When Is an EHR Like a Tesla?

091214-blogMany of us simultaneously adore and fear the high-tech gadgetry that has entered our day-to-day lives. We adore the benefits today’s technology can bring—convenience, speed, connectivity—yet we fear the ramifications of the unknown. From mobile phones to golf clubs, there are so many choices out there, and we all want to make the right choice. But how do we determine what is right for us? Ironically, our high-tech decisions are usually made in a very low-tech way—through discussion with people we trust. In my circle, I’ve always been the one that friends and family have come to for insights on all things technological.

I’ll admit I’m a technophile, but with a caveat: I’m only for technology that actually helps our lives in meaningful ways. Just because a new gizmo exists doesn’t mean it is right for my life—even though many times, it’s just that it’s not quite right, quite yet. I’ll give you an example: lately, I’ve been getting barraged with questions about cars with alternative-fuel sources. Most often I’m asked, “When are you getting a Tesla?” My response, “Not now,” seems to surprise those who know me.

Don’t get me wrong. I wholeheartedly support the inroads Tesla is making in bringing electric-powered cars into the mainstream. These are gorgeous automobiles that are winning awards from all the right sources for everything from performance to safety. Those who have them brag about being on the leading edge, and with every right. But if you dig a little deeper, you’ll find that some of these proud owners are plagued with a fear... a fear that, at some point, they will literally run out of energy because there aren’t enough charging stations. The infrastructure simply is not in place yet. So if I run out of electricity—a very real possibility—I don’t care how amazing these cars are; I’m still stuck, and may as well be driving an AMC Gremlin.

What does this have to do with what I do? Meaningful use makes many high-tech demands of the physicians we serve in the HCIT industry, and it seems that some of those demands don’t consider the implications to the physician in a practical application. Why are doctors—whose time is best spent interacting with patients in a very human way—being relegated to capturing every bit of data imaginable when chances are they will only leverage a very small portion of the information? This is especially true when that data (a) may not be relevant to every patient and/or practice, and (b) may not ever be shared because the information superhighways for this exchange are still under construction.

The right data is critical, of course, and that’s something that medical professionals have long been experts in diagnosing. So what happens when a shiny new EHR technology suddenly makes unreasonable demands on doctors’ time, but with limited tangible benefits? We start to interfere with meaningful patient interactions, and practice-wide productivity, in the name of compliance. Again, the right technology will help in the right way—and in our industry, I believe that means IT solutions that help doctors do more of what they do best: spend meaningful time with patients, and do it more efficiently and with better outcomes.

So if you want to know when I’ll consider getting a Tesla, the answer is when the proper infrastructure is in place to handle it. Until then, I’ll find the vehicle that best serves my needs today and in the foreseeable future. And if you’re looking for my advice regarding mobile phones, golf clubs, or EHR solutions, it’s exactly the same.


Tomorrow’s Technology

As a product manager in the healthcare information technology industry, I speak with customers, potential clients, partners, and competitors on a regular basis to identify emerging trends. For the most part, the feedback is actionable and concrete—there is a market need that is both urgent and pervasive, and, if solved correctly, will bring value to our customers. However, recently the topics on everyone’s minds are more abstract. They are monolithic concepts like “interoperability,” “big data,” “analytics,” “outcomes,” and my favorite: “population health management.”

Every year the research and advisory company Gartner releases a “Hype Cycle” for various industries. It plots the most-talked-about emerging technology trends on a continuum, and, based on historical track records, estimates how long before that technology becomes productive. Below is the continuum and what the stages actually mean. This year’s release includes three technology items that reflect the concepts mentioned above. According to Gartner, “Content Analytics,” “Big Data,” and “Mobile Health” are 5–10 years from becoming productive technologies that are widely embraced and, more importantly, bring value to customers.

Gartner-chartSource: Gartner, Inc.

At this point, some of you may be thinking, “I can’t wait for 5 years, I need these things today.” The good news is that many companies are racing to build, improve, or buy the technology to address all of these trends. Some already exist in the marketplace, and other new products or services will be launched in the near future. The bad news, as I see it, is that no one will get it just right on the first try. As with any other industry offering, we will see many iterations over the next few years. Each one will improve by using lessons learned from the last iteration. Ultimately, the market will decide which options add value to the practice and patient.

