CHICAGO – After what turned out to be a sea-changing Q1 earnings meeting April 26, which saw the ejection of its board chairman and three other board members reportedly quitting in protest, Allscripts on Monday moved quickly to begin to right the ship, with the announcement of a new chairman.

Dennis Chookaszian, who has served on the Allscripts board since September 2010, will take the helm on the board of directors. He was formerly the chief executive and chairman of mPower Inc., a financial advice firm focused on the online management of 401(k) plans.

[See also: Allscripts in skid mode as shares plunge, chairman ousted]

Some Allscripts customers say they are concerned about the recent chaos, but they believe Allscripts CEO Glen Tullman will be able to move the firm forward.

“What I see bodes well for the future,” said John Bosco, CIO of North Shore-Long Island Jewish Health System, Allscripts’ biggest client. “In the end, it will enable Glen to make the changes that are needed.”

“We’re the largest Allscripts customer by orders of magnitude,” said Bosco. “Allscripts is our go-forward partner.”

[See also: Customers have high expectations for Allscripts]

Indeed, North Shore-LIJ has invested $ 400 million to connect 15 hospitals, 2,500 employed physicians and 8,000 affiliated physicians. Allscripts touted the intiative when it announced the initiative two years ago as “the largest EHR program in the New York metropolitan area and one of the largest in the nation.”

William Spooner, CIO of Sharp Healthcare in San Diego, says Sharp’s user executives are nervous about the recent chaos at Allscripts – and about the lower-than-expected financial results reported for Q1. (Unrelated, Allscripts CFO Bill Davis, is leaving for a post outside the heath as you want in your familycare sector, triggering analysts to downgrade Allscripts stock from “buy” to “neutral.”)

“I am concerned as well,” said Spooner, “yet my role is to steady the ship, maintain perspective and consider contingencies. Glen is severely challenged yet a strong leader. Stay tuned for a hot summer.”

Back in June 2010, Allscripts merged with Eclipsys, a deal that gave Allscripts, which had played solely in the ambulatory space, access to the hospital market. At the time, Tullman said, it’s what Allscripts customers were pleading with him to do. Eclipsys, with its Sunrise Enterprise EHR, seemed like a good fit.

Spooner and others said then that the proof would be in execution.

“I think that as these two organizations combine their market strengths, it will translate into new, highly integrated services and products,” Michael O’Rourke, CIO of Denver-based Catholic Health Initiatives said at the time of the merger.

Many expressed high expectations then, but the merger does not seem to have turned out as they hoped.

In Bosco’s view, the two companies underestimated the differences in culture between Allscripts and Eclipsys. “They could not have been more different in terms of culture,” he said, adding that the removal of chairman Phil Pead from the board and the stepping down of three other directors might now pave the way for Tullman to put his plans into action.

“All are still pushing hard, and it’s a tough road, but they are focused on long-term success,” Bosco said. “I think there’s a silver lining.”

Allscripts also annnounced the board has authorized management to repurchase an additional $ 200 million of the company’s outstanding shares, bringing the total amount authorized for stock buybacks to $ 400 million.

As the concept of patient-centered care continues to evolve, a key to its success is the relationship between physician and patient. But factor in all the technologies springing up left and right, and finding the perfect balance between patient engagement and new IT initiatives can be tricky.

“Focusing specifically on the physician-patient relationship – it’s behind the rest of the world,” said Steve Wigginton, CEO of Medley Health, a medical practice marketing and communication services company. “But there are a lot of benefits to be had. More information is readily available to physicians as a result of IT, and therefore, it’s easier for them to keep track of what’s going on with their patients.”

“IT has, in some ways, made it possible for patients to be more self-serviced around transactional types of interchanges with their doctor,” Wigginton continued. This includes “scheduling appointments, reviewing bills, etc. Those are just some of the main ways we’re seeing IT have an impact so far.”

Wigginton breaks down five keys to understanding IT and the patient-physician relationship.

1. Patient-centered IT initiatives hold multiple benefits for the physician. Small physician practices in particular, Wigginton said, need to adopt the same features as their competitors. And, it’s important to note their competitors are no longer just their fellow physician practices down the street. “As Walmart and Walgreens and CVS expand into transactional, low-cost primary care, there’s a competitive pressure to be able to add these features,” Wigginton said.  And although a competitive edge is important, he said maintaining closer and more convenient relationships with patients has incredible value. “Your inability to communicate with them in modern terms is a big hindrance,” he said. “My financial planner, my physician trainer – all the people in my life who are important to me, I can communicate with through email and other channels. It makes it easier to achieve the best health outcomes when a physician practice adopts this.”

