Health

WASHINGTON – The case for leapfrogging ICD-10 and holding out for ICD-11 just got a lot more curious. And though it’s not here yet, when ICD-11 is ready, it will be something ICD-10 cannot be: A 21st Century classification system.

Now that HHS Secretary Kathleen Sebelius has thrown her department’s hat in the ring, saying late Wednesday that HHS intends to delay ICD-10, the most pertinent question is how long will HHS push back compliance?

“My opinion is that CMS won’t be able to announce three months or six months of delay for ICD-10,” says Mike Arrigo, CEO of consultancy No World Borders (pictured above). “They will need to announce a delay from Oct. 1, 2013 to at least Oct. 1, 2014 because of CMS fiscal planning calendars.”

Others in the industry are suggesting that even one year is not enough to lighten the burden on physicians, providers and payers to make the transition smoother.

“I have a gut feeling they’ll go for two years, who knows?” speculates Steve Sisko, an analyst and technology consultant focused on payers and ICD-10. “Maybe January 2015?”

No more mixed signals
There it is on the Department of Health and Human Services Web site, a crystal-clear headline atop a brief explanatory statement: HHS announces intent to delay ICD-10 compliance deadline.

“We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead,” Sebelius said in the statement. “We are committing to work through the rulemaking process, with the provider community, to reexamine the pace at which HHS and the nation implement these important improvements to our healthcare system.”

Whereas acting CMS administrator Marilynn Tavenner was perhaps politically vague when speaking at an AMA meeting on Tuesday by saying that CMS would reexamine the timing of ICD-10 compliance, Sebelius’ statement was careful to erase any doubt about HHS’s plans.

“HHS will announce a new compliance date in forthcoming rulemaking,” the statement explains.

Neither Tavenner nor Sebelius clearly outlined “the rulemaking process” to which each referred. But any kind of rulemaking by the federal government tends to take a while, and there’s no reason to suggest that this instance will differ.

A formal process could take as long as a year, while the informal, conducted through the Federal Register, typically calls for a 180-day response period, after which the comments are taken into consideration to shape a new proposed rule. That, in turn, must be evaluated, eating up more clicks of the clock.

“The fact that [Tavenner] mentioned going through a rulemaking process implies to us that this will take a long time,” Wendy Whittington, MD, CMO of Anthelio Healthcare Solutions, said. “A short delay would be much more tolerable than a long one.”

If HHS has a tack for fast-tracking the rulemaking process for ICD-10, thus far it has not explained that. But if the agency intends only to change the compliance deadline then perhaps there is a way to abridge that cycle.

A time to question the value of ICD-10
Prior to the HHS statement, the AMA praised and AHIMA panned Tavenner’s commitment to reexamine the timing.

In an increasingly heated industry-association Civil War, both groups have fired shots, with the AMA calling on Sebelius and House Speaker John Boehner to block ICD-10 entirely, and AHIMA urging the industry to continue apace toward the new code sets.

Any delay, according to Dan Rode, AHIMA vice president of advocacy and policy, would increase costs while diminishing the value of ICD-10 and other health IT projects, including, of course, meaningful use.

HHS acknowledged the need for ICD-10. “ICD-10 codes are important to many positive improvements in our healthcare system,” says Sebelius.

It’s easy to make predictions about health IT for the year to come, but what if someone asked what your IT wishes were for 2012? What would you like to see happen most in the health IT space? 

We asked Wendy Whittington, MD, a practicing pediatrician and chief medical officer of Anthelio Healthcare Solutions, to list her top 10 IT wishes for 2012. From interoperability to telehealth, Whittington outlined what she, and most of her peers, would hope to see come true during the upcoming year.  

1. A greater emphasis placed on the federal health IT strategic plan. According to Whittington, healthcare professionals and government officials alike should be paying closer attention to federal health IT strategic plan, and she suggests a revision of sorts could be helpful. “I would like to see that become a working document that we’re constantly referring to,” she said. “One of our biggest problems is a document comes out and it’s good, but what’s happening in healthcare is changing – a document needs to constantly be tweaked.” 

