From the Consultant’s Corner 8/4/12

Business Intelligence: Shifting from Generating Reports to Creating a Body of Knowledge

Five years ago, the industry was buzzing about the concept of "business intelligence." Large, sophisticated healthcare organizations were gathering lots of data and running many reports in an attempt to answer key business questions. While this scattershot approach provided insight into certain aspects of the organizations, it did not help paint a comprehensive picture of enterprise-wide performance.

The reality is business intelligence isn’t about the amount of data or types of reports your organization generates. It involves creating a body of knowledge about your organization’s patients, care, and costs that you can use to drive process improvement, reflect compliance, and support decision making.

What I’ve noticed in talking with healthcare organizations around the country is that the art of leveraging business intelligence is not just for the large, sophisticated hospital or medical group any more. It is now a necessity for any organization that wants to survive and grow.

In fact, in the current age of data-driven healthcare policy—including Meaningful Use, patient-centered medical home, and healthcare effectiveness data and information set (HEDIS) requirements—organizations of all shapes and sizes need to use business intelligence to not only demonstrate compliance but, more importantly, to get paid.

A first step in the process of leveraging business intelligence is to take some time and clearly define what your organization’s approach to it will be. As part of this effort, I recommend creating a team of business intelligence consumers who can work together to determine what information is really needed and how your organization will use this key information.

The team’s membership should be diverse and include multiple perspectives, such as finance and accounting, clinical, and quality. The chief medical informatics officer (CMIO) should play a critical role on the team because he or she will bring both the business and the clinical perspectives to the table.

Note that the role of this group is not to figure out the technical aspects of gathering business intelligence. Leave that to the IT folks. This group needs to figure out the strategic goals for business intelligence and decide how the organization will use all the information it gathers. The ultimate purpose of business intelligence is to supply usable data that help develop better care for a better cost, so in my view, the team should be focused on things like how to develop a picture of overall performance, clinical quality, and patient satisfaction. BI should also reliably identify gaps in care and ways to improve revenue cycle efficiency.

I would caution you when taking this strategic look to consider not just what your organization needs now, but also what it will need five years down the road. As I mentioned earlier, many healthcare organizations used to take a more limited view of business intelligence and focused their attention on generating volumes of reports. Now these organizations are replacing many of the systems they purchased five years ago because they don’t have the bandwidth and capability to do what is necessary to meet current information needs. Your organization can avoid making this same mistake by focusing on the future, so that five years from now, you are optimizing solutions for business intelligence not replacing them.

Kyle Swarts is regional vice president for Culbert Healthcare Solutions.

News 8/2/12

The HIT Policy Committee’s Meaningful Use Workgroup presented its preliminary draft recommendations for MU Stage 3 on Wednesday, planning to present the final draft in November. Some notable recommendations impacting EPs include:

• More than 50% of all prescriptions written by an EP are compared to at least one drug formulary and transmitted electronically.
• Implement 15 clinical decision support interventions related to five or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period.
• Enable functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period.
• Store more than 80% of all clinical lab results ordered by the EP into the EHR as structured data.
• Present real-time dashboards of patients with specific conditions for quality improvement, reduction of disparities, research, or outreach.
• Record electronic notes in patient records for more than 30% of office visits within four calendar days.
• For non-English speaking population, provide additional patient education materials.
• Engage at least 15% of patients in secure messaging communication with EPs.
• Support the electronic receipt of immunization histories from an immunization registry or information system for at least 30% of immunized patients.
• Offer at least 10% of patients the option to submit histories or clinical data online.

Pine Medical Group (MI) says that its use of SRS’s Continuity of Care Exchange (CCX) platform to share discrete clinical data with the Wellcentive registry has resulted in increased practice revenue and helped the practice meet PCMH care management requirements.

Kareo CEO Dan Rodrigues advises physicians on the use of technology to thrive in business. Specific recommendations include eliminating paper, sharing office space with other practices, and using social media to get referrals.

GE Healthcare IT reports that its customers have received more than $100 million in MU incentive payments since the program’s inception, including 4,250 EPs earning $80 million using Centricity Practice Solution or Centricity EMR.

Thanks to the reader who forwarded this link to CMS’s a 15-minute video slideshow, which overviews the PQRS and e-prescribing incentive programs. It’s a nice tutorial for someone who wants to learn the basics of the programs.

Hello Health announces the addition of 20 practices to the Hello Health Electronic Medical Revenue Platform.

Latest MU numbers from CMS as of the end of June:

• Medicare and Medicaid have issued over $6  billion in payments.
• Medicare has paid more than $1 billion to 62,177 EPs (including 55,275 physicians).
• Medicaid has awarded 46,136 EPs (34,067 physicians and more than 9,000 PAs/NPs/MWs) a total of $963 million.
• Family practice and internal medicine specialists represent 43% of all doctors or medicine or osteopathy receiving MU funds.