Although I am personally excited to see what the next few years bring, I do have a few words of caution for healthcare providers and practices who are looking to leverage these technologies. First, because these technologies are in their infancy, it is important that you provide frequent feedback to your partners. Let them know what works and what doesn’t. This will help them to develop the functionality that you value. Second, since all of these trends revolve around data, you must be willing to invest time in capturing it. If you don’t have it, you can’t analyze, exchange, or act on it.

I look forward to reading your comments and learning about your views.

How Do You Measure Success?

blog-tape-measureWhen we were kids, we had clearly defined measurements—from literally marking our physical growth each year by standing with our back to the wall, to earning grades, scoring goals, and more. While we couldn’t will ourselves to grow taller (no matter how hard some of us may have tried), we learned that we could work on the other metrics, and we learned the sense of satisfaction that comes with achieving measurable goals. That’s because we had leaders in life who taught us these things: principals, coaches, parents…

So what happened when we ventured out into the workplace? Unfortunately, many of us ended up working in companies where measurement was not built in to the management system. Perhaps it’s because, as adults, we no longer feel that sort of “supervision” is necessary. The fact is, however, that without defining what is most important to an organization—and then continually measuring the effectiveness of the ways we work together to achieve that objective—we simply cannot engage the minds and hearts of every individual on the team.

This is particularly true—and particularly crucial—in the world of healthcare, where the customers are people who are turning to physicians and medical staff for care that ranges from preventive through life saving. Leadership is critical to making sure that each patient gets the best your team has to offer, and every measurement should focus on that—including the measurement of vendors. The right vendors have put metrics in place to measure how well they help you achieve your goals.

That’s my leadership philosophy at work and in life. After all, it seems like if things don’t get measured, they don’t get done the right way, and you certainly can’t fix something if you don’t know that it’s broken. We’re all so busy that it’s easy to get distracted by “squirrels”—things that dart into our paths, taking our attention off of what’s most important. But taking the time to evaluate what your company can do for maximum customer satisfaction, putting metrics in place to ensure that everyone on the team knows how they can help achieve those goals, and regularly reviewing results to see how you’re doing—that’s probably the biggest value a leader can impart to an organization.

Perhaps it’s time to put some new metrics in place in your business to ensure that you’re providing the best service possible—and you can draw from industry analysis, staff, clients and vendors—to determine what those metrics should be. Because it’s human nature: we all want to know how we’re measuring up!


Kudos to CMS for MU 2014 Proposed Rule

Doctors clappingYou can hear the sigh of relief—albeit mixed with a bit of uncertainty-driven anxiety—as physicians await publication of the final rule that will modify meaningful use in 2014. By relaxing the timeline, the government has finally acknowledged what so many stakeholders have been arguing for a while: Stage 2 and upgrading to a 2014 Certified EHR simply required too much of providers, too quickly. The paltry number of Stage 2 attestations to date is evidence enough—by May, only 50 physicians had attested to Stage 2; by June, just 447 had succeeded; and by July (mid-way into the year), the number had reached only 972. To put these numbers in context, over 378,000 providers have earned EHR incentives for Stage 1.

The major challenges that prompted the government’s reconsideration of the meaningful use timeline are reflected in the 1,184 comments submitted to CMS—some of which express frustration with the demands of the program in general, but almost all of which wholeheartedly support the proposed changes. (My comments, submitted on behalf of SRS physicians, are available here.) The following are the most common challenges cited:

  • Availability of 2014 Certified EHR Technology (CEHRT) – But it’s not just about the products that are not yet certified or about vendors with insufficient resources to keep up with the demand for implementations. Many of the products that have been certified were rushed out under overly aggressive and unrealistic timeframes, which has left physicians faced with not-ready-for-primetime software.
  • Overestimation of market readiness for interoperability – Sufficient infrastructure is not in place yet, so even physicians who have implemented the DIRECT messaging capability cannot find enough “trading partners” with whom they can connect to share information.
  • Dependence on non-participating parties – It takes an extraordinary amount of effort to successfully coordinate with labs, radiology providers, long-term care facilities, and registries, who are not required to conform to standards promulgated under meaningful use.
  • Reluctance of patients to embrace portal utilization – The two portal measures (patients accessing clinical information and sending messages to physicians) are cited by many commenters as the major obstacle to MU success. Changing patient behavior in this regard is turning out to be even harder to accomplish than previously anticipated.
  • Excessive workflow challenges – Meaningful use necessitates operational changes to practice workflows that are, in the words of one commenter, “daunting, at best.”