2. The emergence of more affordable solutions for healthcare systems and hospitals to attain meaningful use. Many hospitals and systems have been scrambling to find a fast solution to an EHR, said Whittington, to gain access to those meaningful use dollars. “But what ends up happening is they think to get there, [they need to] buy the biggest and the best,” she said. “The total cost of ownership far exceeds the return they’ll get back. I’d like to see a lot of the lesser-known providers of EHRs getting more attention.” Whittington also added alternatives to EHRs, like open source, could be just as successful for a 100-bed hospital, for example. “I’d put the money into optimizing the less-expensive option,” she said. 

3. Real interoperability and not just “lip service” interoperability of our health IT systems.  Whittington referenced vendors who promise true interoperability, yet, months after implementing the technology, hospitals are still left with communication issues. “[Hospitals] will ask, ‘Will this communicate with doctors in the outpatient clinic?’ and the answer is ‘yes,’” she said. “But years after hearing that answer, you still have the same problem. So interoperability is important, but there’s no progress and, in fact, no financial incentives for vendors to play nice.” And financial incentives, in theory, wouldn’t end with vendors and interoperability – Whittington suggests the same goes for communication among hospitals. “Both technology and health communication,” she said. “Less financial disincentive to communicate and more real interoperability.”

[See also: Telehealth helps cardiac patients improve conditions, study reveals.]

4. A better health IT “roadmap.” Ultimately, Whittington would like to see a healthcare system that’s, “patient-centered, evidence-based, efficient, equitable and prevention oriented,” she said. The health IT strategic plan, she said, has vision but isn’t a “cookbook.” “In medicine, we resist cookbooks,” she said. “It’s taken a long time for physicians to assess protocols and evidence-based medicine order sets, so it’s in our nature to not be told how to do things.” However, with everyone left to his or her own devices, it’s easy for chaos to ensue, so Whittington suggests a more standardized way of implementing required technology. 

5. The optimization of EHRs. Installing them is just the beginning, said Whittington. “We end up doing what we need to do to get by … slap in that EHR and meet those standards, when really, there’s so much more work that needs to be done.” She said not to forget to optimize your EHR, and when it comes to doing so in hospitals, she suggests doing away with commonly held “silos” and working holistically. “[We need to] work more holistically to optimize clinical documentation and ICD-10, and optimize EHRs around those same principles,” she said. “Work as one big team rather than little, individual ones.”

Continued on the next page. 

Although the debate over the delay of ICD-10 has been heated, if there’s one thing both sides can agree on, it’s the sometimes-hilarous specificity of some of the new ICD-10 codes.

That’s why we asked our readers, tweeters and LinkedIn users to weigh in on some of the most ridiculous codes they know of. They outlined 10 of the most outlandish types of ICD-10 codes. 

1. Those that happen up in the air. Both Brad Justus, account executive and blogger at Brad Justus Blog, and Twitter user @PeterNGilbert thought of code V9542XA: Spacecraft crash injuring occupant, initial encounter. “Predicting increase in backyard space flights after the NASA shut down?” added Justus. Twitter user @techydoc added code V96.00XS, which outlines an “unspecified balloon accident injuring occupant, sequela,” while Scott Lucado, a member of the LinkedIn Group ICD-10 Watch, added code X52: Prolonged stay in weightless environment. “I could actually use some weightlessness myself,” he said. 

2. Those addressing your favorite feline. Steve Sisko, blogger at ICD-10 Impact to Health Care Payers & Providers, commented on our LinkedIn ICD-10 Watch Group, pointing out code A281, or cat scratch disease (also known as cat scratch fever). “A la Ted Nugent – ‘I went to see the doctor and he gave me the cure,’” he added. 

3. Those concerning attacks from the sea. Twitter user @ABSystems tweeted @HITNewsTweet and pointed out code W5922XA: Struck by a turtle. Additionally, Justus looked to codes W5612XA: Struck by a sea lion, initial encounter, and W5609XA: Other contact with dolphin, initial encounter. “Are there a lot of swim-with-the-dolphin injuries?” he said. “Maybe this is to protect you from Dan Marino.”

4. Those that are a tad risqué. In our ICD-10 Watch LinkedIn Group, Sisko added code S1087XA: Other superficial bite of other specified part of neck, initial encounter. “Like a hickey?” he wrote. Justus mentioned code G4482, or a headache associated with sexual activity, and code S30867A: Insect bite (nonvenomous) of anus, initial encounter. “Luckily, there doesn’t appear to be any code for venomous,” he added. “I really hope this is because they don’t exist.”