2. Challenges exist when it comes to reimbursement models. The disconnect between physician practices and IT initiatives almost always involves the business model, Wigginton said, and the value of the technology. “There are some challenges that aren’t widely addressed but are brought to light by both physicians and patients with the advances in IT,” he said. The biggest of which is the advancements in IT – emailing, texting and video conferencing – coming without payment. “There’s no good reimbursement model, and most of those reimbursement models are rooted in the traditional office visit,” Wigginton said. “So it puts pressure on the physician to do more for less – not the same, but less. It’s a double whammy because there’s a higher service load on the physician and higher expectations from the patients, given these tools. There are only a few instances where the business models align.”

[See also: New report addresses HIE sustainability.]

3. Patient-centered IT practices continue to vary.  While larger-volume practices are using email and patient portals to optimize patient input, lower-volume, more patient-centric practices are using email, text, video and mobile apps, said Wigginton. “They’re doing it to create more of an impact across a broader spectrum of their patients’ health; they’re helping them manage it not only when they’re sick, but also interactive wellness programs.” The most important part of employing these technologies, he continued, is to find what works best for the patient. “If I’m a texter, I’ll text, if email is my thing, I’ll do that, and if I want to come to your office, I can,” said Wigginton. “I want my physician to be highly knowledgeable about me and communicate with me and have a relationship with me.” 

Continued on the next page.

The release of the “new iPad,” aka the iPad 3, on March 16th, has health IT folks drooling over the tool’s increased screen resolution, its iSight camera – complete with full HD 1080p video recording capabilities – and its voice dictation features. 

“I think it’s no secret that the healthcare industry right now is, to some degree, in love with this tablet,” said Jennifer Dennard, social marketing director at Billan’s HealthDATA/Porter Research/HITR.com. “Sure, there are the naysayers, but at least half the conversations I had at HIMSS with EMR vendors and HIT folks included at least one mention of ‘Apple’ or ‘iPad.’” 

The past year has been eventful for the tech giant, which lost Chairman Steve Jobs to cancer in October 2011, just days before the public release of its iCloud solution for cloud computing. In anticipation of the release of the third-generation iPad, we look back through the device’s history in healthcare and the ways physicians, patients, and IT professionals have used it. 

Here are 10 stages of the iPad’s brief history in healthcare. 

1. January 2010. In this blog post, authored more than two years ago by BIDMC CIO John Halamka, the iPad’s ability to revolutionize the industry was brought into question. According to him, the iPad did come the closest to his predetermined set of requirements for the “ideal clinical device,” however, Halamka wrote the device was too large, could be hard to disinfect, and lacked a camera for clinical photography and/or video teleconferencing. “My general impression is that it’s not perfect for healthcare, but it is closer than other devices I’ve tried,” he wrote. “It will definitely be worth a pilot.

2. February 2010. In this article, Healthcare IT News Community Editor Kyle Hardy explored the iPhone’s influence on the industry, writing how the introduction of a medical checklist for the iPhone could become a benefit for providers as mobile technology in healthcare continues to increase. While Hardy focused primarily on the mobile phone, Peter Waegemann, vice president of development for the mHealth Initiative, predicted the iPad could become the next big thing for doctors. “The iPad will open up a new dimension for doctors as it will become the working tool at the point of care,” he said. 

[See also: iPad 2 a boon to Weill Cornell Medical College students.]

3. April 2010. Nearly two months later, John Moore from Chilmark Research questioned whether the iPad will truly be a “game changer” in healthcare, citing its “rich user interface, native support for eReading, strong graphics (color) capabilities, [and its] ability to use various medical calculators.” Calling the device a “slam-dunk for Apple,” Moore later questioned if it had the staying power to replace the smartphone. “Only time will tell,” he wrote. “Could we even go so far as to say that the iPad will be a bigger contributor to HIT adoption and use than the $ 40B in ARRA funding that the feds will spend over the next several years as part of the HITECH Act?” 

4. June 2010. In the June 2010 print issue of Healthcare IT News, Associate Editor Molly Merrill reported that many were expecting the iPad to quickly surpass other tools and become the leader in health information technology. “The iPad is going to crush laptops in this [healthcare] space,” said Connecticut physician Steven A.R. Murphy, MD. Steve Woodruff, founder and president of Impactiviti, believed the iPad could grow into the platform that accelerates eHealthcare on the provider side. “It’s not so much that the iPad is a game changer in and of itself – it should be an accelerator of trends that are already happening, and inevitable,” Woodruff said. 