The options proposed in the rule are summarized in a handy CMS Decision Tool and include reporting Stage 1 again, instead of Stage 2, and attesting using either a 2011 or 2014 CEHRT.

So what can physicians expect and what would be a good strategy to pursue as they wait for the final rule? CMS is promising—or at least hoping—to publish the final rule in early September. The 60-day comment period ended on July 21, and CMS is obligated to read and consider all of the comments before issuing the final rule. However, I think it is reasonable for physicians to assume that the final rule will be at least as flexible as the proposed rule—maybe even more so. CMS has been asked by many commenters to definitively spell out the conditions under which physicians could avail themselves of the various reporting options, which would address the uncertainty created by the lack of clarity in the proposed rule.

In the meantime, physicians should plan to attest for any quarter during which they have met all of the requirements under one of the options provided for in the proposed rule. It can even be a quarter that precedes the publication of the final rule. They should then aggressively turn their attention to upgrading to 2014 CEHRT—if they have not done so already—and to preparing for Stage 2. Remember: as flexible as the rule may be, it only offers a 3-month reprieve. Physicians who were to be at Stage 2 in 2014 must now be ready to start a full year of reporting on Stage 2, using a 2014 CEHRT, on January 1, 2015.

My First 15 Days as CEO

Turning a new pageI’m Scott Ciccarelli, the new CEO at SRS. Although EMR Straight Talk is industry-focused—not about SRS—in my first blog post I thought I would tell you a bit about my SRS experience so far—I can sum it up in three letters: ETP.

The “eager to please” culture permeates everything at SRS. Each individual I’ve had the pleasure to meet so far is bursting with dedication and a relentless desire to help—each other, our clients, and me. What a support network, where every desk is literally a help desk!

This commitment to ETP is the reason SRS has the highest customer satisfaction ratings in the industry; however, we realize that we cannot rest on yesterday’s success. Like all industry vendors, we work in an ever-changing and uncertain landscape, making use of rapidly developing—and sometimes unpredictable—technologies to cope with the onslaught of government regulations. The challenge for every vendor is to develop products that not only satisfy the government requirements, but also meet the clients’ needs for flexible and efficient solutions. SRS remains dedicated to this goal. If there is anything that sets SRS apart, it is our understanding that even for IT companies, it ultimately all comes down to people—after all, technology is created by people, and it should serve the people who use it. So, let me tell you a little bit about the people who are leading the charge at SRS:

  • Bob Harmonay, our COO, has an unrivaled passion for exceeding client expectations that inspires his team daily—and that is largely responsible for our Best in KLAS customer service and support ratings.
  • Joe Flynn, SVP of Sales & Marketing, champions communication as the path to growth—for SRS and for each of our clients, whom he and his account team ensure are informed and prepared to reach their practice goals.
  • Lynn Scheps, VP of Government Affairs & Consulting Services, is a leading resource on meaningful use and other government initiatives. She represents physicians’ interests with government officials and develops strategies to help practices respond effectively to the ever-evolving demands of government programs.
  • Jack Walsh, EVP of Strategy & Business Development, is responsible for strategic planning, building and nurturing partner relationships, and evaluating opportunities for enhancement of our product platform.
  • Peter Bennfors, our CFO, oversees all financial activities, from accounting to regulatory compliance. His experienced hand at the helm ensures that SRS will stay financially seaworthy and able to weather storms for many years to come.

I am truly grateful to have such a powerful leadership team in place. I look forward to adding my 20 years of Fortune 500 and HCIT experience to the mix and finding new ways to achieve our goal: helping physicians and other professionals provide the very best healthcare.

Please check back here every couple of weeks—or subscribe in order to receive new blog notifications—for no-holds-barred discussions about industry issues, company insights, and ways to keep making things better. I’ll also be featuring some very special guest bloggers, starting with the next blog post on August 1!

