HIT Vendor Executives on Expectations and Plans for 2014 – Part Two of a Series

We asked several vendor executives a series of three questions related to their expectations and plans for 2014.

What emerging technologies will have the biggest impact on physician practices over the next 12-18 months?

Raul Villar, president, ADP AdvancedMD

“Big data” technology will grow significantly. With a continued push on Meaningful Use and the rise of ACOs, business intelligence and big data will have a profound impact on preventative care and on financial management of health care organizations including independent practices. With new technology, doctors will be able to immediately identify their at-risk patients, track and manage patients more closely, monitor the spread of diseases, and take preventative measures to keep patients from graduating to chronic diseases.

Mobile technology adoption will continue to increase over the next 12-18 months although we expect Apple and the iPad in particular to maintain dominance. This adoption will greatly contribute to physician freedom and flexibility and stronger patient care.

Jim Hewitt, VP of solutions development, Allscripts

Clients are telling us that population health management is a strategic imperative. Technology must be able to aggregate and harmonize data from multiple disparate systems and provide real-time reporting and alerts.

We’re also seeing a proliferation of third-party apps that have powerful possibilities in personalized medicine. Technologies that harness genetic and genomic information, for example, can help providers make better clinical decisions.

Todd Rothenhaus, MD, CMO, athenahealth

There will be a new class of technology and most important to note, a new class of services that will emerge. The big honking software systems that cost millions of dollars and take years to deploy are showing massive vulnerabilities. They’re too expensive, too taxing to run and update, they have gaps in their ability to truly manage populations of patients outside of single health systems, and they only get physician practices so far when it comes to plugging into the care ecosystem with which patients seek and get care.

While it’s taken too long in health care, it’s becoming clear that everyone does not need to be on the same system to share information and gain a complete view of care. Technology supported by services, will emerge that will make it possible for information to surround the patient as he or she moves between care settings, so physician practices can better connect, co-exist, and coordinate with hospitals. This new class of technology and services will make true care coordination possible and will provide the financial and clinical visibility necessary to manage risk contracts.

Physicians need to be looking for technology and services that can help them identify patients in need of care or adjustments in care, engage in proactive outreach to those patients, and steward them through their experience of care. It’s about advancing connectivity which static software can’t and won’t do.

When you look at all the start-ups and venture funding going into health care it’s all aimed toward the cloud. Many enterprise software systems are failing in a public way and because of these failures, as well as the capital expenditures they require, they’re no longer a low-risk move for CIOs. The cloud, and service oriented vendors, will have the biggest impact on all of health care in the next 12-18 months.

Albert Santalo, CEO, CareCloud

Mobile capability for an EHR or practice management system has obviously become vital for any vendor to offer their clients. Enhanced analytics and giving practices greater insight into their operations and provision of care will become paramount as well. We are doubling down on both these fronts in 2014.

Stephen Ober, MD, chief medical officer, Emdeon

Twelve to 18 months is a long time in the technology world.  During this time frame I believe we will see a variety of IT solutions:

1) An explosion of real-time apps informing a physician of critical information to improve care delivery. These will most likely come via mobile platforms. An example:  your patient is in the OR and ready for the procedure, here are the labs on your patient from this morning, your patient John Smith needs a refill of his prescription for Amoxicillin 250 mg QID.

2) Big Data analytics will also impact provider practices in 2014. For the first time, the industry can actually aggregate patient level data and provide feedback to providers with information on an individual patient’s overall health risk, etc. These systems can push out preventive care alerts (no flu shot was given to this patient) and also focus on chronic care (this patient hasn’t received an HbA1C this year). These results will be aggregated and can affect their overall reimbursement in 2014.

Patrick Hall, EVP of business development, e-MDs

Patient-facing tools will continue to become more robust, more expected (by patients), and potentially offer tremendous time and cost-savings for practices.  Practices will need to determine which technologies they can adopt.

Much like dealing with the omnipresent pharma marketing that has been known to have sometimes negative effects on the doctor:patient relationship, physicians will also need to learn how to communicate with patients about which technologies are useful, and which are not.

Tee Green, CEO, Greenway Medical Technologies

To address the previously mentioned challenges, physician practices will need to create a foundation for improved quality and efficiency by implementing an integrated system that streamlines electronic health records and practice management functions.

New technology solutions will also be required to extend important functionality to consumers, including patient engagement tools such as portals and care coordination resources.

Finally, there will be a variety of emerging technologies that help physicians better manage the clinical and financial challenges resulting from new value-based care models. These include population health management platforms, advanced analytics and clinically driven revenue cycle management systems that close the loop between clinical, administrative and financial processes. Together, these new technologies will help physicians better manage populations of patients as opposed to transactions of care while improving the financial sustainability of their practices.