[See also: ICD-10 involves an ‘enormous amount of complexity’.]

5. Those that involve unfortunate mishaps. For all those clumsy patients out there, Twitter user @techydoc thought of code W51.XXXA. “Accidental striking against or bumped into by another person, initial encounter,” he wrote. Justus added code V0001XD, or, ”Pedestrian on foot injured in collision with roller-skater, subsequent encounter.” 

6. Those that address when inanimate objects attack. Twitter user @techydoc pointed out one of the most famous ridiculous ICD-10 codes.  “And, of course, the one mentioned many places, V91.07XA – Burn due to water-skis on fire, initial encounter,” he tweeted. Sisko, in our ICD-10 Watch LinkedIn Group, added Z9989. “This is the very last code in the current ICD-10 list,” he wrote. “Dependence on other enabling machines and devices – like a CrackBerry or smartphone – it is?”

7. Those that take place in a strange location. Twitter user @SuccessEHS tweeted us code Y92250, or when a patient is injured in an art gallery. Justus added coded Y92029, or “unspecified place in mobile home as the place of occurrence of the external cause,” and code Y92146, or, “swimming pool of prison as the place of occurrence of the external cause.” “Prisons have pools?” he added. “Must be white collar prisons where Bernie Madoff could drown from swimming too early after eating his club sandwich.”

8. Those that include livestock. Justus added three codes that those on a farm may run into: W6133XA, or being pecked by chicken, initial encounter; W5541XA, or being bitten by pig, initial encounter; and W5531XA, or being bitten by other hoof stock, initial encounter. 

[See also: 7 ways ICD-10 will affect CMS.]

9. Those that take place in nature. Despite its rarity, being struck by lightning does have its own code, Justus pointed out: “T7501XD, or, shock due to being struck by lightning, subsequent encounter,” he said. “I guess lightening can strike twice?”

10. Those that are just plain odd. Lastly, we heard about an array of ICD-10 codes that are, well, just plain weird. “E71510,” Sisko pointed out. “Zellweger syndrome – as in, Renee can’t decide which guy she should marry.” Twitter user @HaggbergConsult mentioned a code that referenced “…the adorable, heart-warming ‘extraction of products of conception,” he tweeted, while Lucado, in our ICD-10 Watch LinkedIn group, pointed out the most obscure code of them all. “Y34,” he said. “Unspecified event, undetermined intent. Well, that narrows it down.”

Have another code you think should have been included? Tweet us! @HITNewsTweet and @Michelle_writes.  For more on ICD-10, visit ICD10Watch.com.

Healthcare will be a hot topic during the 2012 U.S. presidential campaign as the Patient Protection and Affordable Care Act signed into law by President Barack Obama nearly two years ago is attacked or defended by the respective candidates and their surrogates. However, no matter who wins the White House this year, the U.S. heath as you want in your familycare system will be reformed, and more likely transformed, in the near future, and analytics is certain to play a leading role in that transformation. In fact, reform is already well underway, driven by increased competition within the heath as you want in your familycare industry, the trend toward “accountable care” and the realization that spiraling costs make the current system unsustainable.

According to the Centers for Medicare & Medicaid Services, U.S. national heath as you want in your family expenditure totaled $ 2.5 trillion in 2009, or $ 8,086 per person, and accounted for 17.6 percent of gross domestic product. The United States spends more money per person per year on heath as you want in your familycare than any other nation in the world, yet the World Health Organization ranked the U.S. heath as you want in your familycare system 37th in overall performance (just behind Costa Rica and just ahead of Slovenia) in 2000, the last year the rankings were compiled.

Why is heath as you want in your familycare so expensive in the United States and why doesn’t all that money produce better outcomes across the populace? Some of the more notorious contributors to the problem include misaligned incentives among the various stakeholders, bloated administration costs (someone has to shuffle all that paperwork), fraud and abuse, overtreatment and defensive treatment (from fear of malpractice suits), system failures and a lack of coordinated care, almost all of which are target-rich environments for analytical intervention.

To be sure, the United States offers arguably the best heath as you want in your familycare in the world, but at what price? According to the American Journal of Medicine, medical bills capsized 62 percent of the people who went bankrupt in 2007. Clearly, heath as you want in your familycare in the United States can benefit from a strong dose of analytics to help improve the performance of a massive, complex, fragmented, hugely expensive system struggling to sustain itself. 

