Open Government Plan increases transparency for CMS and provides valuable data sets for Business Intelligence analysts

Recently I was invited to contribute to a great healthcare IT community web site. SearchHealthIT part of the TechTarget group contains several useful resources. I am looking forward to continuing to write about healthcare informatics and regulatory changes that are affecting each and everyone of us who are in the healthcare market.

My latest post: Click here http://searchhealthit.techtarget.com/healthitexchange/meaningfulhealthcareinformaticsblog/2010/04/08/open-government-plan-increase-transparency-for-cms-and-provides-valuable-data-sets-for-business-intelligence-analysts/

Summary of the H.R. 3590 and the impact on physicians

Today I reviewed a great summary of the H.R. 3590 bill that was signed into law on 3-23-2010. This was a pdf published by the North Carolina Medical Scociety. http://www.ncmedsoc.org/blog/wp-content/uploads/2010/03/HR3590-and-Reconciliation-Bill-Comparison-3-23-2010.pdf

It is clear that there will be many changes that practices will start seeing. Some are relating to the potiential increase in Medicare/Medicaid patients (estimated at 16 million new Medicaid receipients), also some of the new penalties associated with not participating in the PQRI initiative. It is estimated that a 1.5% to 2% penalty will be imposed begining in 2015 for non PQRI participants . So, if EHR is in your plans, and you the practice does see a high volume of Medicare/Medicaid then this maybe a good time to contact the vendor to seek assistance for PQRI.

I also saw how there will be some bonus payments (10% Medicare bonus) for primary care and general surgeons practicing in shortage areas 2011-2015.

New release on a powerful open source PACS/RIS clearcanvas 2.0

For all the open source fans, a new version if the clearcanvas RIS/PACS 2.0 has been released. clearcanvas is a great suite of imaging solution. This application has many of the functionality and features of some of the market’s top PACS/RIS application providers. The difference is this is “FREE” (more details on licensing available here:http://www.clearcanvas.ca/dnn/AboutUs/Licensing/tabid/105/Default.aspx )


I have installed this solution and I was very surprised how quickly it can be deployed. What were more impressive were the advanced capabilities it enables you to perform just by using their SDK. This solution was built on an extensible application framework.

This solution can be provide immense value for some of the healthcare organizations looking to implement a small PACS system to manage their imaging (Ultrasounds) without all the high costs associated with some of the packages offered in the market. An OB/GYN practice or Imaging center can eliminate all the costs associated with Photo-paper, expensive color ink, and the need to file by hand these images in the chart, just by simply rolling out this type of solution and offering the physicians access to high quality images through the clearcanvas client. For radiology, this open source package offers a great range of features:

• Image storage, retrieval and archival
• Image viewing and or streaming
• Modality work list
• HL7 capabilities
• Workflow engine
• IHE-modeled Scheduled Workflow
• Paperless protocoling
• Preliminary Diagnosis workflow
• Resident-Supervisor workflow
• Customizable technologist documentation
• Multi-facility, multi-HIS Master Patient Index

So if you are a big open source advocate, and want to reduce (eliminate) direct licensing costs, this may just be the PACS/RIS solution you need. But note that as with many open source solutions, having the appropriate skills to support and troubleshoot is critical. While you may purchase support through clearcanvas, it is important to fully evaluate your need, current hardware and how you plan on having the application supported.
Check out their web site http://www.clearcanvas.ca/dnn/Default.aspx

Real-Time Claim Adjudication a "new" way to look at collecting your money

In a time where we are reminded daily that much of the current technologies (EHR, HIE, EDI, and others) will reduce medical error, improve patient care, we tend to overlook the prolific results that other technologies have to offer to health organizations. The market offers that great solutions that billing departments across the nation would appreciate how it can reduce claim denials, put money in the bank much quicker and overall improve the practices bottom line.

Real-time claim adjudication (RTCA) is a solution that enable medical organizations to bill for services before the patient leaves the practice. This allows for the organization to submit a claim with the procedures performed and get a response displaying the allowable charges and patients remainder responsibility based on the contractual agreement.


This has been around for some payers in some states. Humana, some Blue Cross Blue Shied of some states (BCBS of NC has started the development but has not officially released any target dates). Some PMS vendors have been able to successfully enable practices to take advantage of this functionality. AthenaHealth was one of those vendors, with their RTA (Real time Adjudication) services, it makes for a very attractive model for any practice looking to lower the denial rate on their claims.


Using Real Time adjudication is a no brainer when one begins to realize how much time is spent on claim filing, refiling and working the denials. It is known that insurance eligibility verification does resolve some of the claim denial issues, however, much of the billing departments pains lies in dealing with payers who may deny some procedures and not others within the same claim, and then the battle to explain to the patient why they are now responsible for the balance.