Speaking of CMS, Medicare.gov issued a Tweet today reminding EPs that October 3 is the last day to start their 90-day MU reporting period for calendar year 2012. That’s just over 60 days from now, meaning if you don’t yet have a certified EHR in place but want to attest for MU funds, it could possibly be too late to make a purchase or implement an upgrade.

Minnesota achieves the highest rate of e-prescribing use in 2011, with 61% of prescribers routing prescriptions electronically. Massachusetts and New Hampshire had the highest physician adoption rate at 86%.

One-third of US physicians say they will leave medicine within the next decade, including more than half of all hematologists and oncologists. Their primary drivers are economic (medical malpractice and overhead costs) and regulatory (health reform changes.)

E-mail Inga.

DOCtalk by Dr. Gregg 7/28/12

Days of Whine and Proses

In the midst of just another day of too many patients with far too many unexpected problems squeezed into far too few time slots within which were too few moments to reflect and consider, I had an epiphany: I, we, all of us in healthcare delivery are living in the midst of the Days of Whine and Proses.

The Whine? We are still, as I said several years back, in the very midst of the birth pangs of the delivery of this huge "enfant terrible" known as digital healthcare. We are whining about the fact that this infant was ever conceived, we’re whining about the cramps, and we’re whining about the lack of an epidural equivalent.

We whine because it costs us money. We whine because it costs us time. We whine because it invades our processes. We whine because it intrudes upon our interactions.

We whine when it doesn’t work at all, when it doesn’t work correctly, or when it just doesn’t work exactly the way we want it to. We whine when it is less than perfect even when we don’t really have a true reference for just what such perfection is.

We whine because it is different from what we know.

On this particular day, I found myself in the midst of an unspoken internal whine about a merely tangential HIT issue. I had just realized that all of the prose I was "prosing" as I attempted to document by point or by click, by dropdown or by pop-up, by two-fingered typing or by fat-fingered falter was fairly futile.

My whine wasn’t just bemoaning the fact that the process of digitization of my thought processes was far from an enjoyable experience. And, it wasn’t a whine about the less than optimal ergonomics still involved in mental to machine interpolation.

No, within the soundproof walls of my internal mental monologue was a whine about all of the prose I was digitizing for near eternal salvation to be forever lost within the silent world of HIT Neverland.

Think about it. We spend hours each week away from our families and friends, away from the actual act of caring for the health of our patients (or ourselves), away from sleep or supper just to document items and issues with details, many of which, if not most of which, will never be read by anyone, ever.

Every single provider, every one of us, whether digitally or pen-and-paperly, spends countless portions of our working lives documenting things large and small which will never be noted by another human being as having ever been so documented.

Nobody is ever going to read virtually any of the hundreds of thousands of times I’ve written (or clicked) that a tympanic membrane was clear. Few will ever note any of the tens of thousands of exudative pharyngeal tonsils I’ve documented. Only rarely will anyone ever notice any of the thousands of soft systolic heart murmurs heard over all of those left sternal borders that I so meticulously marked down.

I realize that all of those pertinent negatives and their typically more glamorous counterparts, the pertinent positives, are important to note and to note down. But, just thinking about how many numbers and letters and words and phrases I have documented over the years which no one will ever, ever read and then multiplying that by the millions of healthcare providers across the globe who are doing similarly, I found a whine I had never before considered – that is, we are generating billions, maybe trillions, of these precious pieces of pertinent prose for the purpose of… what?

If a tree falls in the woods and no one is around to hear, does it make a sound?

If a documented finding is never read again, was the documentation of that finding worth the time it took to document? Is the disk space it consumes worth the electromagnetic energy it takes to maintain it?

I’m not even thinking about the appropriate answers to those rather rhetorical queries. I’m just whining… whining about all the prose, all the prose that nowhere goes, here in the Days of Whine and Proses.

From the trenches…

“This is the way I look when I’m sober. It’s enough to make a person drink, wouldn’t you say?” – Kirsten Arnesen Clay in Days of Wine and Roses, 1962

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of the Future exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 7/26/12

From Old timer “Dr. Michael Stearns. Thought you might be interested in this press release.” Old Timer forwarded me a copy of a press release prepared on behalf of former e-MDs president and CEO Michael Stearns, who was abruptly fired earlier this month. Not unlike e-MDs’ press release announcing Stearns’ departure, Sterns’ statement is short on specifics and does not provide any additional insight into the nature of the allegations, nor whether a lawsuit may be in the works. An excerpt:

“Very little additional information has been shared, but e-MDs claims they received allegations limited in scope to potential violations of company policy. We know with certainty that any such allegations were only partially investigated. My replacement, Dr. David Winn, founder, board president, and majority owner of e-MDs, was immediately reinstated as CEO. I am disappointed that e-MDs took the unusual step of publishing what amounts to unsubstantiated allegations that have not been subject to due process, in particular given the potential harm false claims may have on an individual’s family and on their reputation. Yet, despite this unfortunate turn of events, I am proud of what we accomplished during my tenure at e-MDs and I wish their staff and customers well in the future.”