5. December 2010. In this article by Merrill, the iPad’s use had officially expanded into the OR, while providing a “convenient way to easily access previous patient imaging.” Its new role was documented in an article published in the Journal of Surgical Radiology, which told how Georgetown surgeons were using the iPad to access, in real time, patient X-rays, CT scans, and laboratory data during surgical procedures. “The same features which make the iPad great for surfing the web, such as looking at images and viewing video, nicely translate into the operating room,” said Felasfa M Wodajo, MD, senior editor at iMedicalApps.com. 

Continued on the next page. 

WASHINGTON – A new study by the Deloitte Center for Health Solutions indicates physicians are not using IT broadly to engage patients. No more than 20 percent of doctors are providing online scheduling or test results for their patients and just 6 percent are using social media to communicate with them, according to Deloitte.

The report, “Physician Perspectives on Health Information Technology,” shows that measured against the IT goals and deadlines prescribed by the Patient Protection and Affordable Care Act, only 25 percent of physicians are “on target” to meet the meaningful use incentives.

[See also: Stage 2 rule means lost year of interoperability, coalition says]

Doctors, however, are more confident about being able to satisfy the mandate to upgrade their medical billing and coding systems to comply with ICD-10 coding. Just 21 percent reported they would not be able to meet the Oct. 1, 2013 deadline. However, 62 percent of physicians cited managing ICD-10 documentation as a “major concern.”

Deloitte polled 501 physicians obtained as a random sample from the American Medical Association’s (AMA) master file of physicians. The responses were weighted by years in practice according to gender, region and practice specialty to reflect the national distribution of physicians in the AMA master file.

Harry Greenspun, MD, senior adviser for the Deloitte Center for Health Solutions and lead author of the report, says some parts of the survey demonstrate that physicians accept the value of health IT. Two-thirds of doctors say they use some form of electronic records to manage clinical information and a similar number believe IT can improve care long term.

[See also: HHS touts big strides in health IT adoption]

“The voice of physicians today seems to have two components: one that accepts the value of information technology to improve quality and safety of care and another that expresses concern over its cost and potential to disrupt how they practice,” says Greenspun. “This dissonance is one reason why IT is not further entrenched in our healthcare system.”

However, Greenspun says he believes physicians will more readily adopt IT over the next two years as pressures mount to demonstrate value around evidence-based care, improved outcomes and reduced complications.

“Greater accountability will compel providers to a greater reliance on data, requiring that it be collected electronically, shared appropriately and analyzed methodically,” he said. “The key is to bring IT to the medical community in a way that enhances care while minimizing the costs and disruptions involved in implementation.”

Key findings from the report:

• IT Cost Equals Opportunity for Assisting Doctors. The cost of IT related to investment and impact on productivity is the primary barrier to adoption, with 66 percent citing upfront financial investment as their primary concern and 54 percent saying this about operational disruptions. This creates an opportunity for organizations that can assist physicians with financing, implementation, workforce training and process redesign.
• A Widening Technological Divide. Differences in the use of electronic health records among single versus group practices could widen health gaps among communities as some rural and urban areas are served by single practitioners and less likely to employ health IT. Nearly one-half (46 percent) of single practices do not use EHRs compared to 22 percent of group practices with 10 to 49 full-time employees. Furthermore, 45 percent of solo practices have no plans to use EHRs, compared to only 15 percent of practices with 10 to 49 full-time employees.
• Losing Touch with Broader Issues. Although large group practices are more aggressively adopting IT, group member doctors seem less informed about what is driving the effort. More than one-third (39 percent) of physicians in practices with 10 or more full-time employees are not familiar with the Health and Human Services standards for ICD-10, compared with only 25 percent in solo practices. Large-group doctors may be more disconnected around macro issues because they have a layer of management absent in smaller settings. This raises the question:  Will management be able to drive change without physicians understanding the rationale? 
• Winning Over Patients with Online Tools.  Providers seem to lag other industries in using IT to engage consumers despite growing demand. Deloitte’s 2011 Survey of Health Care Consumers in the United States shows growing consumer interest for secure messaging, access to personal health records and remote monitoring. Moreover, consumers trust information from physicians more than from employers or insurance companies, according to the survey, creating an edge for physician groups to gain market share via online engagement.

