Ever since the HITECH Act was passed in 2009, the IT efforts of most healthcare providers have been squarely focused on EHR implementation and achieving Meaningful Use (MU). Health IT Outcomes has validated this tendency through its annual Top 10 Health IT Trends survey. Every year since 2010, we’ve surveyed health IT leaders to determine where they plan to focus the majority of their IT efforts and resources the following year. And every year, EHR Adoption/ MU has ranked as the top IT priority for health providers.
What technologies will shape the future of healthcare as the industry ventures into the looming “post-EHR era”?
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Ever since the HITECH Act was passed in 2009, the IT efforts of most healthcare providers have been squarely focused on EHR implementation and achieving Meaningful Use (MU). Health IT Outcomes has validated this tendency through its annual Top 10 Health IT Trends survey. Every year since 2010, we’ve surveyed health IT leaders to determine where they plan to focus the majority of their IT efforts and resources the following year. And every year, EHR Adoption/ MU has ranked as the top IT priority for health providers.
This isn’t surprising, given the level of importance the federal government has placed on EHR adoption and the billions of dollars in incentives it has poured into the MU program. Early on, the MU program produced the desired results — it prompted the healthcare industry to get serious about installing EHR technology. For example, according to HHS data, EHR adoption nearly doubled among physicians and more than tripled among hospitals between 2009 and 2012. However, many have begun to question the direction and ultimate sustainability of the MU program in recent months. Most of the dissent coincided with the release of the final rules for Stage 2 MU attestation. In short, many feel the criteria outlined in Stage 2 is unrealistic, and the reporting requirements place too much of a burden on the provider.
Regardless of the ultimate fate of the MU program, there will come a time (in the not-too-distant future) when the vast majority of health providers will have EHRs in place and MU won’t weigh on IT decisions anymore. Where will providers focus their efforts then? What technologies hold the most promise for improving patient care and outcomes beyond the EHR?
To gain insight in this area, I decided to look to those facilities that have already demonstrated a high level of maturity and proficiency with EHRs — providers that have achieved HIMSS Stage 6 or 7 adoption designation. What technology initiatives are these providers focusing on?
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EHR Optimization Takes Patient Care To The Next Level
While this article will focus on promising technology initiatives in the “post-EHR era,” it’s important to clarify that an EHR implementation is never something a provider should consider complete. It’s something that should be continually enhanced and upgraded to meet the ongoing needs of your facility, your clinicians, and your patients.
“There are three phases to any EHR initiative — installation, stabilization, and optimization,” says Michael Wallace, CEO and president of Fort HealthCare, a HIMSS Stage 7 health system located in Wisconsin. “We’re currently in the optimization phase. We regularly install new updates to our EHR and modify code. An EHR isn’t a ‘check the box and you’re done’ type of solution.”
To that end, one of Fort HealthCare’s current health IT initiatives is focused on connecting not only clinicians, but patients, to the EHR via an online portal. Wallace hopes this effort will not only encourage patients to become more invested in their health, but will also help reduce many of the administrative duties (e.g., scheduling appointments, answering phone calls, preparing records and lab reports, etc.) that can negatively impact hospital productivity.
For Auburn Community Hospital, a HIMSS Stage 6 facility located in Central New York, EHR optimization is all about going beyond the MU checklist and ensuring the software improves patient safety and care. Specifically, the hospital has focused on enhancing its McKesson Paragon EHR to ensure it meets all the criteria for a quality stroke program according to the American Heart Association. For example, Auburn Community Hospital has equipped its EHR with all the realtime alerts and clinical knowledge necessary to ensure its clinicians follow all the stroke guidelines in a timely manner. This EHR enhancement has helped improve patient care, which has been reflected in the hospital’s patient satisfaction scores.
For example, back in January 2013, Auburn Community Hospital was penalized by Medicare for receiving the worst patient satisfaction scores in the nation. However, according to Chris Ryan, CIO of Auburn Community Hospital, preliminary reports of the latest patient satisfaction scores indicate that the hospital will likely finish in the top five percent in New York State and the top ten percent in the nation. Ryan credits EHR optimization, like the stroke program enhancements, for much of this dramatic turnaround.
