Healthcare Informatics 8/10/12

Meaningful Use Attestations Show the Rich Get Richer

Meaningful Use charts and graphs are a dime a dozen these days. As much as I’d like to add another bar or delicious pie chart to the mix, I just can’t bring myself to do it. I have no reservations about creating maps from the data, though.

For the uninitiated, GeoCommons offers a convenient way (despite a few errors) to do some quick mapping. Find my map with the datasets I loaded here if you wish to follow along or play around with it yourself.

But back to Meaningful Use.

As you can see, the vast majority of attestations are coming from what we know to be highly populated areas. However, there are a few exceptions in places like Duluth, Minnesota, which is not known to be a bustling metropolis. To help explain some of these, I brought in another data set: the locations of the HIMSS Stage 6 and 7 Hospitals. Yes, yes, I know these are EP attestations and I’m bringing in hospitals, but the vast majority of those attesting are connected with larger hospital organizations.

Loading in the locations of the Stage 6 and 7 sites, you can now see that a lot of those little exceptions are taken care of. Duluth, Boise, Hays, etc. There are still exceptions, but a lot fewer than before. Many of the HIMSS top stage sites also come from densely populated area. HIMSS has this to say about their Stage 6 users in particular:

The total revenue metrics for Stage 6 hospitals ranged from a little less than $100 million to over $1 billion.

And this:

The average ratio of IT capital budget to IT operating budget for this group is 30 percent.

In other words, these are all places making a lot of money and devoting a lot of money to their IT budgets.

Why is this relevant? Meaningful Use is supposed to encourage those physicians that wouldn’t already be moving to an EHR to get one. Instead, those organizations that are already technologically advanced and making a lot of money are the ones doing the attesting.

Maybe there’s a correlation, then, between EHR using communities and overall health. The goals of Meaningful Use specifically included alleviating health disparities and improving outcomes. Let’s compare the attestations with the top 10 healthiest cities according one survey.

Some alignment exists. Maybe the vendors are right – EHRs really do mean better health. Let’s compare with the top 10 unhealthiest cities, though.

Hmmm, more alignment. So the use of an EHR in a community matches the healthiest and unhealthiest communities? Time will tell if health outcomes actually improve with Meaningful Use, but let’s give it the benefit of a doubt and say it does for second. Shouldn’t the incentives be going to the rural areas and those that don’t have a big IT budgets? Right now, it just seems that those rich with big IT budgets and progressive technology are just getting … well, richer.

Feel free to add your own data sets and see what you come up with.

Aaron Berdofe is an independent health information technology contractor specializing in Meditech’s Medical and Practice Management Suite and EHR design and development.

News 8/9/12

The 20-location Physicians Immediate Care LLC contracts with Practice Velocity for its VelociDoc EMR and PM software.

CareCloud hires former Practice Fusion and athenahealth exec Edwin Miller as VP of product management.

Dr. Dennis Gottfried of the University of Connecticut Medical School provides some straight talk about ambulatory EMRs, which he says are expensive, time-consuming to implement, and decrease office efficiency. He also notes that because EMRs produce more complete documentation, they raise healthcare costs since better documentation allows physicians to charge more for the same services. An excerpt:

The theoretical benefits of an electronic record are not matched by its actual performance-a performance that increases costs but detracts from clinical efficiencies and does nothing to improve patient outcomes. Although the adoption of EMRs is one of the few health care measure to enjoy bipartisan support, the technology is not good enough to warrant that enthusiasm.

Allscripts reports its Q2 results, which were below analyst estimates: net income of $8 million ($0.04/share) from $15.9 million ($0.08/share) a year ago; revenues of $370 million compared to $357 million last year. The company also lifted its adjusted EPS outlook for 2012 to $0.77 to $0.83/share; previous guidance was $0.74 to $0.80/share.

NoteSwift announces the availability of NoteSwift for Allscripts MyWay EHR. I’ve never seen the technology, but apparently NoteSwift works with Nuance’s Dragon Medical Practice Edition to capture the entire patient visit. If you are going to the Allscripts ACE convention next week in Chicago check out a demonstration of NoteSwift with Allscripts Pro or MyWay and let me know what you think.

