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All Things EMR | Meaningful Use

Some Candor About EHR and Meaningful Use


Todd RothenhausMicky Tripathi, CEO of the Massachusetts eHealth Collaborative, just published a terrific piece on the realities of capturing the CMS quality measures as part of MU. It’s a really resplendent post that caught our eye for its accuracy and candor.

“Report ambulatory clinical quality measures to CMS/States” is only a single Meaningful Use requirement. But if tackled faithfully, it essentially doubles the work of achieving MU. In other words, the quality measures are essentially a plump Matryoshka doll stuffed into the mother of Meaningful Use.

Micky accurately points out that CSC was the first to break the story back in January. At the time, we thought it was one of the most under-reported issues of the whole MU deal. As we were busy building all 44 possible quality measures directly into athenaNet, we were scratching our heads wondering how other vendors were going to do it? Our EHR and Quality Management Engine were built for Pay-for-Performance capture, but from what we knew of other vendors, things were going to be mighty complicated.

  • Numerators, denominators, exclusions?
  • Designing the optimum places for data capture without slowing docs down?

It gets really complicated.

Well, according to Micky’s analysis, it turns out that most EHR vendors tackled it by skipping school and not building more than a few required measures! In fact, athenahealth joins only a handful of other vendors that even bothered to build out the measures most specialists will find “meaningful” and want to use to attest. If you are using athenaClinicals, no matter what your specialty, we have your back.

Micky goes on to say:

  • “The most important areas in my view are determining what measures you’re going to report on…” No problem, we have you covered. Choose any measures you like. Our account managers will even help you decide.
  • “Developing a robust data acquisition and documentation strategy to support the numerators, denominators, and exclusions for your chosen measures…” Gross. We know because we did it for you.
  • “…and determining whether your EHR will be able to generate those measures.” athenahealth will. In fact we guarantee it.

Micky rightly points out that electronic reporting won’t begin until Stage 2, and that reporting bad results will still probably get you your check.

However, it’s only a matter of time before the world thinks a doctor is sub-par just because his EHR is.

Rothenhaus is the chief medical information officer for athenahealth.


All Things EMR | Meaningful Use | Medical Billing & Payers

Health IT in the News


Ha! Of course! There are inaccurate medical claims flying around out there you say? Preventing such errors is why we exist! As you’ll see in the article, there’s a 20 percent error rate in medical billing, a mistake rate among payers and doctors that in most lines of work would make short work of the erroneous. There were two points in the article worth noting because, well, they make our point. One: “The problem is not just doctors, health plans say, but physicians who have yet to upgrade to electronic means of submitting their claims.” And two: “Improving claims processing could save patients money and improve medical care by reducing hassles physicians have when they are forced to haggle with health plans over payments or other issues.” Sound familiar? Here’s more coverage of the report from Health Data Management.

According to this story from Minnesota, while health IT is meant to improve care and make sure it’s delivered efficiently, it has some downside. It turns out that all the benefits of EHRs, electronic prescriptions and patient portals may be lost on those who are tasked to make it happen. “Behind the scenes, hospitals are struggling to implement the systems. Rural communities worry the mandate, which can cost millions of dollars to meet, could further strain small-provider finances, forcing them under or leading them to join larger health systems…” Blame is placed on the federal measures under the HITECH Act that are forcing doctors to adopt and achieve Meaningful Use of an EHR by 2015 or face cuts in Medicare reimbursement.

Speaking of Medicare, it turns out there are some potentially very helpful preventative services available to the public but no one seems to be using them.

As local coffee shops fall to a Seattle-based chain with its own strange words for simple ideas like small, medium and large, so too falls the local physician to big hospital systems. This storyline keeps popping up and it’s got localized issues attached—just like when the generations-old hardware store gets steamrolled by some big-box purveyor out on the highway. But for a doctor at least there’s a place to land. Uncle Jimmy and cousin Bob just go out of business and profits go elsewhere. “In 2008, about half of physician practices were hospital-owned, according to an industry group. A survey last fall by another industry group found that 74 percent of hospital leaders planned to hire more doctors in the next 12 to 36 months. Most want primary-care doctors.”

