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All Things EMR | Meaningful Use

Meaningful Use Dashboard Update: It Takes Teamwork

People who cannot function on a team simply do not survive at athenahealth. The nature of our services require people—not just technology—to function together at a high level.

Even people who didn’t play (or get picked very often for) team sports in school will find themselves assigned to an athenahealth team that meets in huddles and scrums and, well, relies on one another to do plenty: complete projects, protect data, launch enhancements, produce marketing material, whatever.

Outside work, athenahealth has a ski team, a running club, a bunch of developers who meet to work out regularly and a battalion of athenistas who launched a foray up north for last summer’s bicycle-borne Trek Across Maine. And it may be an undergrad relic, but an MIT Ballroom Dance Team jacket has been spotted in the hallways here.

So what’s all this about teams? Ever since early September, when we began publishing our Meaningful Use (MU) data, we’ve been talking about how it takes teamwork on our part to support the Meaningful Use program. For example, in late September, we wrote about the MUES team, our folks who take on attestation for our clients. There are eight athenistas on the MUES Team and, by the latest count, they’ve helped more than a few hundred of our eligible providers attest to the measures. How’s that for teamwork?

You can check out the newest Meaningful Use dashboard data here but for a quick rundown:

  • 62% of our Medicare MU providers have attested, up from 58% in the last iteration
  • 28% of our Medicare MU providers are within two core measures of attesting
  • Over 90% of our Medicare MU providers have met the previously troublesome Clinical Summary measure

Now, let’s get back to teamwork. It’s not just athenistas who need to work together to achieve Meaningful Use. Our client practices are good at it, too.

Here’s a perfect example: The eligible providers at Mount Auburn Professional Services (MAPS) Obstetrics and Gynecology, right up the road here at Mount Auburn Hospital in Cambridge, were able to implement the athenahealth EMR, attest to Meaningful Use and get their first incentive checks over the course of just eight months this past year.

We could tell you all about it, but why not just watch the video and let them share the story?

Mt. Auburn video

Stay tuned for the next Meaningful Use Dashboard update in two weeks…

Healthcare Policy & Reform | Meaningful Use

Mr. Bush Goes to Washington

Jonathan BushYou can’t believe the play that little athenahealth gets in Washington, DC… and thank goodness for it because no one has a clue about HIT.

How could they really?

I mean, there are 535 people in our federal legislature (give or take) and there are like a million different market spaces in the nation. This is why I have such a hard time with federal control of things. It’s impossible for them to  know what’s going on…there are just not enough hours in the year.

As I’ve been thinking about care coordination and the complete lack of sustainable models or entrepreneurship in that space, it occurred to me that it’s currently not clear that it is legal for RECEIVERS of electronic health information to pay senders for the value of that health information. This means that the sender has no real motivation to send useful, relevant data in a timely manner (I know I’d pay the doc who sent me exactly what I needed about a patient more than I’d pay the doc who sends over a 30-page PDF) and that our industry will take a long time to understand the true health information exchange needs of providers.

I wanted to bring the concept with me to the Hill that Meaningful Use, in my opinion, is use that is meaningful to a medical care provider in the actual doing of business. In a space with such clear demand, we’ve got to let innovators develop a way to supply information that the market (providers of care) needs, if we want to improve outcomes and reduce costs.

So I flew down to Washington and it was tons of fun… me and Lauren Fifield and the lobbyist and a full dance card on Capitol Hill.

First, we met with Sally Canfield, policy director for Sen. Marco Rubio, R-Fla.

She’s a true health policy veteran who likes getting—and will give you—the straight story. She’s also one of the only people on the Hill with whom I could speak at my normal (lightning) pace and know she can keep up. We talked about everything from the potential fall of hospitals (Need a hospital?  Just scan the horizon for a construction crane)…to the alarming rate of physician employment…to making Meaningful Use really meaningful…to encouraging care coordination…to life in the cloud.

Then we met with Rep. Tom Price, R-Ga. Since he’s a physician, he has great insights into the medical world given his years of practice.

We talked about:

  • Enabling care coordination through innovation and entrepreneurship
  • Defining Meaningful Use as helping doctors exchange meaningful data
  • Using the data to improve outcomes and patient care, at the point of care

Next was Sen. Johnny Isakson, R-Ga. Another Johnny! And a nice guy to boot.

We talked about:

  • Our new office in Georgia and our recent acquisition of Proxsys, which is now known as athenaCoordinator
  • The Meaningful Use dashboard, how athenahealth has been promoting transparency and using data to make Meaningful Use meaningful
  • A potential location idea for our expanding Georgia office!

Around lunchtime that day we met with Rep. Chellie Pingree, D-Me. She’s my neighbor up in Maine.

We talked about:

  • The Maine health care ecosystem
  • The cloud model for health information
  • Dollars from secondary payers currently being left on the table by the Defense Department and the VA
  • The Meaningful Use Dashboard

In the early afternoon, we met with Rep. Paul Ryan, R-Wis. You’ve probably heard of him and he’s already made his mark as a thought leader who strongly believes in the free market. 

