The last rumor I heard was that it will cost $1 million $2 million to certify an EHR, and Certification of the EHR is a major part of what meaningful use is all about at the nuts and bolts level.
Small providers can have a problem justifying the expense of assuring their EHR is certified, especially if the increased payment for services (mentioned in volume 1 of this series) is not sufficient to show true value. Without value, the certified EHR falls by the wayside.
One objective in my work is to help folks arrive at the best EHR option for their agency, whether purchasing a new one or optimizing their current product. So, you’ll see a recurring theme in this series of seeking EHR options with that in mind. Foremost in my mind right now is discovering affordable certification alternatives.
The certification of the EHR in order to receive Meaningful Use incentives is built on previous action, like HIPAA for security and code sets, electronic prescribing standards set forth in NCCD Script 8.1, and the HITECH certification provided by the Office of the National Coordinator (ONC). In and of themselves, these elements are not enough to prove Meaningful Use.
Initially, the HIT Policy Committee was charged with eight areas of responsibility in building the standards, implementation specifications and certification requirements. Elements that jumped out at me included
• Protection of privacy • Nationwide IT infrastructure • EHR for all patients by 2014 • Tracking health info disclosures • Coordination of health care • Transmission encryption for health data • Specific race / ethnicity / gender demographics • Special needs technology
These elements are further defined in a couple sources I’ll cover in future installments. The concepts are not new, it’s just crunch time to use this technologe on a widespread basis.
The time element is critical. It’s March, and Stage 1 needs to be in place by 2011. If your agency hasn’t implemented your EHR sufficiently to capture clinical data (assessments, treatment plans and progress notes), perhaps it’s time to try something new. Contact me if you need help.Read more →
The reorganization of funding for our broken health care system has taken some interesting turns. ”Interesting” meaning “costly”. Incentives offered for meaningful use of the electronic medical record could make the difference between survival and failure for a number of Health & Human Service provider agencies. More interesting news: the Meaningful Use incentives plummet in value after 2011, as the efficiencies, quality enhancement and patient safety measures start to pay off.
It’s tough to get ahead these days.
The Meaningful Use world is rife with acronyms: CMS, ONC, HIT, HITECH, PHSA and EHR to bring up a few. The EP is the Eligible Professional, and as I currently understand, the EPs who write prescriptions can be a godsend by making licensed Community Mental Health Centers eligible to participate in receiving Medicaid and Medicare funding that could amount to millions of dollars a year, depending on the size of the organization (CMHC inclusion is being drafted as you read this, and isn’t included at this time). Each EP could mean $100,000 or so in incentives through the five year program. There are rules and stipulations creating stumbling blocks, but this is the short story.
Meaningful Use incentive details are still being settled, moving at the speed of government and likely won’t give providers any breathing room to organize the agency and take advantage of the incentives once the dust settles on the rulemaking level. The aspect of Meaningful Use incentives that is certain is that provider agencies should be moving fast. • Get ready to institute the Meaningful Use criteria in 2011 and be collecting data for the whole year: 2010 could be a busy year • Get ready in 2012 to use the data you’ve collected to improve quality because in 2013 you’ll need to prove you’re making a difference in the care provided, and need to share electronic patient health data with others providing shared care responsibility for patients • In 2015, Stage three begins. Get ready to prove the improvements all this has meant.
As I uncover more details about how Meaningful Use incentives work, I’ll let you know. One thing’s for sure, it’s a lot of work, and you may need help. That’s why I’m here.Read more →
In the recent post “Wellness and Capitol Hill”, I agreed that the health reform bill was actually a health insurance reform bill. The Legal Action Center’s blog, Policies and Politics commented on the bill in the post “Details on Expanded Health Coverage as Obama Signs Bill”. In the interest of updating my opinion, I discovered two elements of the bill not about insurance coverage that deserved my immediate attention: • SUD/MH workforce in health workforce development initiatives. The final bill includes the capacity of the MH and “behavioral health” workforce as high-priority topics in the bill’s National Workforce Strategy section. • SUD prevention, treatment, and MH service providers to be eligible for community health team grants aimed at supporting medical homes. The final bill lists SUD and MH service providers among entities eligible for community health team grants.