Tom Giannulli, MD, CMIO, Kareo

I really believe that truly mobile EHR is finally having its day in the sun. This trend will only grow over the coming year. The technology has finally caught up with what physicians want. EHR vendors are now offering a full-featured native app for the iPad that allows providers to do almost everything on a tablet. The ease of use and simplicity of the truly mobile EHR allows providers to really engage patients instead of getting swivel chair fatigue as they turn back and forth from the desktop to the patient.

Nick van Terheyden, MD, CMIO, Nuance

MHealth and mobile speech will be the biggest technological enabler in allowing physicians to engage with patients. Patient engagement is the blockbuster drug of the 21^st century. Having patients regularly participate and contribute to their own care through mobile devices and apps, as opposed to being observers and receivers of care, will bring seismic changes to healthcare. Through mobile health, we will see a huge wave of people empowered in their care and the care of their loved ones, and ensuring everyone is fully engaged and part of the process will revolutionize the delivery of medicine.

This increased engagement will go hand-in-hand with the industry’s shift away from the current fee-for-service model. Coupled with the increased granularity that will result from the transition to ICD-10, these changes will transform the way we practice medicine. Emerging and existing technologies that enable these transitions and ease the burden on physicians during the evolution will be crucial investments for practices to make.

Irtaza Barlas, director of software engineering NueMD

Biggest impact of emerging technologies:

a) Online portals, EHRs, PHRs will reduce the waiting-room paper work. This potentially will also produce better quality data that will be used by data-mining companies to detect patterns and behaviors to empower the physician as well as the patients.

b) Wearable technologies’ (such as step counters, sleep monitors, etc) generated data may see more integration into the medical records systems.

c) Cloud-based PM systems will meet the challenges posed by ICD-10 transitions and MU2 interactivity requirements better then the older stand-alone, or client-server type systems.

d) Big data may become overwhelming. Developers and physicians will need to work together to sort pertinent data from irrelevant data and be able to present it in a clear, focused way. This will be imperative to have big data make a physician’s job easier as opposed to overwhelming.

Chip Hart, director of strategic marketing/sales director, Physician’s Computer Company

Medicine moves so slowly as a rule that it’s only now that fairly common and established technologies – texting, mobile phones, tablets – are poised to make the biggest impacts.

In our primary care world, “social media” is the elephant in the room. Some practices are starting to get savvy with Facebook, blogging, and Twitter, for example, and reaping the rewards.  The others will be left behind.

Michael Brozino, president and CEO, simplifyMD

Over the next 12 to 18 months we will witness practices continuing to replace their antiquated, server-based technologies with more efficient, flexible, cloud-based softwares that allow physicians to use their preferred workflows.

These more efficient, nimble technologies will offer physicians additional tools to access, manage and analyze clinical and financial data to better monitor patient populations. As government and commercial health insurers pursue payment models that reward physicians for achieving clinical quality metrics across populations, such as Accountable Care Organizations, Patient-Centered Medical Homes, and Meaningful Use of EHRs, data capture and analysis is crucial.

Physicians will need to incorporate technologies, such as EHR and PM systems, that will support their success in those programs by facilitating and, in some cases, streamlining their proven, effective practice workflows so productivity will be unaffected by increased data capture and reporting demands.

HIT Vendor Executives on Expectations and Plans for 2014 – Part One of a Series

We asked several vendor executives a series of three questions related to their expectations and plans for 2014.

What will be the biggest challenges facing physicians and physician practices in 2014 and how will these trends impact their use of technology?

Raul Villar, president, ADP AdvancedMD

In 2014, physicians in private practice will be challenged with mastering Meaningful Use, weathering the implementation of ACA within the industry and its impact on patient population and reimbursements, preparing for the switch to ICD-10, and juggling everyday issues and challenges to ensure today’s claims will get paid in a reasonable amount of time.

Compliance complexity in each of these areas dictates the use of automation solutions so physicians can focus on patients. This is especially acute in smaller independent practices that do not have the staff or IT departments to manage compliance.  In this environment it will be critical for practices to work with technologies and vendors with compliance upgrades included in their products and processes vs. those requiring the practice to shoulder the responsibility of upgrading technology to remain compliant.

Under ICD-10, the benefits of fully integrated PM and EHR solutions will be dramatic as practices are required to produce more complex charting and coding in their EHRs. Having ICD-10 compliant charts flow directly into billing in fully integrated systems will reduce errors and rework.