We talked about:

  • The need to develop technology structures that do not allow for “silo-ed” information
  • The potential that Meaningful Use could be meaningless if we continue to delay timelines and accept exchange requirements that do not foster the actual exchange of meaningful data
  • Pushing for data usage and transparency in the MU program, as seen in The Meaningful Use Dashboard
  • The relatively low amount of venture capital in health care and the need for an economically sustainable model of information exchange

Then we walked to the Capitol building with Rep. Diane Black, R-Tenn. She’s a former nurse who has been an active member, and vocal in the HIT space.

We talked about:

After a mid-afternoon conference call, we went over to the Senate side and met up with Sen. Mike Enzi, R-Wyo., and then Sen. Scott Brown, R-Mass., to talk about the market-driven, and therefore sustainable, approach to care coordination.  And, as always, it was a pleasure to see Sen. Susan Collins, R-Me. We talked about the job opportunities athenahealth has been creating in Maine and happenings at Point Lookout. We also talked about making Meaningful Use meaningful and letting the program run without further delays or watered-down measures to ensure that only providers demonstrating MEANINGFUL use would receive payments. We also touched on care coordination and the need to let entrepreneurs and innovation drive us.

So you may be asking…why are we doing this? What is the benefit?

If you do ask, I’ll answer.

All Things EMR | Meaningful Use

Using Industry Collaboration for a Better EMR Experience

Lauren ZackIn a recent blog post , our VP for User Experience, Mary Kate Foley, kicked off a discussion about the status of UX in health IT as well as the role of UX here at athenahealth. We take usability very seriously and lately we’ve been working with industry thought leaders to move the needle for users of patient-facing tools such as the Continuity of Care Document (CCD).

Earlier in November, fellow UX designer Luis Gutierrez and I attended a cross-industry collaborative EMR workshop hosted by the California HealthCare Foundation and IDEO. With a wide swath of the health IT industry—and not to mention a lot of doctors—neck deep in Meaningful Use, the timing could not have been better for this first-of-its-kind gathering.

This is how Glen Moy, senior program officer at the California Healthcare Foundation, set the stage: “HITECH and Meaningful Use provide a unique opportunity to more fully engage patients in their care through health information technology. The workshop will bring together a select group of health IT leaders to collaboratively begin to make electronic health records more usable for patients and consumers.”

We were thrilled to be able to collaborate with designers and colleagues from companies (competitors, really!) such as Epic, Cerner, McKesson, Siemens and others, as well as members of the HIMSS Usability Task Force and the Blue Button project, an initiative we took part in to provide better record portability for veterans.

The goal of the workshop was to “re-imagine” the CCD, so we viewed the document through a patient-centered lens to improve the overall visual, interactive and informational experience. We’re trying to make patient health records more accessible to providers, caregivers, and patients themselves.

Guided in various design exercises by IDEO’s project team, ideas were formed for creating interactive, easy-to-use displays of medical information for patients. Ranging from the unconventional to the practical, the ideas served to inspire us to launch from the current standards and also explore interface possibilities. The ideas also exposed the tough questions important to the interconnected health care system of the future:

  • Who owns the data?
  • How can we use technology to get patients more engaged in their own care?
  • How can one’s medical record be a bi-directional, dynamic dialogue between patient and provider while maintaining scientific integrity?

While these questions still linger, this workshop served best as a precedent to industry collaboration with competitors working toward a common goal to tackle hard problems.

By sharing inspiration, acknowledging constraints and even throwing out some wild ideas in an open source workshop, we continue in our mission to help inform and lead the industry. We need to keep improving the usability of products and services in health IT.

Look for more about UX in the coming months. In the meantime, what thoughts can you share about EMR usability? We are always looking for valuable feedback and new ideas.

Healthcare Policy & Reform

Dispatch from Washington: Plenty on the HIT Agenda

Lauren H. FifieldI’ve been in D.C. this week for my second round of government affairs adventures in November. Last week, I was joined by our fearless (no, really) leader—CEO Jonathan Bush—and this week I am joined by Stephanie Good, a fearless-in-her-own-way member of our legal team who will be helping to shape athenahealth’s policy agenda. More on that and my recent expedition with JB coming soon.

Stephanie and I came down here for just two days, but we brought a stacked agenda. In my head I’m calling it a tour de force… 

Yesterday, we started out at the monthly and in-person HIT Policy Committee meeting. The release of the Meaningful Use Stage 2 notice of proposed rulemaking in early 2012 is still on the horizon but until then the committee is still cranking on a number of topics. Many of you may be interested to know they are looking at the CMS rule on Accountable Care Organizations (ACO). There’s also a program that brings together stakeholders across care transitions called “Putting the IT in TransITions.” Finally, the committee recapped the Meaningful Use Stage 3 hearing on October 5th when Jeremy Delinsky, our chief technology officer, represented athenahealth.