So, curious guy that I am, I searched the web for the bill. It’s hard to find. So hard, I couldn’t find it this morning. This brings out the persistent guy in me, so I’m asking experts, searching government web sites, and asking readers to send me a link to the bill.
Where is it?Read more →
On March 11, 2010, BlueCross BlueShield of Western New York (BCBSWNY), BlueShield of Northeastern New York (BSNENY) and American Well™ Inc agreed to provide on line care in upstate NY. This is good news for rural folks reported by Medical News.
I immediately suspect less than altruistic motives and question whether this will degrade outcomes since it’s headed up by insurance companies, leaders in the evil empire with a primary concern of quarterly numbers. I’ll wonder for a while, unless on line treatment is instituted immediately in enough places with rapid-cycle testing that can produce measurable data in three to six weeks. I’ve been a proponent of this sort of program implementation for treatment and software since the early 90’s. I’ve tried it, it works. It turns a situation whereby people must live with the final product into one that encourages fine tuning of the tools to produce the best outcome. Will rapid-cycle testing be used? It’s hard to say with huge companies, and could depend on who’s in charge of the project and current policy. Perhaps this is a newsworthy item for all you cub reporters out there…
Improving outcomes depends on a relentless search for the best way to treat people with problems. If on line treatment helps people get better, it will grow. Issues of saving both agencies and insurance companies money while producing acceptable outcomes in projects like this will determine on line treatment’s role in the future.
With over 1,000 clients, eGetgoing has been using on line treatment successfully a number of years, and it’s covered by insurance. Since it’s backed by CRC Healthcare, which is a pretty large company in the addiction treatment world, and headed up by their CTO, Jay Raimondi, I’d assume they have outcomes data to not only support continuing the business, but also proving outcomes to the insurance companies they do business with. But this is another story for another day.
It looks like on line treatment, telemedicine, gadgets and gizmos are in the treatment world to stay.Read more →
I don’t get sick.
OK, perhaps that’s an overstatement. I have conditions, like a heart that had a problem with blockages and a couple other things middle-aged guys get. Every condition I have is being successfully treated and I have a full life.
I don’t get sick. I can count my bouts with colds and flu over the past 15 years on one hand, I don’t get the crud that’s going around. I’m convinced that’s because I don’t because I do some things: • I eat right • I exercise • I don’t smoke • I don’t drink alcohol or take recreational drugs • I don’t participate in drama or other far too emotionally serious matters
Sounds a little dull, but like I said, my life is full.
In a recent AOL News interview, David Feinberg, CEO of the UCLA Hospital System, shared that the argument on capitol hill is not about health-care reform. It’s about health-care insurance reform.
I agree. I haven’t read the entire bill, but that’s the deal on the surface. Democrats are scrambling, Republicans are striking fear into the hearts of senior citizens, and business as usual. It’s intense drama, but has little if anything to do with health care and everything to do with money and how much insurance companies will lose if everybody’s somehow insured under a plan they don’t control.
He goes on to estimate 50% of his 800 patients in his hospital have illnesses that could have been prevented by changes in lifestyle. • Eat right (we all know how, learned in grade school) • Exercise (we all know how, learned in grade school) • Avoid smoking, & alcohol (if you can’t, free help’s available)
I didn’t know that the surgeon general was obese like Feinberg says…so I Googled her. I’m not so sure she’s 100 pounds overweight, but she’s a big woman.
Here’s what she says on the Surgeon General’s home page.
“Americans will be more likely to change their behavior if they have a meaningful reward–something more than just reaching a certain weight or dress size. The real reward is invigorating, energizing, joyous health. It is a level of health that allows people to embrace each day and live their lives to the fullest without disease or disability.”
I am in violent agreement that health gets better if we take care of ourselves and feel powerless over the lies and misdirection coming from Capitol Hill. For now, I write my little blogs and help provider agencies get their EMR running right…and follow Feinberg’s advice.Read more →
Gaining user trust is a special skill, and sometimes the project managers from software companies just don’t have it. Software companies love bean counters as project managers because they keep track of billable hours. It’s always good to get paid. It’s better to gain the users’ trust, have a successful rollout with some aftercare, and get paid more. Some software companies’ solution to this is to insist on a person from the provider’s staff as an internal person to do the touchy-feely work with the users.