According to some recent MGMA statistics published in http://www.mgma.com/SwipeITWaste/ we can see some of the costs associated with claim denials:

57,168,299 Number of claims per year that must be resubmitted due to payer denial due to incorrect patient demographics from non-electronic registration


857,524,484 Minutes per year to resubmit claims denied due to payer denial due to incorrect patient demographics from non-electronic registration


14,292,075 Hours per year to resubmit claims denied due to payer denial due to incorrect patient demographics from non‐electronic registration

289,762,993 Dollars saved per year by not having to resubmit claims denied due to payer denial due to incorrect patient demographics from non-electronic registration


While in the perfect world RTCA would work so well with an EHR, especially when the provider can submit the encounter electronically right after the visit, it is important to note that even if a physician write the data or circles the procedures and diagnosis on the paper charge sheet, the checkout individual may have the ability (depending on the Practice Management System) to perform the RTCA task and benefit from this wonderful technology.

High level review of new proposed certification process

With the recent publication of the Proposed Establishement of Certification Progreams for Health Information Technology, it has been the most anticipated item since the meaningful use proposed requirements. As many have anticipated, CCHIT is in fact on top of the list of the most likely to become the certification body or the (ONC-ACB) ONC Authorized Certification Body.

While most or possibly all the proposed rule focuses on what are the requirements on the certification body, testing and accreditation. The HIT recemendations very much in line with the CCHIT and that also includes the costs of the actual certification which still range from 30,000 to 50,000 dollars for complete EHR/EMR or 5,000 to 30,000 dollars for modules.

The document outlines some estimates on what products will be tested, including statistics on Commercial/Open Source EHR products, Commercial/Open Source EHR Modules and Self-Developed Complete EHRs modules. The total count of products tested is about 181.

The document also outlines that there will be addiotional certifications that the ONC will potentially use for other technologies. The reference was made to the Personal Health Records (PHR) as well as Health Information Exchange (HIE).

The much anticipated Proposal for certification or Certified EHR

While many are still talking to the EHR vendors at the exhibit halls at the HIMSS 2010, The Office of the National Coordinator for Health IT (ONC) released yesterday the notice of proposed rulemaking (NPRM) for the two certification programs. This proposed program has two proposals in it. One that will be temporary and the other would be permanent.

The proposed program outlines the following:

The first proposal would create a temporary certification program that would be issue temporary certifications through the authorized testing and certification bodies (ONC-ATCB) to test and certify complete EHRs/or EHR Modules. During this first proposal the ONC would assume most of the responsibilities during the temporary certification program. This means that no other organization (private ones) would serve as an accreditation body.

The second proposal would create a permanent certification program that would replace the first temporary proposal. This would also mean that the ONC is intended in allowing approved private sector accreditor to fulfill the responsibility of the accreditation body.

The National Institute of Standards and Technology has been working with the ONC to develop the test method and infrastructure that will be used by many of the testing laboratories in the testing stage for both proposed certification programs. This entity (NVLAP) would include specific calibration and or test standards related methods and protocols that would satisfy the needs and requirements of an “Certified EHR”.

The details of what would be the methodology used in the certification test is defined as “The same basic methodology used in third-party conformance assessment”.

More details to come once I can get through the 184 pages of the proposal.

News Media Party at the Georgia Aquarium HIMSS 2010

Another highlight of my day was the exciting news Media meet up. Organized by John Lynn creator of the EMRAndHIPAA.com (Great healthcare informatics resources). During this meeting, I was fortunate to meet up and discuss with several individuals the current challenges our healthcare faces as well as some of the exciting changes going on. John and I got do talk about healthcare technology, ARRA and some of the challenges we all face in this field. John who is very passionate about the healthcare field shared with me some of his thoughts on the current ARRA and impact it has on healthcare practices.
Jean DerCurahian who is a news writer for TechTarget was also attending, and had the opportunity to exchange some thoughts. We in the healthcare bloggerspere have a lot in common. Sharing our thoughts, opinions and experiences hopefully can bring value to others.

Visiting the exhibitors at the HIMSS 2010

The second half of my day I did have the opportunity to walk through the exhibit halls. And while it is overwhelming at first, I had my list already prepared of vendors I wanted to meet up and discuss their products. I categorized the vendors I wanted to visit into the following sections. This is just a tiny list of the ones I visited, but this was my initial list I created before hitting the exhibit hall:

EHR vendors
GE, AllScripts, Greenway, NextGen, e-MDs, eClinicalWorks,DDS Inc. (OpenVista)

Technology and Hardware vendors
DELL, IBM, CDW, Microsoft, Fujitsu, JAOTech

Solutions, Service providers
MEDNET, Claim processing with CPeople, Online Backups, MeDecision

Standards and HIE
Hl7, NHIN, NCHICA

Vendors with the coolest toys for my 3 year old.