This comes from the ‘this could get ugly’ file. According to MGMA, almost half of all practices have not yet begun the conversion of their financial software to the ANSI 5010 standards. The other half of the story? There’s only half a year left to comply. MGMA’s survey said only 2% of the practices they polled have finished implementation and practices report back that many are waiting on their vendors to meet the deadline. At athenahealth we’ve been proactive and our clients are going to transition just fine. Learn more about ANSI 5010 in this on-demand webinar.

Finally, don’t forget to vote for the most influential person in health care. It should not take you too long because the list is alphabetical and there’s no need to scroll past the letter “B”.


All Things EMR | Medical Billing & Payers

Health IT in the News


Ha! Of course! There are inaccurate medical claims flying around out there you say? Preventing such errors is why we exist! As you’ll see in the article, there’s a 20 percent error rate in medical billing, a mistake rate among payers and doctors that in most lines of work would make short work of the erroneous. There were two points in the article worth noting because, well, they make our point. One: “the problem is not just doctors, health plans say, but physicians who have yet to upgrade to electronic means of submitting their claims.” And two: “Improving claims processing could save patients money and improve medical care by reducing hassles physicians have when they are forced to haggle with health plans over payments or other issues.” Sound familiar? Here’s more coverage of the report from Health Data Management.

According to this story from Minnesota, while health IT is meant to improve care and make sure it’s delivered efficiently, it has some downside. It turns out that all the benefits of electronic prescriptions and communicating with your doctor via email may be lost on those who are tasked to make it happen. “Behind the scenes, hospitals are struggling to implement the systems. Rural communities worry the mandate, which can cost millions of dollars to meet, could further strain small-provider finances, forcing them under or leading them to join larger health systems…” The blame is placed on the federal measures under the HITECH Act that are forcing doctors to adopt EHR by 2015 or face cuts in Medicare reimbursement.

Speaking of Medicare, it turns out there are some potentially very helpful preventative services available to the public but no one seems to be using them.

As local coffee shops fall to a Seattle-based chain with its own strange words for simple ideas like small, medium and large, so too falls the local physician to big hospital systems. This storyline keeps popping up because it’s a trend and it’s got localized issues attached—just like when the generations-old hardware story gets steamrolled by some big-box purveyor out on the highway. But for a doctor at least there’s a place to land. Uncle Jimmy and cousin Bob just go out of business and profits go elsewhere. “In 2008, about half of physician practices were hospital-owned, according to an industry group. A survey last fall by another industry group found that 74 percent of hospital leaders planned to hire more doctors in the next 12 to 36 months. Most want primary-care doctors.”

This comes from the ‘this could get ugly’ file. According to MGMA, almost half of all practices have not yet begun the conversion to the ANSI 5010 financial system software. The other half of the story? There’s only half a year left to comply. MGMA’s survey said only 2% of the practices they polled have finished implementation and practices report back that many are waiting on their vendors to meet the deadline. At athenahealth we’ve been predictably pro-active and our clients are going to transition just fine. Learn more about ANSI 5010 in this on-demand webinar.

Finally, don’t forget to vote for the most influential person in health care. It should not take you too long because the list is alphabetical and there’s no need to scroll past the letter “B”.


All Things EMR

Part I: Musings from the Burn Unit


Todd RothenhausIn my previous post, I wrote about how much athenahealth resembles my former IT department at Steward Health Care. In this post, I want to tell you a little about my experience with ambulatory EHR strategy and deployment. This is the first of two parts on my realizations from that work that led me to the “dark side.”

To set the stage, a big part of Steward’s strategy is to be a disruptive innovator in the marketplace by being a high-quality, low-cost alternative to Boston’s more expensive in-town hospitals, and by aggressively embracing new payment models and insurance product reform. Market by market, contract by contract, Steward is diving headfirst into global capitation, downside risk, and growing the proportion of revenue from pay-for-performance and self-pay collections.

Steward began its mission to become a community-based accountable care organization by rolling out clinical systems to all its hospitals. In addition, like many other health systems, we developed an extensive ambulatory EHR program for both employed and affiliated physicians that included Stark-allowed subsidies for software and implementation.

The inpatient work was difficult but straightforward. In just a couple of years, Steward’s achieved HIMSS Stage 6, significantly and forever altering the delivery of care within the walls of its hospitals.

