A Triple Play Updates CARE*Link

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Pictured: Analyst Cathie Stahl of HealthTECH Resources gives a recent project road show overview for Emergency Department nurses.

If you visit Epic headquarters in Verona, Wisconsin, you’ll find a star for The Queen’s Health Systems pretty close to the front door of an Electronic Health Records (EHR) “hall of fame.” The closer to the front one is, signifies earlier adoption of Epic’s EHR system, which Queen’s calls CARE*Link. It demonstrates that Queen’s is a tech-savvy organization, but mixed in with that early adoption is a current need to address major CARE*Link issues. Triple Play is a major QHS project to update CARE*Link to current industry best practices and will involve a massive team effort from both

IT and CARE*Link users. The project is called Triple Play because it encompasses a double upgrade, plus standardization that will resolve CARE*Link’s foundational issues, bringing it in line with current industry best practices.

QMC adopted an inpatient EHR ahead of many major health organizations such as Kaiser Permanente, which rolled out their Epic-based system in 2010. When Queen’s rolled out CARE*Link in 2006 (the star photo reflects the 2004 contract date), there was less industry standardization of EHR systems, and Queen’s chose to customize its EHR. As EHR systems like Epic became more and more standardized, it became difficult for QHS to take full advantage of subsequent upgrades. As a result, a disproportionate amount of resources are currently being spent on CARE*Link maintenance, and QHS is not able to use many of Epic’s newer features that are designed for efficiency and improved care delivery.

Because of this customization, previous CARE*Link upgrades have been relatively small, but this double upgrade will be much bigger, bringing over 1,500 enhancements to the system. Further, Queen’s will shed its CARE*Link customizations in favor of more standardized Epic modules. This will fix foundational issues, improve the maintenance burden, and make future upgrades much easier.

The benefit is improved efficiency and productivity for physicians and nurses via new tools, which will allow for more time with patients. Standardization will upgrade CARE*Link to current industry best practices, as well as meet federal regulatory requirements and prepare for payment transformation.

“One of the most important parts of Triple Play is that we’re restarting a super user program with doctors, nurses, and other frontline staff,” says C. Becket Mahnke, MD, QHS Chief Medical Information Officer. “We will be taking staff with additional CARE*Link training and infusing their expertise right where people work.” He indicated that there will be about 300 super users at Queen’s Punchbowl; 55 at Queen’s – West O‘ahu; 40 at North Hawai‘i Community Hospital; and 15 at Molokai General Hospital. The Super User program is not just for the Triple Play project but will continue on as an industry best practice. Dr. Mahnke emphasized that training is key to the success of Triple Play, as well as a partnership between users and the CARE*Link team.

There will be “road shows” that showcase the new improvements through June, with training registration now open. Training for end users is from July 23 to September 8, with Go-Live scheduled for September 9. For more information, visit Triple Play on the Queen’s Intranet.

Article reprinted with permission.

Meaningful Use in the ER: Interview with Dr. Whitney Kiebel

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The writing has been on the wall for years and CMS has read it. While the Meaningful Use program may have achieved its goal of widespread EHR adoption, the time has come to focus on performance and patient outcomes.

Andy Slavitt MU TweetWhile the program can be hailed for catalyzing a wave of modernization in the healthcare industry, it can be equally roasted for ignoring EHR usability, letting the role of physicians in providing data entry and compliance get out of control, and delivering attestation requirements with no apparent relevance to the delivery of quality care. American Medical Association President Steven J. Stack, MD argued that, “Most electronic health record systems fail to support efficient and effective clinical work. This has resulted in physicians feeling increasingly demoralized by technology that interferes with their ability to provide first-rate medical care to their patients.”

Cue CMS head honcho Andy Slavitt announcing the death knell for MU at the J.P. Morgan Healthcare Conference January 11th, and later in a tweet that pledged “something better” is on the way, causing some dissatisfied doctors to celebrate and some to shrewdly ponder the corporate greed and regrettable sunk cost of the program thus far.

It is a welcome change for most, but who’s to say what comes along next will be any better? The uncertainty around MU’s replacement has led many to temper their enthusiasm. The College of Healthcare Information Executives (CHIME) is advocating to CMS and congressional committees for ”greater alignment and harmonization of quality measures; creating parity between eligible professionals and eligible hospitals; and removing the pass/fail approach to gaining incentives; reinstating the 90-day reporting period; and ensuring that MU focuses on using IT to transform care, not just reinforce a check-the-box mentality.”

“Most electronic health record systems fail to support efficient and effective clinical work. This has resulted in physicians feeling increasingly demoralized by technology that interferes with their ability to provide first-rate medical care to their patients.”

Echoing the sentiment that it’s high time to move into the phase of making the program live up to it’s Meaningful moniker, Karen DeSalvo, MD, National Coordinator for Health Information Technology affirmed that “this new chapter” of health IT will be “more about knowledge that can come from that data as opposed to thinking about the adoption of platforms themselves.” We know this will involve transitioning to the Medicare Access & CHIP Reauthorization Act’s (MACRA) emphasis on Merit-Based Incentive Payment System (MIPS) and alternative payment models, but as of yet it seems the champagne should remain corked.