“It’s not that we weren’t doing the right things prior to 2013; it’s that we weren’t documenting them properly or accordingly,” says Ryan. “Improved documentation and compliance has become increasingly important with our renewed focus on quality, and we’re seeing the results.”
Population Health Management Turns EHR Data Into Actionable Information
Patient portals and stroke program adherence are direct extensions of an EHR system. However, there are other IT initiatives that leverage the EHR (and its data) that are a bit broader in scope. One such example is population health management. This is an area where many providers with mature EHRs are focusing their IT efforts in 2015 and beyond.
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For example, Fort HealthCare is currently working with Cerner to implement a population health management platform called HealtheIntent. This cloud-based solution is able to receive data from any EHR, existing HIT system, and other data sources, such as pharmacy benefits manager or insurance claims. With HealtheIntent, Fort Health- Care is beginning to aggregate, transform, and reconcile data across the continuum of care to create a longitudinal record that it is using as the basis of its population health management efforts.
“With our population health management platform, we will be able to analyze data from multiple sources to gain enhanced visibility into our patient population,” says Wallace. “For example, we’ll be able to create registries around patients with chronic conditions such as diabetes, coronary artery disease, congestive heart failure, and asthma. Through these registries, we’ll be able to develop evidencebased guidelines for disease management and clinical intervention.” Wallace believes this effort will pay off in the form of improved compliance, reduced ER visits, and fewer hospital admissions for patients with certain chronic illnesses.
Auburn Community Hospital is also currently focused on interoperability and population health management. The hospital is an active participant in New York’s Delivery System Reform Incentive Payment (DSRIP) program. DSRIP’s purpose is to fundamentally restructure the healthcare delivery system by reinvesting in the Medicaid program, with the primary goal of reducing avoidable hospital use by 25 percent over five years. Up to $6.42 billion are allocated to this program with payouts based on achieving predefined results in system transformation, clinical management, and population health.
“DSRIP is encouraging healthcare facilities in New York State to collaborate, share data, and improve the continuum of care for patients,” says Ryan. “Through this effort, we hope to ensure that chronic conditions are well-maintained and cared for outside of the hospital setting.”
Ryan sits on the IT committee responsible for developing DSRIP’s infrastructure strategy. The committee is currently screening all of the healthcare providers in Central New York in an attempt to identify a methodology for sharing electronic health data seamlessly and securely between facilities.
“This is a significant undertaking,” says Ryan. “To achieve true interoperability and population health, you need to involve more than just inpatient and outpatient facilities. Primary care physicians, long-term care centers, home health agencies, mental health organizations, and other ancillary providers must all be included in (and accept) this accountable care model.”
Using Data Analytics To Improve Price Transparency
Fort HealthCare is leveraging analytics for more than just population health. The health system is also looking to Big Data to help improve price transparency.
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“The entire healthcare industry needs to get better at being able to identify how much it costs to deliver its services,” says Wallace. “We struggle as an industry to pinpoint how much it costs to perform an endoscopy, a knee replacement, or any other procedure. The cost structure also varies greatly from one provider to another. As we move from volume to value, healthcare facilities will likely receive a fixed payment for certain procedures, and providers will need to be able to live with that reimbursement. The key to thriving in this new world is to gain a better understanding of your cost structure today.”
The State of Wisconsin has been a leader in the realm of price transparency. The Wisconsin Hospital Association (WHA) has worked with its members to develop a website called PricePoint. Basically, all WHA providers, including Fort HealthCare facilities, upload their charge data to this online repository where it is aggregated. Healthcare consumers can use the site to gain insight into what certain medical procedures cost at different health providers throughout Wisconsin. WHA also maintains a companion site to PricePoint (called CheckPoint) that aggregates quality report data for Wisconsin hospitals and makes it available to consumers. While Wallace admits that much of the current pricing data in PricePoint isn’t fixed (i.e., there are often drastic differences between the amount a provider charges and the amount it is ultimately reimbursed that aren’t reflected), he also states that the platform (along with CheckPoint) is a huge first step to making patients informed healthcare consumers. Moreover, Fort HealthCare is using these sites to benchmark its own cost and quality efforts.
