Ready for ONC Required State HIE Assessments?

According to ONC's State HIE Cooperative Agreement Program, each state must perform an annual self-assessment of its progress against its HIE goals. Many states are at the point of planning -- or actually performaing -- those assessments now. Are they ready to successfully complete their assessments? Are they using the right approach? Do they have the right resources?

For more information, see my recent article in For the Record at "State HIEs Face Assessment Deadline to Maintain Federal Monies" for insighs on preparing and conducting these HIE assessments.

Creating a Sustainable HIE

Creating a Sustainable HIE is hard. It’s hard work and it’s difficult.

We continue to be hampered by misaligned payment incentives, competing health care systems and high priced technology vendors.

Sustainable business models depend upon a balance of two things:
Costs and Revenue
Revenues ultimately must be greater than costs.
It’s that simple – and that hard.

An HIE cannot be sustainable if its costs are too high or its revenues are too low. There’s a lot of discussion about revenues for HIE. We are asking payers and providers to ante up revenue and pay for services to support the exchange of health information. CMS has said that it’s willing to pay its fair share for HIE development. Others must also contribute.

But, what about the cost side of the equation? How can we bring HIE costs down to a more reasonable level? One that HIE revenue can support. One of the reasons that HIE ROI is so hard to obtain is that the investment in the technology that’s needed to enable the sharing is so expensive – thus requiring huge revenue streams to support sustainability.

It’s time to also ask the vendors to step up to the plate and bring their prices more in line with what the market can bear. The vendors have designed proprietary systems that hoard data. We now have technical standards that they are supposed to be using to share that data, but when put to the test, many vendors require additional fees from providers who want to share their data – particularly if the data will be shared outside the vendor’s proprietary system.

Imagine an ED that has to pay a translation charge for every patient it sees in a year – whether they request the data or send it out. Even at $2/patient/year, for a moderately busy ED seeing 40,000 patients a year this amounts to $80,000! These fees go to a vendor who should have made the capability available as part of its software package to begin with.

In other words, it’s like there’s a “tax” levied by the vendor if the health care provider is bold enough to want to share patient data with a provider using a different vendor’s system.

At Mosaica Partners, in our work around the country, we consistently hear that HIT costs are too high and the technology doesn’t meet the needs of the providers. We have a free-market system here and the market is saying that the value delivered by the software does not support the huge prices vendors are charging.

There are also a health care and economic crises in this country. What part of all of this motivates the vendors to continue to charge outrageous prices? ( Hint: “Because we can” is not an acceptable answer.) VENDORS, BE PART OF THE SOLUTION!. We have a free-market system in the US. Vendors should be paid a fair “market price” for their products. That means a price the market – not necessarily the subsidized market – is willing and able to pay.

If HIT/HIE vendors can’t deliver software at a market-affordable price, then maybe it’s time for a major shift in how the software is developed and provisioned to the market place. Maybe we need a new model for creating 21st century software. One that is efficient to develop, easily customizable to meet the USERS needs, and will readily (and securely) share patient information when it’s for the good of the patient.

I can check my heart rate with an app on my phone, but I can’t get my lab results from the lab to my PHR without a password from my physician – who says I have to get the password from the lab who says I have to get it from my provider who says… You get the picture.

I’m looking forward to seeing you at HIMSS11

This coming week the senior staff members of Mosaica Partners will be attending HIMSS11 in Orlando.  It seems that each year this conference gets better and better. 

This year is an especially exciting year for us at Mosaica Partners as the book that I co-authored with my colleague, Bob Brown,  “The Health Information Exchange Formation Guide” has just been published by HIMSSPress. You can buy it at the conference at the HIMSS Bookstore or order it on-line.  Click Here   

Writing this book has been challenging, but also a labor of love as we believe, and our experience has shown us,  that access to complete health information – through health information exchange – is essential to improving health care.

What great strides we, as a country, have made since last year’s HIMSS Annual Conference.  In 2010, Meaningful Use was new; we were exploring its meaning and wondering what the final regulations for stage one would ultimately require.  I remember leading a workshop on that very topic last year. This year we see Meaningful Use being implemented; the Regional Extension Centers are making progress; over one-half of the states have had their State HIE plan approved; and 17 communities have been named as awardees of a Beacon Communities Collaborative Agreement.

We have been fortunate to participate in many of these activities, from working with states and communities developing their plans to providing program management for one of the Beacon Communities. 

While last year was heavily focused on Meaningful Use we anticipate the coming year will include continuing emphasis on the HIE movement and the building of Accountable Care Organizations (ACOs).  HIMSS11 will valuable information on all of these topics.

See you there!