Jim Hewitt, VP of solutions development, Allscripts

2014 is going to be a very busy year for physicians and their practices. The biggest challenge for most practices will be managing their system upgrades for MU2 and ICD10. On top of that, they will continue to move to a value-based care model which will be a major operational and financial shift for them. They’re going to need technology to help them manage their risk-based contracts as well as proactively manage their populations.

The other big challenge for physician practices is implementing a patient engagement strategy to meet MU2 requirements. Not only do they need to implement a solution, they need to engage patient populations to use the technology.

Todd Rothenhaus, MD, CMO, athenahealth

You can’t think of 2014 challenges in health care without thinking of ICD-10. Our annual Physician Sentiment Index survey, completed in 2013, showed physicians’ confidence in their practice’s ability to transition to ICD-10 is extremely low with only 8% saying they were “very confident” that the transition would happen smoothly. ICD-10, for too many, will be difficult and another massive “must do,” that needs to get done – in addition to Meaningful Use stage 2, and perhaps most overwhelming, smack in the middle as physicians and practices work to navigate and understand changing reimbursement models and their associated expectations – most importantly the ability to coordinate care.

I think in 2014 we’ll also see a massive EHR shopping spree and replacement trend that will be driven by significant failings of vendors who didn’t adequately support things like ICD-10, Meaningful Use, and aren’t building network-based open platforms to enable their clients (physicians/health systems) to truly coordinate care across the continuum. The tides in health care are changing and so will the technology that is deemed necessary to survive, let alone thrive.

Albert Santalo, CEO, CareCloud

This is always top of mind for us, so it’s something we’re constantly asking physicians about. Just a few months back, thePractice Profitability Index (PPI) – which surveyed more than 5,000 physician participants regarding issues impacting the financial and operational status of their practices – found that three of the top four issues negatively affecting profitability for all physicians stemmed from healthcare reform, led by declining reimbursements (65 percent), rising costs (57 percent), Affordable Care Act-related requirements (48 percent) and coding and documentation changes, including ICD-10 (44 percent).

Stephen Ober, MD, chief medical officer, Emdeon

The biggest challenges facing physicians and physician practices in 2014 revolve around patient engagement in two themes:

1) continued interaction with patients after they leave the provider’s office, and

2) how to assure that  the practice is meeting the payer performance criteria they signed up for earlier this year. Providers have to engage patients through technologies (portals, cell texts, etc.) to continue the relationship after the acute encounter. From a clinical performance standpoint, practicing providers have to understand the metrics that the payers are evaluating them against. Some provider groups fail to push these criteria down to the practicing clinician.

Patrick Hall, EVP of business development, e-MDs

ICD-10 compliance will present a unique challenge. Practices will need to invest not just in technology, but also the time and effort to learn the new coding system and, depending upon how their vendors/partners deal with the change, potentially modify existing systems and workflows to make the transition.

Many physicians will also need to adapt to an increasingly “open” environment with respect to exposing information to patients through portals and other tools. Patients are starting to expect this and so physicians and their staff will need appropriate protocols in place with respect not to whether information is shared, but how and when in the clinical information cycle.

Tee Green, CEO, Greenway Medical Technologies

There are three fundamental trends that will create both challenges and opportunities for physicians in 2014 while impacting their use of technology. The first is the electronification of healthcare, which will continue to progress rapidly in the ramp-up to ICD-10 compliance, meaningful use Stage 2 and other industry changes. Electronic health records are only one component of this trend, and it’s evolving to include access to real-time clinical insight that is available inside and outside of healthcare settings.

A second trend is consumerism. Consumer expectations now drive fundamental changes to the way healthcare is purchased and delivered in our country. As individuals become increasingly responsible for a greater share of their healthcare costs, they will no longer accept inefficiency and redundancy in care. They also have high expectations around convenience. As a result, physicians must be more transparent about costs and quality, while making it easier for patients to engage in their care.

Another trend is an increased focus on improving population health as physician groups take on greater risk and accountability through value-based medicine payment models. Technology that can give physicians the ability to monitor clinical and financial metrics, while identifying and managing at-risk patients, will be essential to addressing this challenge.

Tom Giannulli, MD, CMIO, Kareo

2014 is going to be a year of big changes for healthcare providers. The biggest challenges are going to be ICD-10, ACA, Meaningful Use, and the ongoing shift to more patient-centered care. Each one of these comes with its own unique issues, and the use of technology will be invaluable all the way around. It’s a given that you need an EHR for MU and a good billing system for ICD-10. The gray areas are the ACA and the growing movement to more patient-centered care. We still don’t know exactly how these things will play out so a practice needs to prepare for the unexpected. To do that you need to optimize your practice with the most seamlessly integrated and robust practice management, billing, and EHR solution you can find.