Volume vs. Value

The U.S. heath as you want in your familycare system has historically operated on a fee-for-service model. The more patients a doctor sees, the more operations a surgeon performs, the more beds a hospital fills, the more money the care provider in question makes. While patient outcomes and experiences are obviously a concern for all involved, they don’t impact the fee schedule. In short, the fee-for-service model emphasizes volume over value. That is about to change.

The mandate requiring individuals to purchase heath as you want in your family insurance has turned into a popular talking point for politicians, but the provision of the Accountable Care Act that has caught the attention of the heath as you want in your familycare industry is the one that imposes financial penalties for providers who don’t meet certain standards of care for Medicare and Medicaid patients. The most prominent yardstick is hospital readmissions – patients who come in with certain ailments and then have to be readmitted to the hospital within 30 days after they are discharged. If a hospital’s number of such readmits exceeds a national standard, the hospital will suffer financially in terms of Medicare and Medicaid reimbursements. That means patient outcomes are now part of the heath as you want in your familycare fee structure, which makes it a whole new ball game.

“If I, as a heath as you want in your familycare provider, am now financially at risk if you as a patient have to be readmitted to my hospital within 30 days, it changes the relationship I have with you,” explains Steve Conti, senior director of clinical innovation and population management at Seton Healthcare Family and head of the analytics committee at the Integrated Care Collaboration (ICC), a nonprofit alliance of heath as you want in your familycare providers in Central Texas. “In a fee-for-service environment, the system is not financially affected by how many times you get admitted. It may call into question the quality of the care you receive, but from a purely financial perspective, it is advantageous to have you readmitted. In a value-based system, it’s just the opposite.”

Conti predicts that within five years, the U.S. heath as you want in your familycare industry will move from a largely fee-for-service, volume-based system to a value-based system. “And the way you get to that new type of structure is through analytics,” he says.

ICC, one of the seven highest-rated Health Information Exchanges (HIEs) in the nation, has embraced and employed analytics since the alliance was founded in 1997. In support of its mission to provide high-quality heath as you want in your familycare in a cost-effective manner, particularly for patients who can least afford it, the ICC operates a regional heath as you want in your family information exchange called ICare that contains data on more than a million patients and more than 8 million encounters (provider visits) at 70 locations throughout the Central Texas region.

According to Conti, analytics coupled with the wealth of patient data available in ICare enables ICC provider organizations to identify and reduce duplications in services, thus cutting costs and driving value. ICC also uses analytics and a team of epidemiologists and database analysts to measure and assess everything from readmission rates to clinical ventures. The team uses statistical models to compare how its member providers are managing their diabetic care clinics, for example, to see which ones are doing well and where there’s opportunity for improvement.

“Healthcare is too expensive,” Conti concludes. “When we look at the national expenditure for heath as you want in your familycare it becomes pretty evident that it’s unsustainable. As you back out from that, it causes large heath as you want in your family organizations to begin to ask the tough questions. How are we contributing to that cost, and what can we do to become a change leader in the process of making heath as you want in your familycare more affordable, more effective, more efficient and more accessible? And the only way we can understand and improve the process is by having strong analytic capabilities.”

Realigning Incentives

Until fairly recently, the provider side of the heath as you want in your familycare industry had been reluctant to embrace analytics. Humans are naturally resistant to change, and doctors are notoriously wary of ceding the control they’ve historically wielded regarding their patients’ diagnoses and treatment to others, let alone a “mathematical model.” After all, who could possibly know a patient’s medical history and issues better than the patient’s personal doctor?

For-profit hospital organizations had reason to resist employing analytics because “optimizing” their systems could theoretically hurt profits. Imagine a major hospital group that used analytics and electronic heath as you want in your family records pre-Affordable Care Act to eliminate overtreatment and unnecessary lab tests and imaging, while simultaneously cutting patient queue times, improving patient outcomes and reducing readmissions. At the end of the fiscal year, everyone would be happy except the company CEO, whose bonus is tied to profits and who has to explain a multi-million dollar drop in revenue to shareholders.

The days of tweeting, Yelp-ing, and checking-in are here to stay, but as social media’s use expands, certain guidelines are needed to ensure its “optimal” practice in the heath as you want in your familycare realm.  