 

HHS Adopts "Cafeteria Style" EMR Meaningful Use Approach

The much anticipated EMR "Meaningful Use" regulations have finally been released for Stage 1 (2011-2012)

While similar to the proposed regulations released for public comment in January of this year, they also reflect the input HHS received.  For instance, rather than a strict "all or nothing" approach, the regulations for Meaningful Use combine a set of 15 core objectives -- which are required, with a set of 10 additional objectives as a sort of  "menu" from which eligible providers can choose five which they will meet to fulfill the requirements.  

We applaud the responsiveness of HHS in modifying their approach to meeting the requirements.

Hopefully, this added flexibility will enable more providers to strive for - and meet - the goal of meaningful use -- which is better patient outcomes.

For more information on the Meaningful Use regulations Click here.

Another take on health information exchange

In a recent article in The New York Times, comparison shopping of the prices associated with health care treatments was covered.  Recent entrants into the marketplace like Castlight are making the fees that individual doctors and hospitals charge available to their clients; typically large employers who self insure.  The information comes from an analysis of the explanation-of-benefits forms that patients receive after a doctor visit.  According to the Times, “Castlight developed a way to pull information from the millions of forms provided to it by employers.”

 

Many believe that this price transparency will lead people on high deductable health insurance plans to become better shoppers when it comes to purchasing health care services.  The Times also opines that many hospitals’ business models could be turned upside-down by price transparency.

 

So, it seems that an overall improvement in the availability of health information will not only affect HIEs, it will also affect high prices.  The obvious next step is in correlating prices charged to outcomes measures.  That will really be a game changer.

 

Meaningful Use - Just Like Healthcare - is Local

I’m just back from HIMSS10 and what a conference it was! If there was any doubt before, we now all know “it’s all about meaningful use.”  Meaningful use (MU) was everywhere around the conference – in the exhibitor hall, in the educational sessions, in the workshops, and in almost all the conversations.

I led several breakout sessions at the Meaningful Use workshop on Sunday on HIE and MU.  It's abundantly clear that there’s a lot of work to do before we can achieve the meaning in meaningful use at a national level. 

However, it’s heartening to see all the great local efforts that are sprouting up like spring daffodils.  Health care is local and that’s exactly where we find the leaders in meaningful use.  These are the folks that understand that the HITECH is about incenting a change in behavior – not reimbursing for technology.

There are still a lot of obstacles to overcome before we arrive at the point of overall improved outcomes. However, here’s to the local efforts where physicians are leading the way.  They’re leading, not just because it may put a few extra dollars in their pockets, but also because they genuinely care about providing better care for their patients.  They understand that adopting the right technology and sharing information is going to help move them towards that goal.

Don’t wait for the ‘big’ efforts before you begin.  Develop your plans now and use those 'big' efforts to help you achieve your goals. 

 

Understand meaningful use for yourself and your patients.  There are many resources available through HIMSS and through government web sites.  Here are a couple of links to get you started.

http://www.himss.org/EconomicStimulus/

http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3564

The Human Side of Health Information Exchange (HIE)

Finally!  On Friday, February 12, 2010, HHS announced the award of nearly $1Billion of ARRA funds "to build capacity to enable widespread meaningful use of health IT."  The awardees and the amounts they'll receive for the State HIEs and for creating HIT Regional Extension Centers can be found at http://www.hhs.gov/news/press/2010pres/02/20100212a.html.

Moving our health care providers to the meaningful use of technology is a laudable and necessary endeavor. It's also a change.  It's a change for them. And it's a change for patients.  As human beings, we generally don't like change.  We're programmed that way.  Our bodies physically seek homeostasis - that normal good working order - and our psyches do as well.

Think about the providers. We're asking (telling?) our providers to make a giant leap in the use of technology in less than 2 years.  This same change took other industries over 20 years to accomplish.  Do we need to do it?  No doubt.  However, if we're going to do this right, we need to concentrate on the human side of the change - even more than on the technology components.

We've seen some attention to this by way of all of the fear, uncertainty, and doubt that has dominated conversations regarding privacy and security.  This is valid to address, but I can't help but wonder how much of the discussion is based more on a fear of change than a fear of exposure of health information.

If we want our health care providers to change, we must first listen to their wants, needs, and concerns.  A first step in any effort to plan and implement HIE must be to purposefully reach out and listen to what our physicians and other providers have to say.  Get them engaged from the very beginning.  Use their real concerns, not as reasons why HIE can't be done, but as guides to understand what MUST be done for it to be successful.

At Mosaica Partners, we work with states and regions in their HIE planning efforts.  We always begin by engaging the key stakeholders.  Through our structured approach, we educate them and obtain their input. This in itself is an extraordinary learning experience for many of our clients. 