While the industry awaits CMS and the government to shed light on future health IT incentive programs, we wanted to hear from a local MD about her impressions of MU, the rapid adoption of EHRs, and their impact on how physicians take care of and interact with patients at her organization.

Dr. Whitney Kiebel, MD, iMU Quantum States an emergency and pediatric physician in her final year of residency at the University of Arizona College of Medicine in Tucson. She was interviewed via email in late February.

HealthTECH: What are your overall feelings on the the impact EHRs have had on your day-to-day work?

Dr. Kiebel: I 100% agree with the comments [from AMA President Stack]. Sometimes [the EHR] reminds me to do things that I otherwise would not…but for the most part, I do not find it useful and it just adds another tedious task to our charting. I spend significantly more time at the computer than I actually do interacting and caring for patients. The EPIC interface is probably the best one that I have worked with and does make it easier (I have used CERNER, Meditech and Sunrise Clinical Manager).Kiebel MD

HealthTECH: While the MU program may have accomplished its primary goal of getting providers to adopt EHRs and begin digitizing patient information, and we can acknowledge there have been challenges, what value have these efforts had to you and the organization? If not now, are you confident that we will see the value of this massive endeavor in the future?

Dr. Kiebel: I do like EHRs. I think it is easy to get carried away with various things that are purely just for data and have no merit in affecting patient care (i.e. MD in room button). We have it set up in our department that we bring computers with us into the room. In order to actually chart efficiently most people do this. I do think that typing does take away from the patient experience and makes it less personal. But there is no way that I could get my charts done in time if I did not do this.

The best thing about EHRs is being able to look at old records. In a busy emergency department, this would be impossible to do without EHRs. This has seriously changed my practice, particularly in patients with chronic issues or who frequently visit. It would be nice if there was a better way to link with other hospitals in the community.

HealthTECH: Part of the announcement of the MU changes included a new focus on the use of API’s to promote innovation. What do you imagine true innovation in Healthcare IT looking like?

Dr. Kiebel: I really like the idea of the APIs. Patient’s need better access to their records. However, sometimes a test will come back abnormal and in the appropriate clinical context it is not something that I would be concerned about. It is hard to communicate that with patients and to prevent unnecessary worry. So though I like the idea, it may not be the most productive in some situations.

I think promoting communication after a visit is very helpful particularly in the primary care setting.  As far as a busy ER, probably not as much so since we do not have a longstanding relationship with our patients (most of the time). It is much easier to type a quick text or email to a patient, than to try to get in contact via snail mail or phone.

It would be amazing if healthcare IT could come up with a way to link all EHRs so that we could access other hospital’s data.  I have so many patients that come in and say, “I don’t know my list of medications, don’t you have it on file?” It would help us eliminate unnecessary admissions and workups.  I have had patients come in that have had extensive workups in other cities but I have been unable to access these records, and as a result end up ordering the same workup for the patient here because legally I do not have any documentation of prior workups.

“It would be amazing if healthcare IT could come up with a way to link all EHRs so that we could access other hospital’s data.  I have so many patients that come in and say, ‘I don’t know my list of medications, don’t you have it on file?'”

HealthTECH: What are your feelings going forward with Stage 3 attestation, MIPS, and alternative payment models? Incentivizing good quality care is obviously the goal, but developing metrics to measure that quality sounds tricky.

Dr. Kiebel: I do not quite understand the impact that this will have and it sounds like it is really tricky. I do agree that incentivizing good care is necessary, but I do not know if these models really assess that. They are trying to objectify something that really can’t be objectified. To be penalized financially because you are not clicking buttons on a computer seems like the wrong way to grade physician care and doesn’t seem like an appropriate model of determining physician reimbursement.

Many places have hired scribes to ensure efficient and effective charting. It is kind of crazy that you have to hire somebody to chart for you, but most places are moving to this.

What happens if UnitedHealth Opts out of ObamaCare?

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By Larry Hodge, CEO HealthTECH Resources, Inc.

UnitedHealth Group is forecasting losses and considering an early exit from the Obamacare exchanges. With 20+ years of past experience in the healthcare IT industry, I believe that this would create problems for the payer market. How will this affect the healthcare IT sector, as those 3 ½ million people will have to figure it out for themselves or they walk around, again, with no health care? If managed health care insurance, our payer market, start opting out of the system, it will affect our business as people will no longer need to be on-boarded into the system in those insurance clients not participating.

Larry Hodge is CEO of HealthTECH Resources, Inc., located in Phoenix, AZ discusses his company and how UnitedHealth exit from Obamacare would affect the Healthcare IT industry.

Larry Hodge, CEO, HealthTECH Resources, Inc.