Nick van Terheyden, MD, CMIO, Nuance

The ICD-10 transition will impact providers and their organizations the most in the year ahead. Under the new coding requirements, physicians will be mandated to document in a more detailed and complete way in order to justify the same care they’ve been delivering for years. From a clinician’s perspective, the transition will pull their focus away from  the patient and force them to devote even more of their time and attention to technology, documentation and administrative tasks. Added to the challenges physicians are already facing with EHRs, ICD-10 will create a perfect storm. As a result, we’re going to see an increasing demand for technologies that re-connect physicians with patients, and bring them back to focusing on the art of medicine, while still enabling them to meet the new regulatory and reimbursement standards.

Irtaza Barlas, director of software engineering NueMD

Biggest challenges facing physicians:

a) Given that the year 2014 may go down as the ‘the mandate year’, physicians in many specialties will be enrolling new patients. New insurance plans for new and existing patients will continue to be created that will make the medical billing potentially more complex.

b) Since 1979, physicians have been happily using the ICD-9 coding to classify diseases. With ICD-10 being introduced later this year, a major learning curve awaits the back office.

c) With more interconnectivity will come more headaches to manage patient data in a secured manner.

Chip Hart, director of strategic marketing/sales director, Physician’s Computer Company

As a practical matter, it’ll be ICD-10 and SNOMED.  The former is going to kill insurance company payments for an unknown period of time, which is a giant cash flow issue. The latter is going to change the EHR flow for many groups as their vendors race to comply with Stage 2 with a lot of time to get used to it.

Frankly, other obligatory demands will also be a problem – particularly from HIEs and the need to integrate with some newly (read: poorly) formed ACO. I really hope that last prediction is wrong.

Michael Brozino, president and CEO, simplifyMD

The impact of the Patient Protection and Affordable Care Act (PPACA), the transition to ICD-10, Meaningful Use Stage 2 and emerging value-based payment models are all challenges physicians and practices will face this year. These changes, along with increased clinical data demands from payers, can distract physicians from their core mission of caring for their patients while maintaining a profitable practice. To succeed in this environment, physicians need a flexible EHR and PM system that helps them work more efficiently so they can improve productivity while monitoring their quality of care metrics.

In 2014, many practices will be replacing their current EHR systems with ONC-certified software that supports their preferred workflow and improves productivity while complying with the demands of the PPACA, transition to ICD-10 and attestation of Meaningful Use Stage 2. These replacement systems will need to be flexible and customizable enough to evolve with the practice allowing physicians the ability to capture additional data for clinical quality improvement initiatives or financial data analysis.

News 1/16/14

A victory for transparency proponents: CMS announces it will consider on a case-by-case basis requests made under the Freedom of Information Act for information to find out much Medicare pays individual physicians.

CMS reports that as of the end November, approximately 60 percent of Medicare EPs are meaningful users of EHRs and 76 percent of Medicaid EPs have received an EHR incentive payment. Medicaid EPs are not required to attest for MU in advance of payment and a mere 17 percent of Medicaid EPs are considered meaningful users. That’s a pretty alarming gap, in my opinion. As of the end of November, EPs had been paid a total of 68 million in EHR incentives.

Allscripts reveals that its KLAS scores are on the rise with Allscripts Enterprise EHR up 11 percent for the 12-month period ending December 2013; scores for Allscripts Sunrise Clinical Manager increased four percent for the same period. KLAS is scheduled to release its annual “Best in KLAS” awards the week of January 24.

The 20-provider Urology Austin (TX) selects CareCloud Concierge for RCM and PM for integration with the practice’s existing HealthTronics UroChart EHR platform.

The ONC releases the Safety Assurance Factors for EHR Resilience (SAFER) Guides, which include checklists and recommended practices to help providers assess and optimize the safety and safe use of EHRs.

The Drummond Group certified Practice Fusion’s EHR Version 3.0 a 2014 Complete EHR on December 19, which is notable because Practice Fusion guaranteed its users that it would be certified by the end of the year. The guarantee required Practice Fusion to reimburse EPs up to $5,000 for out-of-pocket licensing fees for a third-party EHR if the company failed to meet the year-end certification deadline.

A report by Patient-Centered Primary Care Collaborative finds that practices following a PCMH model demonstrate  decreases in the cost of care; reductions in the use of unnecessary or avoidable services costs, such as ER visits; improvements in access to care; and, improvements in patient satisfaction. The impact on clinician satisfaction remains unclear.