Christina Thielst, hospital and heath as you want in your familycare administrator and author of the blog Christina’s Considerations, offers 10 tips for proper use of social media in heath as you want in your familycare. 

1. Recognize social media as new sources of feedback and opportunities. Use it to connect with various audiences, the public, patients and stakeholders, said Thielst. Most importantly, connect with your audience on the channels they’re already using. “If someone Yelps about the experience [at your organization], you need to know about it,” said Thielst. “Organizations can’t be ignoring social media. Google someone’s name, and you can learn so much about them. I think organizations need to be Googling their name as well.” Another project Thielst suggests? Creating or updating your Wikipedia page. Many hospitals have these pages, she said, whether they know about it or not. “It’s important for them to do that, and I don’t think enough of them are seeing what’s being said,” she said. “They’re risking their reputation.”

2. Avoid taking on too much, too soon. Have a strategy, said Thielst, to avoid confusion. “I have people asking all the time what they should do first about social media, and I say ‘I don’t know,’” she said.  According to Thielst, your strategy should depend on your organization and should fit with your culture and needs. “It needs to reflect a lot of things,” she said. “If you’re a small organization and don’t have a lot of people who understand social media, though, Twitter is an easy start.” Thinking about hiring a social media producer? Although he/she can be helpful, Thielst suggests everyone in the organization have some basic understanding of the foundations of social media. “What you don’t want to do is hire someone, they come on board, and there’s a layoff,” she said. “You need multiple people who can keep the content going.”

[See also: Social media response to East Coast earthquake part of growing trend.]

3. Recognize and manage the risks. Establish policies and guidelines for appropriate use, said Thielst, and take the time to educate staff. “Implement safeguards for protecting privacy and confidential information,” she said. This aspect of social media is important, said Thielst, and is illustrated best in a recent blog post. “Young people are in hospitals, and they have access to private heath as you want in your family information,” she said. “Millennials come along, and they’ve been using [social media] since they were babies—they’re comfortable sharing their lives online.” She said to beware of the disconnect between knowing what to share and what to not. As new people come into the workforce, Thielst suggests helping identify boundaries between their personal and professional life. “That’s what’s going to keep us out of trouble,” she said. “It’s engrained in them, unlike us.”

4. Recognize opportunities for improving heath as you want in your family and outcomes, and social media’s ability to contribute to longitudinal heath as you want in your family and documentation. Using social media to track a patient’s progress is also key, said Thielst. Examples of this include Boston College, which uses a “discharge advocate,” or an avatar, to take patients through the discharge process. In addition, other social media platforms are focusing on after-care programs for recovering addicts. “If it’s 2 in the morning, and you have nowhere to go, you can log onto the site, which is always on,” she said. “You can also do virtual AA meetings, where patients check in with micro-blogging technology and a ‘tweet’ of their mood. There are a million ways this technology can be applied.”

5. Use it to enhance the patient experience. “Patients appreciate the opportunity to engage on their social networking channels to stay in touch with family and friends while they are in the hospital,” said Thielst. In fact, blocking access to social media could lead to lower HCAHPS scores. “Access to social media sites may reduce isolation and depression among hospitalized patients, “ Thielst added. 

Continued on the next page.

ANN ARBOR, MI – The top healthcare systems in the United States have lower 30-day mortality rates finds Thomson Reuters’ fourth annual study naming the top 15 health systems in the country. The measures used to score the top systems are underpinned by health information technology.

Thomson Reuters’ 15 Top Health Systems, released Jan. 16, singles out those hospital health systems that have achieved superior clinical outcomes. Thomson Reuters determined the scores of more than 300 organizations based on a composite score of eight measures of quality, patient perception of care and efficiency. The study used data primarily from the Medicare Provider Analysis and Review data set and the Centers for Medicare & Medicaid Services Hospital Compare data set.

[See also: Top 100 hospitals named for 2011]

Thomson Reuters’ 15 Top Health Systems are:

Large Health Systems (more than $ 1.5 billion total operating expense)

• Banner Health, Phoenix
• CareGroup Healthcare System, Boston
• Main Line Health, Bryn Mawr, Pa.
• Memorial Hermann Healthcare System, Houston
• St. Vincent Health, Indianapolis

Medium Health Systems ($ 750 million–$ 1.5 billion)

• Baystate Health, Springfield, Mass.
• Geisinger Health System, Danville, Pa.
• HCA Central and West Texas Division, Austin, Texas
• Mission Health System, Asheville, N.C.
• Prime Healthcare Services, Ontario, Calif.