Then, we headed over to a Senate Judiciary Committee hearing entitled “Your Health and Your Privacy: Protecting Health Information in a Digital World.” It was time well spent but we felt like a lot of the discussion was happening in a bubble. We completely agreed with the intention to protect the consumer and allow both providers and patients to adopt and leverage health information technology. However, it felt somewhat detached from day-to-day life for medical practices and vendors. Clearly we have some work to do there. One bright spot was Sen. Al Franken, D-Minn. Not only is he an advocate for access to affordable health care and protecting health information, but he brings a quick wit and energy to the room. 

Today, we started our day on the Hill and then headed over to the Institute of Medicine (IOM) for the official release of its report on health IT and patient safety (that had been leaked earlier…oh D.C. theater). Then we wrap up with a Health, Education, Labor, and Pensions (HELP) Committee hearing on health reform.

Stay tuned. And in the meantime, follow me on Twitter for the latest.

All Things EMR | Meaningful Use

Meaningful Use Dashboard Update: An Opportunity to Expand a National Health Information Backbone

Today, I’m going to give you a glimpse into athenahealth’s development of a national health information backbone and the nation’s first immunization registry hub. 

Improving public health is one of the core objectives of the Meaningful Use program.  For providers to demonstrate Stage 1 of Meaningful Use, they are required to submit electronic data to either a state immunization or syndromic surveillance registry. As we do with payers, labs, and various other health care supply chain partners, adding state immunization registries to the network has been on our agenda for some time. The onset of Meaningful Use and the public health measure requirement increased the priority of establishing those connections. So in October 2010, we formed a dedicated team to bring them all on board so that every provider would be able to exchange the required data with their individual states and demonstrate Meaningful Use in 2011.

It wasn’t so easy, but we’re building out the athenahealth network all the time. We identified every registry in every state and reached out to them by phone, fax and email to track down the appropriate contact. (Check out this behind-the-scenes video.) Then we worked methodically to scope and build everything required to connect and test with every registry. Apparently we were in uncharted territory. In our travels, we had several conversations with the Centers for Disease Control and it became clear that a comprehensive picture of public health registries and their capabilities did not exist. 

Well, one does now and we’ve got it. Over the course of the past year, we scoped and built an electronic pipe into each state immunization registry capable of supporting one. By building that single connection between athenaNet and each registry, every provider on athenaClinicals has a connection to their state registry. Adding a new provider does not mean a new connection. It can be as simple as subscribing them to the interface – like adding someone new to your Twitter feed. As a part of our core service, we also take the extra step and actually send test messages to the registries for all providers who administer vaccines to ensure they satisfy the public health requirement for Meaningful Use. As of last week, the public health measure had been satisfied for 98% of providers pursuing Meaningful Use. I have no doubt that we’ll be at 100% before the end of the year.

What’s significant about this? Simply put, if you are not on athenaClinicals, you have to build your own pipe once it’s your turn at the registry and do your test yourself. We’ve heard a lot of stories from providers and even other EMR vendors about their inability to get the registries’ attention, or that they’re sitting in a queue waiting their turn.  Providers on athenahealth bypass that line altogether. And not only do we save our providers the hassle of establishing these interfaces as a part of what we do every day, but this will help make medical practices more efficient. Today, providers have to manually enter the record in a separate portal or fill out the information on a paper form for the state. Our solution will eliminate that step. Registry updates can be sent automatically when the provider updates the EMR, also ensuring accuracy and timeliness. And in states that have the capability, a provider can query the registry to understand what immunizations a patient has already received, further reducing redundant work, but also eliminating critical gaps in patient care.

So, it’s a great solution for physicians and patients, but public health agencies also get the data quickly and their data stays current at a lower cost. This is important now for Medicare Meaningful Use but will be even more so for physicians in the Medicaid program due to its large pediatric patient populations and the requirements for childhood vaccinations. It’s another great example of how we are building a national health information backbone that’s creating real value.

We wrote about immunization interfaces this week because in this blog and elsewhere—as in at MGMA in Las Vegas —we have been steadily beating our Meaningful Use drum in the hope that others will share their data too. We want to know how vendors that simply provide EMR software can possibly know how client practices are performing on achieving the measures. Our cloud-based model allows us to know how every eligible provider is performing, not only on Meaningful Use of course, but on claims, patient volume and any other practice performance metrics.

You can explore the dashboard here, but some quick highlights:

  • 58% of our Medicare MU providers have attested, a 10 point increase in two weeks
  • 31% of our Medicare MU providers are within 2 core measures of attesting
  • 88% of our Medicare MU providers have met  5 of 10 menu measures, just under a 2 point increase in two weeks
  • 89% of our Medicare MU providers are now satisfying the clinical summary measure, a 3 point increase in two weeks

At this point in the year, providers are either on their way to meeting Meaningful Use or running out of time. Thanks to the visibility we enjoy as a cloud-based service, we know which (few) of our providers won’t be crossing the finish line this year, providing additional insights into what it takes for ALL providers to demonstrate Meaningful Use. It also allows us to focus all of our energy on those providers who haven’t made it yet, but have a realistic shot at meeting Meaningful Use by the end of the year.

Come back again in two weeks for the latest Meaningful Use Dashboard results.

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