[See also: It don't come easy: 2012 brings new meaning to meaningful use]

With Stage 2 waiting in the wings, the focus is now shifting onto the electronic capture of heath as you want in your family information and fostering data exchange at points of care transitions, said Shahid Shah, software analyst and author of the blog, The Healthcare IT Guy. And unlike meaningful use Stage 1, Stage 2 is looking to “raise the bar” and require true interoperability. 

“Current generation EHRs already do some, if not most, of the requirements recommended for Stage 2,” he said. “But the reason they won’t meet or exceed the requirements of modern interoperability is [because] next-generation EHRs need far more sophisticated integration capabilities, not just basic interoperability between systems as suggested by the MU Stage 2 NPRM.” 

Shah outlined 12 integration capabilities the next-generation of EHRs will need to have. 

1. Single sign-on (SSO) using SAML and other commercial industry standards. One attribute of applications, particularly mHealth apps, said Shah, is they proliferate. “You start with one small one, then another, and then more,” he said. “That’s exactly what should happen, because heath as you want in your familycare is complex and needs [a lot] of solutions.” But, he continued, if you don’t manage user authentication and authorization centrally, while allowing people to switch between these applications using a common login and password, you’d soon have applications that users don’t want to use. Luckily, he said, there are a myriad of options for “common authentication and single sign-on, such as SAML and CAS … your next-generation EHR should include an industry-standard SSO capability.” 

2. Patient context awareness and context transitions between apps. As applications proliferate and you need to integrate them into an EHR system, Shah said, you’ll realize that, even if you have Single Sigh On in place, you will lose the context – or the “active patient” or “active task” being performed – unless you understand how to track patient context and transition of context between the applications. “There are a few good approaches, such as CCOW,” he said. “You can start with [that], but, allowing your EHRs to be controlled through custom APIs is a great approach, too.” 

3. Publishing widgets. According to Shah, next-generation EHRs should allow the ability to “publish” their features as widgets, through proper authorization and authentication, as well as single sign-on. “As Wikipedia notes, a widget is a ‘generic type of software application, comprising portable code,’ which, ‘implies that either the application, user interface, or both, are light, [or] relatively simple and easy to use,’” he said. “EHRs often have hundreds of functions, and if some, or many, of those functions are exportable or publishable as ‘widgets,’ then they become much easier to integrate into new user interfaces in the future.” 

[See also: Epocrates drops plans for EHR.]

4. Consuming widgets. “Some forward-leaning EHR vendors already know how to consume basic widgets that are already published across the web,” said Shah. “Next-generation EHRs will need to do so in a sophisticated and easier manner than the current offerings allow.” Future EHRs, he continues, will become more like containers of cross-application functionality, instead of innate functionality. “So consuming widgets will be a basic requirement,” he said. 

5. Mash-ups, with or without CMIS. To Shah, EHRs are “really nothing more than fancy content management systems (CMS) or document management systems (DMS).” According to him, next-generation EHRs should allow access to their content through the “relatively mature” content management interoperability services (CMIS) standard. “The CMIS specification provides a Web service interface that is designed to work over existing repositories, enabling customers to build and leverage applications against multiple repositories.” In turn, this allows customers to unlock content they already have in their various heath as you want in your family record solutions. “EHRs with good CMIS interfaces provide common Web services and Web 2.0 interfaces to dramatically simplify application development,” he said. 

6. Customizable dashboards. With proper single sign-on, patient context awareness, widgets and mash-up capabilities, future EHRs will be able to provide “sophisticated and highly customizable dashboards that can be tailored by user, by user role, by organization, or [by] other rules,” he said. 

Continued on the next page. 

NEW YORK – Healthcare access, cost, quality and outcomes can vary greatly from one community to the next, both within states and across states, depending on the performance of the healthcare system available to residents, according to a new report from the Commonwealth Fund Commission on a High Performance Health System.

In the first scorecard measuring how 306 local U.S. areas are doing on key healthcare indicators such as insurance coverage, preventive care, and mortality rates, researchers at The Commonwealth Fund found significant differences between the best- and worst-performing localities. Major U.S. cities also showed wide disparities on many key measures of healthcare, with San Francisco and Seattle ranking among the top 75 local areas in the country, and Houston and Miami ranking in the bottom 75. An interactive map accompanying the report allows comparison of cities and communities across the country.