[See also: Leapfrog Group names top hospitals for 2011]

Small Health Systems (less than $ 750 million)

• Baptist Health, Montgomery, Ala.
• Maury Regional Healthcare System, Columbia, Tenn.
• Poudre Valley Health System, Fort Collins, Colo.
• Saint Joseph Regional Health System, Mishawaka, Ind.
• Tanner Health System, Carrolton, Ga.

“This year we are seeing stronger system-wide performance and increased rates of improvement, particularly among the 15 Top Health Systems award winners. Health system performance is beginning to reflect aspirations to provide more consistent outcomes across communities served,“ said Jean Chenoweth, senior vice president for performance improvement and 100 Top Hospitals program at Thomson Reuters, in a statement. “Healthcare reform appears to have stimulated the increased rate of improvement at the system level.”

Thomson Reuters’ study found that the top 15 health systems had:

• Lower 30-day mortality rates: The top 15 systems held 30-day mortality rates steady, while their peers demonstrated a significant increase in post-discharge mortality.
• Better survival rates: The top 15 had 17 percent fewer deaths than expected considering severity, while their peers had 4 percent more deaths than expected.
• Shorter hospital stays: Patients treated in the top 15 hospitals had a median average length of stay of 4.7 days, while those not in the top 15 had a median of 5.1 days.
• Better patient safety and core measure adherence: The top 15 had 23 percent fewer adverse patient safety events than expected and adhered better to core measures of care.

Follow HFN associate editor Stephanie Bouchard on Twitter @SBouchardHFN.

[See also: Thomson Reuters names top hospitals for heart care]

Mobile devices, data breaches and patient privacy rights were some of the most talked-about topics in health IT in 2011, and according to expert opinions complied by ID Experts, 2012 won’t be any different. 

In fact, experts continue to predict an upswing in mobile and social media usage, response plans, and even reputation fallout. Eleven industry experts outlined healthcare data trends to look for in 2012.

1. Mobile devices could mean trouble. Healthcare organizations won’t be immune to data breach risks caused by the increased use of mobile devices in the work place, said Larry Ponemon, chairman and founder of the Ponemon Institute. A recent study confirms that 81 percent of healthcare providers use mobile devices to collect, store, and/or transmit some form of personal health information (PHI). But, 49 percent of those admit they’re not taking steps to secure their devices. 

2. Class-action litigation firestorms are looming. Class-action lawsuits will be on the rise in 2012, predicts Kirk Nahra, partner, Wiley Rein LLP. This will most likely be due to patients suing healthcare organizations for failing to protect their PHI. This past year was filled with several similar suits for organizations, some of which involved business associates and breached patient data. And despite the outcomes, one affect is certain: significant risk and cost for companies affected by the suits. 

3. Social media risks will grow. Chris Apgar, CEO and president at Apgar & Associates, predicts that, as more physicians and healthcare organizations move to social media, its misuse will increase the exposure of PHI. A recent example includes a healthcare worker posting sensitive information about a patient on his Facebook. According to ID Experts, healthcare organizations often don’t develop a social media use plan, leaving a gray area of sorts for employees exposing PHI through personal social networking pages. 

4. Cloud computing is not a panacea. Moreover, the technology is outpacing security and creating unprecedented liability risks, said James C Pyles, principal, Powers Pyles Sutter & Verville. According to Pyles, with fewer resources, cloud computing is an attractive option for healthcare providers, especially with the rise of HIEs. But, with privacy and legal issues coming to light, ID Experts said a “covered entity” will need to enter into a “carefully written business associate agreement with a cloud-computing vendor before disclosing protected health information.” 

5. Reliance on business associates could result in new risks. Larry Walker, president of the Walker Company, believes economic realties will force healthcare providers to continue to outsource many of their functions. This includes billing to third parties or business associates, even though business associates are considered the “weak link in the chain” when it comes to privacy and security. 

Continued on the next page.

With Medicare’s push toward shared savings and accountable care organizations, healthcare business models are getting more complex, said Shahid Shah, software IT analyst and author of the blog The Healthcare IT Guy. And according to him, the industry needs software to implement these new models. 