Too cool to miss:
Microsoft Surface, NHIN (participating vendors and the IHE)

My first day at the HIMSS 2010

So, the HIMSS 2010 is still going on, but I definitely needed to take this opportunity to collect all my thoughts and review my notes to see what I have learned so far.

My first day went as follows:

It started out with a great presentation done by the Governor of Vermont Jim Douglas. He discussed several of the advantages of having electronic health data and also how it will help the states improve healthcare and reduce the costs. He recognized that most governor are dealing with difficulties balancing their budgets while trying to avoid making any major cuts to critical services. He also covered that a big chunk of his state’s budgets is taken by Medicaid (26% to be excact) and that with the help of healthcare information exchange he is encouraged to see that there will be some potential cost reductions.

One very interesting subject that was brought up and cough my attention is what credentialing and jurisdiction will need to be applied when Telehealth becomes widely adopted. As we all know, TelHealth is when providers from out of state are providing care to local patients or providers instate are caring remotely for patients in other areas. This poses the questions on who gets taxed, what credentialling entities will be used and so forth.
While he did not discuss in details his thoughts on what is going on in capitol hill in regards to the “healthcare/insurance reform”, he did point out that it is a far more challenging task for each of the state governors ahead in reguards to dealing with balancing their books and continue to cope with the ever increasing healthcare costs.

Some of the additional sessions I attended included the review of "Meaningful Use" presented by Sanjay Shah and how the ARRA affected their hospital. He discussed how they have started planning on going paperless several years prior to the enactment of the ARRA. He was able to provide some very good insight to what hospitals need to plan for, and how the three stages of Meaningful Use will impact everyone.

In the presentation he did outline how there are still some areas where his hospital is facing some potential Meaningful Use Gaps. This included e-prescription needs, CPOE implementation outside of the ED, and potential upgrade requirements once the certification is announced.

Next came a presentation by Gregory T. Fairnak the Chief Architect of CONNECT Gateway project. And as he started talking about Opensource and some of the technical aspects of the solution, I was in cloud nine. This was one of the highlights of my day. As a junior software architect and a developper, getting to interact with Greg was a delight, and a great opportunity to pick his brain on some of the details of the CONNECT. I also had the opportunity to meet another icon “in the Opensource arena”. As many in the interfacing world already know, Mirth Project has been in the front lines of the EDI and Interfacing . I have personally assisted many of our clients overcome some of the high costs of interfacing by utilizing this powerful FREE solution. I had the chance to have a short conversation with Gary Teichrow one of the creators of Mirth. It was such a delight to hear how the product came about. I expressed by appriciation to his product creating and thanked him for such a great contribution to health informatics.
It is critical to also note that some of the Mirth components are being utilized by the NHIN (National Health Information Network) which as everyone already knows is the backbone of the federal healthcare information exchange for CMS, SSA, DoD and other federal entities.

This concludes one part of my day at the HIMSS!

North Carolina gets its share of the stimulus money and a boost to help with EHR adoption

Today the white house announced what has been awarded to the different states to support Health Information Exchange and assist care providers with training and technical support with Electronic health records.

This makes the state of North Carolina one of the 41 states to get $ 12.9 million dollars in funding to facilitate HIE for the state. While there are several other already established health record exchange initiatives, the NC HWTF (North Carolina Health and Wellness Trust Fund) has greater potential to get a strong NC HIE started.

In addition, with the establishment of the regional extension centers and their awarded 13.6 Million dollars available through North Carolina Area Health Education Centers Program (AHEC) North Carolina care providers will have better access to onsite technical assistance to help with the adoption of electronic health records.

For a full list of grants awarded visit: http://www.whitehouse.gov/the-press-office/sebelius-solis-announce-nearly-1-billion-recovery-act-investment-advancing-use-heal

Top 10 EHR failure contributing factors

With the Economic Stimulus bill recently enacted into law by president Obama, and recent relaxation of the Stark Rules allowing hospitals to subsidize up to 85% of implementation costs of HER many are renewing their interest in an EHR purchase. But while many are excited about the encouraging subsidize available, others are still fearful on undertaking such a complex project after many “horror stories” they hear.

One must wonder what is really the source and true factors that contribute to the de-installations and or lack of return on investment on EHR. By reviewing these items, we can separate fact from fiction and expose what can be done to avoid these pitfalls.