The ambulatory side was another story. At one point, I was quoted as saying that I’d rather roll out EHR to another hospital than tackle another physician practice. Here’s why. Ambulatory EHR, especially in systems with a high proportion of independent affiliated physicians, is completely different business then inpatient work.

Like most large health systems, we created our own infrastructure for hosting our vendor’s software in our own data center. Licenses, server infrastructure, and other hardware took a lot of CAPEX, but at the time there were no alternatives. As the program grew (and when technical issues struck) we did what needed to be done:

  • We bought more hardware
  • We doubled down on network bandwidth
  • We migrated systems from old stack to the new
  • We began an almost continuous process of upgrading to newer versions of the software

To take on the upgrades, we had to take resources off of new rollouts in order to re-touch every practice, deploy and test the new version, and to train users on new features and functionality. As resources became more of a problem, we ended up rolling out updates without training on new functionality—functionality that could improve users’ experiences. We had bought expensive licenses, paid for maintenance and support, and ended up with users on multiple versions of the software. I lost a lot of goodwill and we were consuming far more resources than I had planned. Our team needed to grow almost linearly in order to take on more practices. Things just didn’t scale.

Then I had my first realization: the traditional software model won’t work in the ambulatory world.

We began exploring having our EHR vendor (or an outside vendor) host our systems. However, we still owned the entire application and the entire implementation. I’ll talk a bit more about application support in my next dispatch from the Burn Unit.

Rothenhaus is the chief medical information officer for athenahealth.


All Things EMR | Meaningful Use

Health IT in the News


  • So make mine, a Benz? According to this article from Information Week, some CIOs think an EHR should be more like a car. The point, which was made in a letter to the new ONC, Farzad Mostashari, MD, is that EHRs need some standardization in the way that you can climb into any car and expect to find a steering wheel, gas pedal, brake, gear shift and all that. But just as car manufacturers build in their own custom features, the equivalent in an EHR makes it hard for clinicians to adapt to a new system. So, “One suggested improvement was to define a limited set of icons that would be consistent across applications, as well as consistent terminology for actions taken within the EHR.” Probably a good place to start would be making sure every EHR actually gets you where you want to go in terms of care and revenue…
  • These past few days have seen a series of reports from regional extension centers around the country announcing milestones in EHR adoption. Mississippi hit its mark and the 1,000th provider was enrolled in Maryland.  In Vermont some 750 doctors have signed on for assistance with EHR adoption and South Carolina put up some big numbers as well. In late 2009, athenahealth spun up a major effort to work with the RECs and we continue to collaborate with them today. Just last week we conducted a webinar training session for all of our extension partners and we continue to focus on our unique approach to guaranteeing Meaningful Use for our providers. In the most recent webinar, we walked the RECs step-by-step through each measure and highlighted areas where they are able to support athenahealth providers.
  • Speaking of EHR adoption, patients need to be assured about the use and the safety of their health information as growing networks mean more exchange of data. The market for EHR is growing too, according to this article from Healthcare IT News.
  • Hmmm, more time for Meaningful Use? That’s what a federal panel has recommended. According to this report, the Health Information Technology Committee for the Department of Health and Human Services wants decision-makers to cut some slack for doctors and hospitals to meet the second phase of Meaningful Use deadlines, shifting from 2012 to 2014. Our CEO, Jonathan Bush tweeted some initial thoughts about MU shifts this week. We’ll have more to say on that one…
  • Maybe we should be grateful we’re not stuck in a sooty locomotive factory all day or that life doesn’t mean you get to dig a massive canal with a shovel beneath the blazing sun, but it turns out this age of information is not so kind to its laborers either. Believe it or not, the hazards of sitting for hours a day using your body for not much more than clicking a mouse and tapping keys is being compared to the consequences of smoking. The article notes that some with an eye to longevity are resorting to stand-up desks, something you will notice in several offices here at athenahealth.
  • Finally, we’re happy to announce our recent membership in the Cloud Security Alliance where we join the likes of Google, Salesforce and Microsoft. It’s telling that we seem to be the only health care company in the group and the only self-described “cloud-based service” as well.

Rocket Fuel