Sometimes the separation of implementation resources in to “us” (provider) and “them” (software vendor) causes problems.
Recently, a CFO friend’s boss has been getting testy about the EMR not being on line a few years after buying an expensive enterprise software system that’s expensive to maintain. Not his fault. Not even the vendor’s fault or the software’s fault. Some people simply have trouble relating to humans on a human level when it comes to business, and I think that’s what’s happened in their implementation.
The thing that strikes me as the most important thing to do is gain the trust of the users and get it up and running before they have a chance to think about it. There are always Negative Nelly’s around, and if given a chance, they will unwittingly sabotage the effort with negative rumors. Once you quietly design the software, move fast to implement. Having elements of the EMR, like progress notes, successfully operational creates a fabulously positive buzz in the organization, so be ready to roll something else out, quick!
There are a ton of experts out there who tout Rapid Cycle Implementation and other systems for making your software work. Mostly, they’re good and embody the ideas we pioneers had about getting software up and running years ago. They also add a bundle of good ideas every project manager should steal.
That said, gaining trust of the users is the one foundation that deserves more attention than it gets. Is that because there’s no line item in the budget for that?
I’m available at firstname.lastname@example.orgRead more →
I was catching up on some reading this morning, and reviewed a January editorial from the NY Times about the increasing role of the feds in supporting Medicaid to meet expanding demands.
It seems that a decade of tipping the income scales has left a bundle of families of four bringing in less than $30,000 a year, which expands the Medicaid culture (a social issue I love to talk about, but won’t today). The political argument is whether the feds or the states pay for the increased Medicaid usage. There are disparities among states in how they pay their share, which leaves shortfalls of billions and billions of dollars. In the face of this problem and increased demand (those families I just mentioned), the dam will burst on capitol hill, something will happen, even if it’s wrong, to increase federal participation in Medicaid funding.
C-level executives of provider organizations that I know are faced with increasing workloads and per-service recompense dwindling at the state level. The states have to adjust their budgets and have passed the problem on to my friends. A number are worried that their agencies won’t be around to offer mental health and social services to this increasing population that needs the help. Think about the resulting world a minute. Overworked surviving agencies serve a smaller percent of the population, poorly, and America has a lot of sick people on the streets. Homelessness increases, crime increases, hospital emergency rooms go nuts and jail population explodes. America the beautiful.
Think it’s not that bad? OK. Perhaps I’m reactive, perhaps not.
I only know only a little: I can help in a small way. I help agencies serve more people and increase their quality of care. More people can be served in an agency that demands its practitioners to use concurrent documentation and other efficiency directed aspects of the Electronic Medical Record. Quality of treatment increases when all practitioners and agencies have instant access to electronic records and the right-hand provider knows with professional certainty what the left-hand provider’s doing with the patient.
You can contact me now at email@example.comRead more →
It’s a slow news day for Health & Human Services.
So, like any dutiful blogger, I dug and burned till I came up with a great topic: Five Factors for Optimal Software Selection, as shared by Joe Naughton Travers at Open Minds. I liked Joe’s five topics, which are actually the foundation of the list, and added my twist: • Functionality: Having helped many companies to implement software, I can say the key to success is more than just what the software does out of the box…meeting workflow demands in positions from the front desk to counselor to the CFO are key; how flexible is the product? • Company stability and reputation: Has the company made it past the first big “choke point”? Are you comfortable the company can weather a financial storm and not leave you out in the cold, looking for software support? • Vendor customer support and service: Talk with a few customers in addition to the vetted, strong supporters (who might have a marketing agreement with the vendor). • Implementation expertise: Implementing software is a partnership between you and the vendor…your businesses are getting married, and remember, the vendor is a polygamist. Devise a plan with the vendor to bring the software up quickly, one area at a time, starting with the area you can get running effectively first. This increases staff buy-in and keeps the excitement going about the ongoing implementation that can take from a few months to a few years. • Cost: Software’s Return On Investment can be measured. I use a tool that’s tailored to your exact situation to determine potential service delivery that can be added, throw in some marketing plans and come up with a goal. Joe advises a three to five year budget plan, which is what I’ve used and like. Software vendors will offer a significant product upgrade that includes technology they were unable to add to the platform you bought every five years or so. Oh, and by the way, they commonly charge big bucks for these upgrades. There are a boat-load of other factors that need to be considered when purchasing software. For the sake of business success, juggling these elements into a reasonable plan seems to be the approach most providers take. Contact Terry McLeod at firstname.lastname@example.org for help purchasing, replacing, or upgrading your current software.Read more →
I attended a NIATx webcast supporting their Rapid Change initiative recently, and once again was impacted by the desire of agencies to provide more services with fewer resources…and not wait around a year and a half to discover whether an initiative is working…and if it doesn’t work, get rid of it. The webcast told agency success stories resulting in increased delivery of services.