The following are the top 10 biggest contributors to an EHR failure for certain products available in the market place:

1. Lack of strong follow up from the EHR vendor:

After Go live date some of practices begin to sense that the honeymoon period is over. Faced with new workflow challenges and staff not always sure what to-do and resort to a best guess on how to perform certain tasks, frustration grows and lack of confidence of the product begins to show.

2. Lack of training:

With a constant reminder of budgets and economic downturn some practices often resorting to less training and more self discovery tends to be another step into dangerous waters. With Computer Illiteracy many realize that they are still not comfortable with the product and don’t know enough to resolve some of the obstacles that accompany such products.

3. Unreliable infrastructure:

While many of the subsidies have reduce actual implementation/training and licensing costs of an EHR, weak and unreliable IT back bone infrastructure tends to offset the efficiencies that are meant to be gained. Far too many cases slow response, unreliable wireless and reoccurring system outages leave a terrible after taste of the EHR when it should be the one of the lack of infrastructure.

4. Not very user friendly:

While all care providers and clinical staff understand that when they are seeing patients all their attention is rightfully given to their patient, but too often they fall victim to the overwhelming screens, 2 dozen buttons to click or all flashing indicators reminding you that you have more work to follow up on.

5. Lack of interoperability:

It is clear that interoperability is “essential” for coordination of care and reduction of medical errors due to lack of information, and unfortunately many software makers lack to capital and expertise to arm their products with the ability to enable practice to participate in exchanging electronic health records within their community or just simply with a nearby hospital or IDN. In addition, it has been stated time after time that the ARRA’s ultimate goal is to promote exchange healthcare information to improve patient care.

6. Slow and painful ROI:

Statistic after statistic shows us that adoption rates for EHR have been slow, despite the growing enthusiasm. In some cases incentive payments can provide a boost, but often we find that citing a positive ROI is largely anecdotal. While upfront costs can range from 10,000 to 25,000.00 per provider in costs, it can take from 3 to 4 years before an actual positive ROI is seen in some cases.

7. Same engine under the hood for years:
As a developer I am guilty of trying to recycle applications I have created in the past and just performing a facelift on the interface. Unfortunately this trend has contributed to lack of new functionality and features for some of the products being used today. By simply changing a 10 year old product screen from black DOS screen to a “windows” based program with still the same engine under it. Many practices are still facing outdated functionalities and lack of new and much improved and newly discovered efficiencies.

8. Lack of sufficiency data visualizations:
Whether a healthcare organization is looking to identify the most common CPT codes used, performing internally RAC audits, or simply identifying trends in patient outcome measures, medical organizations are looking to EHR vendors to answer the calling. But with very few able to provide access and usable data, many are faced with the reality that data visualization is nothing but a dream. It is hard to truly understand the power information, but as stated in a recent article in the BusinessWeek written by Maria Popova: “Ultimately, data visualization is more than complex software or the prettying up of spreadsheets. It's not innovation for the sake of innovation. It's about the most ancient of social rituals: storytelling. It's about telling the story locked in the data differently, more engagingly, in a way that draws us in, makes our eyes open a little wider and our jaw drop ever so slightly. And as we process it, it can sometimes change our perspective altogether. “

9. Lack of or unreliable integration:

In the current healthcare environment, there are many connecting devices, entities and stakeholders. Whether you are ordering blood work or waiting for a pathology report to be downloaded integration is the glue that holds it all together. In certain cases missing labs, down interfaces and failure of communication can lead to dangerous and risky outcomes for the practice. Many of these situations lead to frustration and mistrust of the technology and products.

10. Loss of confidence:

At the center of it all, lack of staff buy-in poses the most common management mistake made that leads to complete EHR implementation failure. Many leaders discover after working hard on making sure the right product was selected for the right price that their staff is not confident in the adopted direction of the management. This leads the practice to face significant struggles. Ultimately, every staff member needs to buy-in to the change, and for this to occur successfully it is important to involve everyone in the process and ensuring they are part of the solution.

It is commonly cited that the practice should hold most of the blame for the failures of EHR projects and implementation. But who are we kidding here; it is like asking an IT engineer to manage a busy restaurant’s kitchen just because they watched few episodes of hell’s kitchen. The burden of a successful EHR should be shared amongst the product vendors who have far more experience in project management and technology as well as the team effort of an EHR committee from within the practice. Both parties must commit to proper education up front, continued education and follow ups to ensure that the product is being used the way it should be. The success of the project will benefit both vendor and customer.

In conclusion, while many of the indicated struggles above are contributing factors to failures of some of the EHR implementations out there. It is important to know that not all products have these challanges. In addition, many of the items listed can be resolved by taking the appropriate corrective measures. When in doubt always contact your vendor or a qualified healthcare IT export to assist you and your organization ensure that you are in the right path.