For the first ten years in this business, HealthTECH focused on the payer side of healthcare.  We saw the Provider market take off after ObamaCare mandated the adoption and implementation of electronic health records along with incentive payments for their Meaningful Use. Most major hospitals in the U.S. were behind schedule with Stage 2 compliance, designated as “the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible” by the Centers for Medicare and Medicaid Services. After significant industry feedback, CMS released an update to the Meaningful Use program on October 16th, 2015. All providers are now in Stage 2 of Meaningful Use, with those who were previously in Stage 1 moved to a “Modified Stage 2”. The new deadline for attestation is February 29th, 2016. CIO’s know that if they don’t get through these stages by the deadline set by the government, they may not get reimbursed for Medicare, or worse.

HealthTECH focuses on EHR Market for Meaningful Use Compliance

HealthTECH focuses on the EHR market, with specialized support for regional hospitals under 100 beds, to larger hospital clients nationwide with more than 200-400 beds. In my view, in addition to ObamaCare, another significant reason the payer market has been challenged is due to the intense M&A and consolidation activity in the Insurance market over the last 5-7 years.  United, Aetna, Anthem and Coventry have bought everybody seemingly (or considered them). If one of them didn’t acquire them, one of the other already owns them. There used to be dozens of reputable insurance companies to choose from and now there are a handful. That affects the IT professionals we hire to meet demand.

The majority of our resource requirements are now on the Provider side. We still maintain a very strong bench of top talent in the payer market as we continue to support our payer clients nationwide. Five years ago, I saw just the opposite. Provider consultant bill rates are higher than our payer bill rates across the board nationwide. Of course, we take care of everybody but the demand for payer resources is less, I feel due to consolidation in the payer marketplace. I am starting to see the same thing beginning to happen on the Provider side. Consolidation and M&A activity has increased naturally and we support that activity as prudent business practices.  Whether it be clients like Cedars, Banner, or St Josephs buying up smaller hospitals, we are vigilant of this trend and understand the support issues that follow a major acquisition, migration or upgrade.

I’ve kept an attentive eye on this over the years, and I see this as a big snowball coming down the mountain. I feel there is now way to really “slow” this trend, regardless of Congress interventions.  People are living longer. They are utilizing hospital systems to live longer. There is no way to stop this transition in the Hospital and EHR market. Hospitals can’t push back, or they won’t be Meaningful Use compliant, they won’t receive Medicare reimbursements, or they will be acquired many times against their will…..it is a “process” we must continue to work through and in my opinion we cannot “stop the snowball” that has been underway. We have to be prepared for it and plan for it accordingly.

Experience with every EHR Application

HealthTECH has expertise with all major EHR applications, whether it be a major implementation, migration to a different EHR, or required upgrade along the way. We have resources available for Payer and Provider clients in all 50 states nationwide, on site, for any duration. It doesn’t matter where you are located or what EHR application you choose, HealthTECH has over 20 years of implementation/upgrade experience that includes every available EHR application. We understand Meaningful Use guidelines and the various stages of compliancy required for Meaningful Use. We know the critical efforts to move from ICD-9 to ICD-10. Our consultants understand this complexity and their role in our client’s objectives. It may sound easy, but it is a nightmare at times…we understand that. We can support you through this transition as we have been for Payers and Providers since the 90’s. This is all we know, and we understand the task at hand as we have specialized in this arena for over two decades and evolved through the process.

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EHR Satisfaction: A Look at Healthcare IT News’ 2015 Survey

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checklist-154274_1280Electronic health record (EHR) systems are playing an increasingly greater role in the operations of your hospital and its staff. Their effectiveness – or lack thereof – can even affect your bottom line in relation to achieving meaningful use requirements. This all makes the happiness of your EHR users critically important.

With that said, it was almost shocking to see the results published last month for Healthcare IT News’ 2015 EHR Satisfaction Survey.

Healthcare IT News’ 2015 EHR Satisfaction Survey findings

Healthcare IT News polled almost 400 EHR users and healthcare IT professionals on their EHR’s 1) quality of support at installation and ongoing; 2) interoperability with medical devices, billing, and clinical systems; and 3) features and design, meaning visual appeal and ease of use. The publication then provided an overall ranking for nine leading EHR providers. Here are a few highlights of their report:

  • Epic nabbed first place in all three categories, even though its total score only amounted to 7.6 out of 10.
  • eClinicalWorks took second place overall with a 6.2 score, as well as third place in support and second place in features and design.
  • McKesson and Siemens landed in the last two spots with a 4.9 and 4.6 overall score respectively.

Again, considering the impact that EHR is having and will continue to have on your hospital’s day-to-day operations, hospital executives and healthcare IT professionals simply cannot afford to just get by with their EHR system. Taking measures now to correct issues will certainly pay off in the long run, rather than to just accept these systems as is.

To help maximize their EHR investment and ease their staff’s burden, proactive hospitals are calling in healthcare IT consultants. If you’re interested in doing the same, contact our team at HealthTECH Resources. We can have a healthcare IT professional, who is expertly trained on your EHR system, at your facility within 48 hours. Let us help.