From Numbers skeptic “Re: attestation numbers. Attestation numbers by EMR continue to look anemic. It might be interesting to show a graph of the number who have attested, divided by the number who use the EMR. For example, eClinical and Practice Fusion each boast well over 50k users; that makes the number who have used the program to successfully attest woefully small.” While the graph you are suggesting might be an interesting data point, I don’t think it would give much insight into whether or not a product is Meaningful Use-friendly. Note that the CMS data does not include attestation data for the 41,000 EPs who have qualified under state Medicaid programs. A provider with a heavy Medicaid population probably has less disposable income and is more likely to select a lower-priced EHR solution, such as Practice Fusion or eClinicalWorks. Also keep in mind that many providers are not necessarily interested in attesting for MU, even though they want a functional EHR. For example, an orthopedic surgeon may want a basic EHR but believes a $44,000 bonus is inadequate incentive for changing practice workflow, if it were required to meet MU requirements. He/she may elect to go with a low-cost solution, or, may implement an EHR better suited for orthopedic-specific workflow. I love to crunch numbers but developing reasonable conclusions can sometimes be tricky.

The 30-physician EyeCare Associates (AL) consolidates 19 PM systems with the deployment of EMRlogic Systems’ activEHR PM solution.

Doctors Access, a PM company and division of iPractice Group, partners with CareCloud to offer its 500 users access to CareCloud’s Doctors Access Pro PM software.

Practice Fusion names Riyad Omar general counsel (NewsRight) and Patrick Dugan (Bloodhound) VP of corporate development.

The American Board of Internal Medicine (ABIM) announces that CMS will include ABIM’s Maintenance of Certification program in its 2012 PQRS Maintenance of Certification Program Incentive, meaning ABIM board certified physicians can earn an additional .5% bonus payment beyond the standard PQRS incentive.

The ONC’s HealthIT.gov Website publishes information to help providers calculate the cost of purchasing an EHR. Key considerations include the cost of hardware, software, implementation, training, and ongoing fees. Based on input from RECs, the ONC estimates the total cost of ownership over five years for an-office EHR is $48,000, compared to $58,000 for a SaaS option.

The AMA launches the Cutting-Edge Contracting Group, an online community to help physicians evaluate and negotiate payment options and contracts with managed care organizations.

E-mail Inga.

News 7/24/12

CMS posts updated data on MU attestations by vendor. On the ambulatory EHR side,  Epic accounts for twice the number of attestations compared to the next closest vendor, Allscripts, whose numbers are a roll-up of four different products. More than 70,000 EPs attested using products from over 300 vendors, but the top four vendors made up almost half of all the complete ambulatory EHR attestations. I used Excel to massage these numbers and just this simple graph was a bear to create. If you like to number crunch, you might want to find a more robust reporting tool.

Providence Health & Services plans to deploy Nuance’s Dragon Medical 360 voice recognition technology across its 250 clinics and 27 hospitals. Over the next year, Providence will integrate Dragon with Epic EHR for the health system’s 8,000 clinicians.

Rep. Michael Burgess (R-Texas) introduces legislation to extend Medicare physician payment rates for one year as Congress continues to work on a payment program to replace the current sustainable growth-rate formula.

CalHIPSO adds Mitochon Systems, Medstreaming, and Meditab/SuiteMed to its list of EHR vendor partners. CalHIPSO’s CIO notes that the new vendors offer “an economical option for small and solo practices that are ready to adopt an EHR.”

Lifelong Medical (CA), Summit Orthopedics (CO), and Midwest Eye Care (NE) implement Indigo Indentityware’s SSO and authentication solution along with BIO-key International’s fingerprint biometric software to access their EMRs.

Arthritis and Rheumatology Associates of Palm Beach (FL) selects TSI Healthcare to deploy, train, service, and host their NextGen System.

Curious: Safe Future ACO, a South Florida organization with a pending CMS application to named an ACO, posts an ad on Craig’s List recruiting physician participants. The posting offers primary care physicians the opportunity for shared savings of up to $100,000 a year.

A June report by the Office of the Inspector General reveals that eClinicalWorks is the single most utilized product by the 1,500 Medicare physicians participating in a 2011 survey.

E-mail Inga.