Rapid Change played a part in this. The concept of Rapid Change has been around a while, and elements of getting staff buy-in, setting goals and proving you can meet the goal in a “pilot” effort to improve practices has been proven to work. Throw in a little Lean Thinking and a few business process analysis and management concepts, and you have a recipe for success. I was glad to see somebody implementing these concepts successfully; it proves the effectiveness of sensible business measures.
What seemed lacking in the efforts was effective use of the EMR to make the process more efficient, record the data, and minimize the effort of data entry and measurement of success.
Forms development & flexible reporting are great EMR tools that enable digital recording of the work performed and reporting outcomes of new processes that are instituted for the sake of process improvement and doing more with less.
Why don’t agencies who institute new processes in the interest of improving business practices use these tools to gather data quickly? It seems reasonable that a project could be abandoned in six weeks if the measures aren’t working as long as the data is available for analysis. If it is abandoned and a new form is involved, most software user tools make it easy to dump new forms or remove data elements that have been added.
The answer may lie in manpower. Resistance to change results in staff “noise” and over coming that is a skill in itself. Having instituted many systems that deliver results of increasing services without increasing staff to provide them, I’m sure I can help your agency develop and implement “practices” that become “best”. Connect with me at email@example.com.Read more →
I was invited as a guest to a group meeting of CFOs who meet on Long Island, and shared my insights about the conversation.
One topic I mentioned prompted note-taking: Marketing.
Once all the efficiencies of the EMR are introduced and measures are taken to shorten the time between the inquiry and delivery of service, staff will have time to provide more services. The methods of gaining referrals for Health & Human Services agencies that rolled off my tongue in closing were to establish relationships at the local Hospital Emergency Room and Police Precinct (not with CEOs and Captains, but the people who actually tell prospective patients where to go for help).
Coincidentally, this morning I was pointed to three reasons why patients may not refer others to an agency’s vital services. This observation from a chiropractor can be applied in many healthcare environments; see the article “The 3 Reasons Patients Don’t Refer “.
1. Patients will refer you to others if you ask them to. It’s a simple matter to have the front desk person smile at the person as they exit and exclaim “Be sure to tell folks we’re here to help!…or something of that ilk. Remind the person at the front desk in your EMR, or even with a billing system pop-up if the patient owes a co-pay.
2. Patients don’t feel comfortable referring you to others. Is this a treatment issue for the patient? A quality assurance issue for the agency? A suggestion aimed at building business could start with the person at your agency who knows the patient best, hopefully their counselor. This sort of discussion extends to the entire staff, and can be repeated with every patient visit. It should be simple enough to set up a reminder for the counselor in your EMR, perhaps to appear during concurrent documentation of the session.
3. Patients are reluctant to share with friends & acquaintances that you’re helping them. This could be an issue ranging from confidentiality to not liking somebody who needs help. We want to “do good” in this business, and the appropriate staff could help the patient overcome this reluctance with patient coaching. Staff would help their charge do some good, and it shouldn’t hurt the patient to help others. Another simple reminder to the appropriate staff in the EMR or billing software would help.
Staff may be unwilling to help…They can be sold on it. Company policy must be upheld for an agency to survive, and staff should want the agency to survive and thrive, not shrink. An employee joins the team when they’re hired, so engage them.
Staff may just plain forget to mention it at the end of a session. Remind them with your EMR and build in redundant impressions for the patient, like posters. Message repitition is a big key to advertising.
Staff may be opposed to helping build business: it’s not their job, man!. Everybody on the team needs to pull for the team.
Optimization of the EMR can help with these details, and we always need to provide more services with fewer resources.
Contact me if you need help.Read more →