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“Our strategy is to try to provide a highquality procedure at a low (but not necessarily the lowest) cost,” says Wallace. “We feel that striking the right balance between cost and quality is critical to our future growth. People will drive across town to save a nickel on a gallon of gas. It stands to reason that they’ll travel across the state to save 10 to 20 percent on a $40,000 procedure. At the same time, patients don’t necessarily want to have their surgery performed by the lowest bidder if it means sacrificing quality. We want to be the provider that strikes the right balance for them, and we’re reviewing the data in PricePoint and CheckPoint and working with Cerner to apply better analytics to our own cost structure data to put our best foot forward.”
The Impact Of Telehealth
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Both Wallace and Ryan envision that telehealth, remote patient monitoring, and clinical device integration will have a major impact on improving population health and reducing the cost of care as we move into 2015 and beyond. “I think the use of wireless blood pressure cuffs, glucometers, scales, and other devices holds great promise for wellness plan adherence and timely clinical intervention,” says Wallace. “With real-time insight into key chronic condition indicators, clinicians can proactively intervene and possibly prevent a patient from ending up in the ER or being admitted to a hospital. We realize we may have to invest a large sum of money on these devices on the front end, but the downstream payback is significant. It’s all about getting a better outcome.”
For Auburn Community Hospital, clinical device integration has been on the back burner until this year. However, the provider plans to develop real-time integration between point-of-care hospital devices (such as EKGs and EEGs) and its McKesson EHR in 2015.
EHR Optimization Takes Patient Care To The Next Level
For example, Fort HealthCare is currently working with Cerner to implement a population health management platform called HealtheIntent. This cloud-based solution is able to receive data from any EHR, existing HIT system, and other data sources, such as pharmacy benefits manager or insurance claims. With HealtheIntent, Fort Health- Care is beginning to aggregate, transform, and reconcile data across the continuum of care to create a longitudinal record that it is using as the basis of its population health management efforts.
“The entire healthcare industry needs to get better at being able to identify how much it costs to deliver its services,” says Wallace. “We struggle as an industry to pinpoint how much it costs to perform an endoscopy, a knee replacement, or any other procedure. The cost structure also varies greatly from one provider to another. As we move from volume to value, healthcare facilities will likely receive a fixed payment for certain procedures, and providers will need to be able to live with that reimbursement. The key to thriving in this new world is to gain a better understanding of your cost structure today.”
“Our strategy is to try to provide a highquality procedure at a low (but not necessarily the lowest) cost,” says Wallace. “We feel that striking the right balance between cost and quality is critical to our future growth. People will drive across town to save a nickel on a gallon of gas. It stands to reason that they’ll travel across the state to save 10 to 20 percent on a $40,000 procedure. At the same time, patients don’t necessarily want to have their surgery performed by the lowest bidder if it means sacrificing quality. We want to be the provider that strikes the right balance for them, and we’re reviewing the data in PricePoint and CheckPoint and working with Cerner to apply better analytics to our own cost structure data to put our best foot forward.”
Both Wallace and Ryan envision that telehealth, remote patient monitoring, and clinical device integration will have a major impact on improving population health and reducing the cost of care as we move into 2015 and beyond. “I think the use of wireless blood pressure cuffs, glucometers, scales, and other devices holds great promise for wellness plan adherence and timely clinical intervention,” says Wallace. “With real-time insight into key chronic condition indicators, clinicians can proactively intervene and possibly prevent a patient from ending up in the ER or being admitted to a hospital. We realize we may have to invest a large sum of money on these devices on the front end, but the downstream payback is significant. It’s all about getting a better outcome.”