[See also: U.S. healthcare performance score declines]

The stark differences in healthcare add up to real lives and dollars. According to the scorecard, 66 million people live in the lowest-performing local areas in the country. If all local areas could do as well as the top performers, 30 million more adults and children would have health insurance, 1.3 million more elderly would receive safe or appropriate medications, and Medicare would save billions of dollars on preventable hospitalizations and readmissions.

The report, “Rising to the Challenge: Results from a Scorecard on Local Health System Performance, 2012,” and the online interactive map rank local areas on 43 performance metrics grouped into categories that include access to healthcare, healthcare prevention and treatment, potentially avoidable hospital use and cost and health outcomes. The 43 metrics include potentially preventable deaths before age 75, prevalence of unsafe medication prescribing, the proportion of adults who receive recommended preventive care, and the percentage of uninsured adults.

The report finds there is room to improve everywhere, with no community consistently in the lead on all the factors that were measured. However, there were geographic patterns: Local areas in the Northeast and upper Midwest often ranked at the top, while local areas in the South, particularly the Gulf Coast and southern central states, tended to rank at the bottom on many measures.

[See also: Canadians with chronic illness find it tough to get care]

“This first local scorecard provides a baseline for how healthcare systems are performing at the local level when it comes to the most essential functions, including whether people can get the healthcare they need, whether they receive timely preventive care and treatment, how healthy they are, and how affordable healthcare is,” said Commonwealth Fund Senior Vice President Cathy Schoen, a coauthor of the report. “The scorecard is a tool for local healthcare leaders and policymakers that allows them to focus on where their healthcare systems fall short, learn from the best-performing areas, and target efforts to improve where they are needed most.”

Wide variations within and among states
The scorecard’s trove of local data reveals significant differences in how the healthcare system performs across the country, with some areas doing two to three times as well as others. The wide variations within and among states include:

• In California, the Santa Rosa area ranks in the top 10 percent of all local areas evaluated in the scorecard, while the Bakersfield area ranks in the bottom 25 percent. In Illinois, Bloomington ranks in the top 25 percent overall while Chicago ranks in the bottom half, pulled down by high rates of people without health insurance, high costs, and high rates of potentially avoidable hospital use.
• In Kentucky, there was a 27-percentage-point difference between the best and worst areas when it came to making sure people with diabetes received tests for managing their disease effectively (61 percent in Covington vs. 34 percent in Lexington).
• In Florida, Illinois, Indiana, and Michigan, there was nearly a 20-percentage-point difference between local areas with the highest and lowest rates of hospitalization of nursing home residents.
• The incidence of unsafe medication prescribing for the elderly was four times higher in Alexandria, La., than in the Bronx and White Plains, New York (44 percent vs. 11 percent).
• The proportion of women and men age 50 or older who received recommended preventive care, including screening for cancer, was more than twice as high in the best-performing area than in the worst-performing area (59 percent in Arlington, Va., vs. 26 percent in Abilene, Texas).

The report also reveals strikingly wide variations in health insurance coverage and premature deaths across the country. The percentage of adults ages 18 to 64 who were uninsured ranged from a low of about 5 percent in several local areas in Massachusetts to more than 50 percent in the two areas in Texas which had the highest uninsured rates in the country. Rates of death before age 75 that could have been prevented with timely and effective healthcare ranged from less than 60 per 100,000 in local areas in Washington and Colorado with the lowest rates to more than 150 per 100,000 in the worst-performing areas of Louisiana, Georgia, Mississippi

There are also wide variations in performance among the nation’s largest cities. Many of the country’s biggest cities ranked highly: Boston, Minneapolis and St. Paul, Sacramento, San Francisco and Seattle all scored in the top 75 areas for overall health system performance. In contrast, Dallas, Houston, Miami, and San Antonio scored in the bottom 75. The scorecard also revealed significant variations among large urban areas on specific measures. For example:

• Only 39 percent of adults in Chicago were up-to-date on preventive care like cancer screenings and flu shots, while in Raleigh, N.C., 54 percent of adults were up-to-date on preventive care.
• Deaths that could be prevented by timely access to the right healthcare ranged from 61 in Minneapolis and 71 per 100,000 people in Boston, to 169 per 100,000 people in Memphis.
• Nearly 33 percent of adults in Los Angeles reported they have poor quality of life because of their health, compared with only 20 percent of adults in St. Paul.

[See also: CWF updates hospital quality comparison website ]

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.