“Due to the new intricacies of organizational connections between different providers, standardization of workflows on existing EHRs won’t really be possible,” Shah says. “Most EHRs are not up to the task of handling the complexities of newly shared accountability and what I call ‘patient team’ business models, so we need EHRs to become more social, more collaborative, and far more integrated than they are now, EHRs need to grow up from the adolescence of basic electronic typewriters and chart storage systems to mature real-time care coordination and collaboration platforms.”

Shah gives us five more reasons EHRs need to “grow up.”

1. It’s all about the apps. According to Shah, the looming shift toward mobile technology will mean smaller and more “nimble” apps (both web-based and mobile) will begin to take on some of the burdens being “thrown in by new business models.” He added this is because EHRs can’t change fast enough to accommodate new requirements. “However, these nimble apps will proliferate and their data needs [will need] to be ‘coordinated’ by next-generation EHRs to be truly successful,” he said. “EHRs must recognize they aren’t apps themselves, but containers for other apps or other apps’ data.” 

2. Vendors will jump onboard. The “common wisdom” in the industry today is there will be fewer EHR vendors in the future as consolidation occurs. But that’s not true, said Shah. “I think that interfacing, interoperability, and real service-based platforms will be created, which can handle the next level of more sophisticated requirements being thrown at EHRs.” He said EHRs that survive in the long run will have “graduated” from basic record-keeping and document management to more refined patient management, patient engagement, and collaboration-driven software. “The older vendors will start to hear the collaboration siren songs and jump onboard pretty quickly,” he said. 

3. Everyone needs to be on the same page. “Today’s reality of patient management is ‘disjointed care,’ and most of the players in a patient’s care don’t know what each other is doing for the patient in real time,” said Shah. Knowing all the participants in the patient’s care team, and coordinating their electronic activities, is what future successful EHRs must “handle with ease.” In addition, Shah mentioned current EHR apps are typically restricted to “legal entities” or a single hospital or hospital system. “However, to manage coordinated care, successful EHR systems must open themselves up beyond legal boundaries into ‘trust federations,’” he said. These trust federations, said Shah, are more than health information exchanges; they’re platforms that both welcome and encourage real-time data integration for activities beyond clinical data. 

4. Flexibility will be key. Shared savings programs, capitated payment models, ACOs, and PCHMs require a level of coordination and measurement of quality metrics that are tough to define, implement, and secure, said Shah. Future EHRs, as care coordination platforms, must “allow dynamic business models that can accommodate a great deal of uncertainty and flexibility,” he said. “When you move from the uncertainty of supporting users inside a single organization to working with the uncertainty of multi-organization relationships and user communities, application architectures must accommodate more fluid workflows that can change daily or weekly based on the demands of new participants.”

5. Integration and interoperability will be front and center. Integration has to be more than lip service, said Shah. “Most EHRs today, after being dragged kicking and screaming into the new ‘Meaningful Use World Order,’ are marketing more interoperability, but they’re not doing so in reality,” he said. In the future, EHRs will have integration and interoperability as an architecture requirement and not an add-on, he added. “Data liquidity into and out of EHRs must be natural and need to be handled without resorting to excuses about privacy and security,” Shah said. “There are many ways to tag and secure liquid data based on patient consent.”

Follow Michelle McNickle on Twitter, @Michelle_writes

2011 was a standout year for health IT, and as sure as debates regarding EHRs lingered on, certain articles on Healthcare IT News attracted record-breaking social media reactions and comments galore.

We rounded up 10 buzz-worthy health IT articles of 2011. From social media’s use in the industry to job prospects and more, these articles garnered the most attention and sparked the most discussion among Healthcare IT News readers. 

1. iPad 2 looks even better for docs. In March, Associate Editor Molly Merrill wrote about the introduction of the iPad 2 – and more specifically, an appearance by John Halamka, MD, chief information officer at Beth Israel Deaconess Medical Center, in a video showcasing the technology’s use in different fields. Halamka’s comments on the iPad’s practicality resonated with readers, with nearly 30 comments and 120 tweets. “What we have tried to do on the iPad is give doctors at the point of care the tools they need at the exact moment the doctor can make a difference,” said Halamka. 

2. 5 technologies every hospital should be using. This past September, software analyst Shahid Shah spotlighted the five technologies every hospital should consider using. He included innovations such as single sign-on, virtualization, HTML5 and document management systems. Shah’s practical look at what technologies would benefit hospitals the most gave way to debate in our comment section and a follow-up article, five technologies every hospital should avoid. 

