business positioned for future growth in a way that increases your specialists’ productivity, enhances patient care, and takes advantage of innovative technologies?

If the answer to any of these questions is no, perhaps it’s time to place a different order. Perhaps we can talk about it over a cup of coffee?

Send us your special order!

Can Innovation Be the Cure?

clock-blogTechnology has revolutionized almost everything. From the way we consume music to how we engage in commerce, the entire experience has been dramatically transformed to make our lives better, more efficient, and in some instances to provide us with services that we could only have imagined just a few years ago. Consider how we currently use GPS in our cars versus how we navigated to our destinations just a decade or so ago. However, Healthcare Information Technology (HIT), and EHR in particular, has been one of the few industries that has not taken full advantage of the digital revolution.

Despite this, I believe that all is not lost. Although EHR solutions remain highly inefficient, I am convinced that many real, practical problems that couldn’t otherwise be solved in the analog world—such as identification of drug interactions, clinical-decision support, and machine learning to identify result-driven workflows—are now ripe to be addressed by digital technology.

Why now? The answer might surprise you—it can, at least partially, be credited to the meaningful use regulations. Don’t get me wrong, the negative unintended consequences of the MU programs have been well documented, from the inefficiencies and overhead burdens it has created for healthcare professionals, to the consolidation of the EHR industry, to the commoditization of EHR. There are plenty of cons to go around, but there are pros that, if leveraged properly, could form the foundation that the industry needs to achieve the ultimate goal of better outcomes and reasonable costs for everyone. What are some of these advantages? Patient charts are finally in some type of digital format, information sharing is beginning to be a reality, and interoperability among various systems is not just a buzzword that you read in articles and blog posts and hear at conferences—vendors are now allocating big dollars towards achieving it.

Make no mistake: healthcare professionals will always be at the center of the decision tree when it comes to how you and I are treated for medical issues, but leveraging advancements in computer science such as artificial intelligence (AI) and predictive algorithms can support more informed decision making. With AI, the abundance of data, and the right tools to analyze it, workflows can be better adapted to each professional’s specialty and needs, patients can engage in their healthcare, and treatment plans can be better optimized.

Today, many healthcare professionals hate their EHRs, and over 40% say that “EHRs interfere with the doctor-patient relationship.” It’s time we take on this issue. If providers, vendors, and patients join forces, we might be able to unleash the next generation of solutions and supercharge the healthcare digital revolution. I believe innovation is the just the cure we’ve been searching for!

What innovators are you looking for? What HIT innovation would you like to see?