I’d like to thank everyone who has already made me proud to be part of SRS. Now I look forward to meeting and hearing from all of you readers. Tell me what you want to hear about. I’m all (ETP) ears.


Posted in SRS

Exciting Transitions are Underway at SRS and EMR Straight Talk

passing batonAfter 17 years as the founder and CEO of SRS, I am transitioning to the role of Senior Advisor. I am extremely proud of the position that SRS has come to occupy in the healthcare technology industry, and as I hand the company reins over to Scott Ciccarelli, a seasoned executive with extensive healthcare experience, I am confident that SRS will continue to make its mark.

Writing the EMR Straight Talk blog has been one of my passions since its launch on February 17, 2009, as President Obama signed the Economic Stimulus Package making “meaningful use” a household term. The purpose of the blog has always been to educate readers and to stimulate critical thinking about the issues that impact physicians, so the number and intensity of comments from readers has been particularly rewarding.

For more information about the transition at SRS, read today’s press release. I hope you will continue to read EMR Straight Talk as the blog undergoes its own transition.

Thank you for reading.

Best wishes for your continued success,

Evan Steele


Proposed SGR Fix – It’s Different This Time

Year after year, physicians live for months with the uncertainty and angst of threatened, often draconian, Medicare reimbursement cuts born out of the Sustainable Growth Rate (SGR) budgeting formula.  And every year, intense lobbying and complex negotiations lead to short-term patches that maintain or slightly increase reimbursement rates—these solutions are commonly referred to as the Doc Fix. This year’s fix is set to expire at the end of March, which would leave physicians facing a 23.7% reduction—but on Thursday, a bipartisan piece of legislation proposed a repeal of the SGR and the creation of a new payment model that would reward quality, rather than volume of care provided. All that’s left now is to figure out how to fund the $128 billion price tag over the next 10 years.

Although I haven’t read the 200-page bill, the following is a summary of its major provisions:

  • The SGR fix would increase Medicare physician reimbursement rates by 0.5% annually for the next 5 years, i.e., through 2018. This would provide income predictability and stability for providers.
    • 2018 rates would be maintained through 2023.
    • From 2024 on, physicians who participate in Alternate Payment Models would see a 1% annual increase; non-participants would receive 0.5% increases.
  • It would create a new payment system called MIPS (Merit-Based Incentive Payment System) by 2018, which would roll up meaningful use, PQRS, and the Value-Based Payment System into one program that would tie physician reimbursement to quality and cost. Physicians would be assessed in 4 areas:
    • Quality: based on current and future quality measures from the PQRS and Meaningful Use programs
    • Resource use: assessment of cost structure using a method similar to that currently in use in the Value-Based Payment Program
    • Meaningful Use: satisfying current meaningful use requirements demonstrated by use of a certified EHR
    • Participation in practice improvement activities: a new area of measurement related to clinical improvement.
  • Physicians would receive a composite score on all of the above.  Based on total score relative to other physicians, they would receive either:
    • A negative adjustment of up to 4% in 2018, 5% in 2019, 7% in 2020, and 9% in 2021
    • No adjustment
    • A positive adjustment of as much as 3 times the maximum negative adjustment for that year.
  • The new payment system would provide additional incentives (5% per year from 2018 to 2023) to providers who derive a substantial part of their income from alternative payment models that base payment on quality assessment and financial risk sharing rather than volume of services provided, (e.g., ACOs, Medical Homes, or other new healthcare delivery models).
  • It would encourage cost savings by incentivizing care coordination and adherence to Clinical Decision Support (CDS) mechanisms and Appropriate Use Criteria (AUC) aimed at reducing unnecessary testing—specifically in the area of advanced diagnostic imaging:
    • Effective 2017, physicians would be paid for advanced diagnostic imaging only if the claim shows consultation with CDS mechanisms and AUC.
    • Effective 2020, the 5% of physicians with the lowest adherence rates would require prior authorization for such tests.
  • Beginning in 2015, patients would have access to quality and cost data regarding individual physicians that would be made available on the Physician Compare Site.

MIPS would rely heavily on quality measurement, data sharing, and interoperability, so one thing is abundantly clear:  Robust EHRs and extensive data management capabilities will be critical tools for physician success in the future, even more so than they are today.