CareCloud reports it closed 2013 with more than 520 new clients and finished its 16th consecutive quarter of triple-digit revenue growth.

Nearly 10,000 scribes work in ERs and physician offices inputting EMR data, according to a New York Times report. Typically scribes earn $8 to $16 an hour and are employed by services that collect $20 to $25 an hour from providers. Despite the cost, many physicians using scribes say they come out even or ahead financially because they are able to see more patients.

Hello Health introduces Hello Health Billing Services, an RCM solution to compliment its no-cost EHR and patient portal. Hello Health charges patients a monthly subscription for portal access that practices can apply against Hello Health’s billing service fees.

Athenahealth announces its roster of 21 solutions available in the athenahealth Marketplace.

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News 1/14/14

MedMatrix Solutions, a North Carolina-based medical billing service, files suit against a former client for prematurely terminating its services contract. The practice had signed a 12-month contract that included a termination option only if the billing service failed to provide adequate services. The billing service contends it provided services according to the contract but the practice canceled the agreement after just six months. It’s not clear why the practice terminated the contract but filing a lawsuit against a customer doesn’t seem like a move that will help MedMatrix win future business.

Practice Fusion will double the size of its existing office space when it moves to its new headquarters in San Francisco in mid-2014.

OB/Gyn-specific EMR provider Artemis Health Group, formerly known as DigiChart, announces that CEO/president Phillip Suiter will step down and be replaced by John Doulis, MD (MedCare).

Emdeon achieves CAQH CORE Phase III Certification, which certifies the company accurately and efficiently exchanges healthcare electronic funds transfer and electronic remittance advise information.

More evidence that the industry is far from ready for ICD-10: half of providers say they haven’t estimated the impact of ICD-10 on their cash flow, according to a KPMG report. Almost three-quarters of industry stakeholders state they have yet or are not planning to conduct testing that involves external entities. Things could get ugly around October.

Another ICD-10 readiness survey by Navicure and Porter Research reveals that 74 percent of physician practices have not yet started implementing their ICD-10 transition plan, though most don’t anticipate any disruptions from their EHR, PM, or clearinghouse vendors. A couple of alarming stats: 27 percent of survey practices are unsure how or where to start preparing for the transition, while 22 percent claim they don’t have the staff or resources to begin preparing.

The free physician social networking site Doximity doubled its network last year and now boasts 250,000 members, or about 35 percent of all US doctors. More than 10,000 physician-to-physician messages are being sent daily and 200 paying clients use TalentFinder, which last year facilitated 70,000 consulting and career offers to physicians.

Almost two dozen EHR vendors selected Surescripts’ clinical network for secure HIE over the last year include Adaptamed, AssistRx, Bizmatics, ChartLogic, ClinixMD, CureMD, ScriptSure by Daw Systems, GeniusDoc, gloStream, HealthFusion, Henry Schein MicroMD, Medical Office Technologies, Intelligent Medical Software (IMS by Meditab Software, Inc.), Merge Healthcare, OA Systems, PatientPoint, SRSsoft, STI Computer, and SuccessEHS.

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News 1/9/14

From K. Systrom: “Figure 1. This is cool app your readers might be interested in.” Figure 1 is a free Instagram-like app for licensed and verified healthcare professionals. The app facilitates the sharing of de-identified  photos of medical conditions while at the same time creates a crowdsourced image library. Looks quite cool and you have to love the price.

CMS proposes a rule that would ban abusive prescribers from government programs, as well as ban providers whose licenses have been suspended or revoked due to drug-related sanctions.

A report from the HHS Office of the Inspector General criticizes the government for inadequately addressing potential fraud and abuse issues as EHR adoption becomes more widespread. Warning that “certain EHR technology features may be used to mask true authorship of the medical record and distort information to inflate health care claims,” the OIG contends that CMS and its contractors have not changed their program integrity practices and recommends that CMS provide its contractors with guidance on detecting fraud associated with EHRs.

I was amused by this New York Times article about doctors that Google their patients. I guess I had never thought about my doctors caring too much about me beyond my blood pressure, pulse, and current meds. On the other hand, I Google people the time, leading me to wonder whether I (like doctors) should spend more time simply asking others the details I want to know.

AMA President Ardis Dee Hoven, MD includes two HIT-related issues on her list of top federal issues affecting physicians in 2014. Hoven notes that the October 1 implementation deadline for the ICD-10 code set and the September 30 MU attestation deadline for physicians wishing to avoid 2015 Medicare penalties are two significant issues that could have a significant impact on physicians and patients.

The AMA, by the way, offers free educational resources to help physicians prepare for the ICD-10 transition.

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