We often hear that we don't need to talk to the actual providers, because others can speak for them. "We know what they want."  "They're too busy to come to a meeting to talk about HIE."  But when we invite them, they come -- and they typically stay for the entire session.  These providers are appreciative that their local HIE planning groups are interested in what they have to say. They do want to get involved. They want to be a part of the change.  What they're resisting is not change so much as a change they fear may render them less effective in providing care.

Listen to your providers. Incorporate their concerns and desires into your plans.  When you do this, they'll become engaged, stay engaged and even actively participate in the development and operation of the HIE.  If the HIE planning is done well, it will meet their needs and they will want to participate. 

In fact, in one of our recent sessions when we asked doctors to imagine they were in the future and looking back on what made their area's HIE successful, one person spoke up and said,    "The Physicians Demanded It!" 

Now that's a change we can all live with!

U.S. Health Care Reform Is Nothing New

Those of us who have been in the field for awhile know that health care reform is nothing new.  It's a journey that's been going on in the US for nearly 100 years. (No, I haven't been around that long.) And for the first 75 years, contemporary technology was not even an option.  No HIT.  No HIE - at least not electronic.

The New England Journal of Medicine has just published an extraordinary interactive timeline which shows the history of health care reform in the US beginning in 1912 and continuing to the present day.  Each of the significant events on the timeline can be opened to read detailed information.

Reviewing this timeline puts our current efforts into perspective.  It doesn't specifically address HIT and HIE, but if you juxtapose the HIT efforts since 2004 on the timeline, it's obvious how great an opportunity we have to improve our current health care system through the use of health information technology as an enabler.   

We're being asked to "meaningfully use" that technology to help change the current health care system.  There's lots to learn and a great deal to discuss. Please join me at HIMSS 2010 in Atlanta, at the Meaningful Use Workshop, to discuss how we can help improve our delivery of care.

I encourage you to take a look at this timeline.  You can find it at 

U.S. Health Care Reform Interactive Timeline

Health Information Exchange – 2010

It’s a new year. Health Information Exchange will emerge as more of a reality this year than any of us could have dreamed only one year ago.  I invite you to join me on the journey to HIE realization.

 

2010 is a year for action in advancing our ability to share health information. Take the first step now – today.  Become informed on what’s happening so you can use it to shape your 2010.   

 

On December 31, 2009, the Office of the National Coordinator (ONC) and CMS announced the release of the Notice of Proposed Rule Making (NPRM) for Meaningful Use Criteria. 

 

For Stage 1 there are 17 specific objectives identified for eligible providers, hospitals and critical access hospitals; an additional 8 objectives for eligible providers; and an additional 6 objectives for hospitals and critical access hospitals.  

 

To make it easier to understand the requirements, Mosaica Partners has created a document summarizing the objectives and measures that are in the rules released for public comment.  Click here to download our summary document.

 

Read the complete Proposed Rules for Meaningful Use here.

http://www.federalregister.gov/OFRUpload/OFRData/2009-31217_PI.pdf 

This is an important step forward in our ability to electronically share health information.  Please share your comments. 

 

Many of you have made New Year’s resolutions. I don’t usually do that – preferring instead to make improvements whenever they‘re needed, but this year I have resolved to use this space as an opportunity keep you better informed.  Better informed about how to help shape our destiny and our legacy.  I’ll be talking about the milestones we can achieve as we make HIE a reality. 

 

I look forward to taking the 2010 journey with you as we improve health care through  availability of health care information.

Meaningful Use and Your HIE / HIO

I spent last week in Washington DC at several events relating to HIT and HIE.  They all had one thing in common and that was that meaningful use was one of the hot topics. 

ONC is working on the definitions of meaningful use for EHR's and promises to have a final definition in early 2010. 

As I was thinking about this I began to realize that each Health Information Organization (HIO - the term used by ONC for the organization that supports the exchange of health information) needs to understand how their stakeholders define meaningful use of their HIO. 

What do your stakeholders find meaningful and what are they expecting of you?

Meaningful Use and Stakeholder Sustainability

Financial sustainability of your HIO depends upon stakeholder sustainability.  Stakeholder sustainability for your HIO, in turn, depends upon your ability to develop and provide services that are meaningful (i.e. have VALUE) to your stakeholders.

How do you find out what's meaningful to them? 

Start by asking them.  You can use surveys, focus groups and town hall meetings.  You can interview them and ask them to participate in your planning efforts.  Get them involved early and keep them with you by designing your services to be directly related to meeting their most pressing needs.

The definition of meaningful use of EHRs will come from HHS.

The definition of meaningful use of your HIO will come from your stakeholders. 

Ask them.