3. Social media sites help patients make healthcare decisions. In this article, published in March, we saw how one in five Americans use social media websites to receive healthcare information. The article focused on multiple surveys, where respondents confirmed their high likelihood to turn to social media to help make a healthcare decision and educate themselves on procedures, facilities and doctor/patient relationships. Commenter “nrenicker” added social media monitoring is becoming an interesting trend. “[It’s] one that has limitations and dark sides, but also one that has tremendous benefits.”

4. Americans not ready to use social media to talk to their doc. Despite consumers’ likelihood to look to social media for information, this article showed the same couldn’t be said for using social media or other chat systems to contact physicians. According to a national Capstrat-Public Polling survey, more than five of every six respondents said they wouldn’t use social media or instant messaging for medical communication, even if doctors offered it. The consensus was the same with commenters. “Be sure to set your ad settings to ‘no one’ if you don’t want to be circulated all over the web,” commenter “MedQuack” wrote. 

5. Five ways health IT will reduce the cost of care. In February, Web Producer Jamie Thompson looked to Jerry Buchanan, account director, healthcare technology and services at eMids Technologies, to describe some of the ways IT will reduce the cost of care. Buchanan listed improved standards of care and increased patient involvement and collaboration as just a few of the ways. Feedback in our comment section was noteworthy, with readers both supporting and debating Buchanan’s points. 

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Recently, the Care Continuum Alliance, an advocate for population health management, surveyed industry leaders to assess the market and predict key issues for 2012. According to the alliance’s white paper, two predominant themes were brought to light as a result of the survey.

“First, significant market movement will occur toward accountability and value creation in healthcare, driven partly by new physician-guided and collaborative models,” according to the report. “And second, population health management is well-positioned to add value to and support these emerging models, but must continue to build the case for wellness and prevention.”

Here are eight additional key issues, identified in the report, that could affect population health management in 2012. 

1. Accountable care and the Medicare Shared Savings program. Many comments from survey respondents centered on accountable care and collaborative models, as well as federal support for both. According to the report, population health has a lot to offer collaborative care, such as health risk assessment and predictive modeling, HIT infrastructure, data analytics, care coordination and other core competencies. “But tempering optimism around accountable care models were caveats,” the report noted. One respondent summed it up: “If ACOs become a reality and are structured in a way that provides a real incentive for managing health, they could be a major market opportunity. If they just become HMOs redux, not much will change.”

2. Consumer use of mobile and eHealth technologies. According to the report, population health management has been both a driver and benefactor of the rise in eHealth and mHealth technologies. The demand for these technologies, said one respondent, will drive healthcare “to adopt … a patient-centered, consumer-empowered, pull-rather-than-push model, which has already been realized in the music, travel, book and news industries.” The importance of social media was also noted by those surveyed, and when coupled with mobile technology, will be used as a tool and patient engagement and shared decision-making. 

[See also: Mobile health monitoring market on the rise.]

3. Reducing avoidable hospital readmissions in Medicare. The Hospital Readmissions Reduction Program (HRRP) could be a “big opportunity for companies who have developed proven strategies for reducing hospital readmissions,” wrote one survey respondent. The program includes Medicare tracking readmissions for three conditions – heart failure, acute myocardial infarction and pneumonia – within 30 days on or after Oct. 1, 2012. Medicare will then reduce payments to hospitals to account for excess readmissions. “The Centers for Medicare & Medicaid Services (CMS) Office of the Actuary projects that the HRRP, when fully implemented, will reduce Medicare costs by $ 8.2 billion through 2019,” the report read. “Further, the law gives CMS the authority to consider additional conditions in 2015.”

4. Quality improvement in Medicare advantage. The Medicare Advantage’s (MA) “stars” rating system was another topic of discussion. The program will award bonus payments to plans under the stars system to assess performance on a myriad of measures. “The developing stars system appears [to be] headed toward a structure consistent with industry-advocated changes, including additional wellness and prevention measures and retirement of process-related measures,” the report read. It added that, combined with continued growth in the Medicare Advantage population, the need for plans to demonstrate improvement in wellness and chronic care measures will drive “expanded opportunities” in the Medicare managed care market, according to industry experts. 

Continued on the next page.