MED3OOO customer Family HealthCare Network (CA) receives more than half a million dollars in EHR incentive payments using InteGreat EHR.

Occasional HIStalk Practice contributor Dr. Lyle Berkowitz provides some expert commentary in a Wall Street Journal article evaluating various telemedicine service providers. Berkowitz’s bottom line is that telemedicine services can be convenient for quick consults but should not replace treatment from a patient’s own health system.

Email Inga.

Joel Diamond 8/8/12

Accountable Care Organizations

I have this deep dark fantasy I want to tell you about.  I’ll admit that it’s unlikely that I will ever obtain it, and even if by chance I could, it’s doubtful that I would really know what to do with it. (Get your mind out of the gutter… it’s not twins.)

I was referring to an Accountable Care Organization.

The truth is that before we become a nation of well-intentioned “Accountable Care Organizations,” we must inevitably concede our current state as Unaccountable, Don’t care, Disorganized  (Everyone’s Readmitted).

Hey, wait a minute… I just realized that makes an acronym: UDDER. A rather apt visual of insatiate calves, hungrily sucking on the proverbial government teat.

But I digress.

Speaking of acronyms, if you Google ‘ACO,’ you’ll find a long list of other official definitions. Use your imagination and a few of these seem to actually work as metaphors of our national experiment in payment reform:

• Algorithms, Combinatorics, and Optimization
• Automatic Cut Off
• Ant Colony Optimization
• Animal Control Operation

Apropos of nothing, I include another actual ACO listed here, for no other reason other than I personally found it extremely funny:

• American Cornhole Organization

Sorry.

I guess that’s the point, though. The term ‘Accountable Care Organization’ is ambiguous and offers no insight into what it actually is. Its abbreviation, in fact, might better connote what might Actually Come Operational only in some American Congressman’s Op-Ed piece. (Notice the clever way I incorporated the letters A-C-O twice in that last sentence…  I continue to amuse myself.)

Here are some probably more realistic ACO acronyms:

• Actually Can’t Operate
• Aspirin Costs Onehundreddollars
• Accept Colonic Opening
• Ain’t Covering Oldpeople

Seriously, there is no doubt that all of us need to have skin in the game if we are ever to reduce the economic burden that healthcare places on this country. Ongoing efforts to align financial incentives through shared risk clearly makes sense. The need for integrated data, improved analytics, and intelligent point-of-care quality improvement interventions are the great responsibility of the HIT community.

Since I can’t really think of a better term than ACO, then at least let’s make sure that the emphasis is on “care” (i.e. compassion) in organizations that are accountable to their patients first.

Joel Diamond, MD is chief medical officer at dbMotion, adjunct associate professor at the Department of Biomedical Informatics at the University of Pittsburgh, and a practicing physician at UPMC and of the Handelsman Family Practice in Pittsburgh, PA. 

News 8/7/12

Montefiore Medical Group (NY) deploys Phytel’s population health management tool to identify and manage patients for preventative and chronic care.

The AAFP issues a statement expressing support for electronic prescription drug monitoring programs and the interstate exchange of prescription drug registry information to reduce the abuse of opioid analgesics for pain control.

Market analysts say the economic recovery has helped drive a 5% increase in physician visit volume in the second quarter of 2012 compared to a year ago. Another contributing factor: the growth of high-deductible insurance plans include no out-of-pocket costs for preventative and other primary care services.

The Tucson paper profiles Jeffrey Selwyn, MD an self-professed EMR skeptic who seven years ago was the last physician in his eight-provider group to adopt NextGen’s EHR. Despite having to initially cut back on his patient load, he soon was “amazed at what it did to enhance care” by boosting the continuity of care and allowing for electronic chart sharing. Selwyn is now chairman of the board of the ACO Arizona Connected Care and has elected to defer his retirement to help other physicians convert to EHRs.

E-mail Inga.

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.