Use cases will indicate development in data exchange

Data exchange among healthcare agencies has acquired increased significance as many in the regulatory sphere now recognize the significance of ensuring the free flow of information among all constituents.

Pressure is rising to make sure that the industry isn’t engaged in blocking information, either due to the competitive pressure or technical issues.

This year’s progress in acquiring interoperability will be on display at HIMSS17, where 34,000 square feet of floor space will be utilized to show industry progress in exchanging data or information among several partners in healthcare.

In the Interoperability Showcase, HIMSS gives an immersive experience that indicates the use of data and its exchange or data exchange, through several profiles and standards with live products that are presently in the marketplace.

“Because of the shift from fee-for-service to value-based models, the new showcase moves from beyond concentrating on the EHR as the sole data source for electronic health information, to a wide range of health information technologies utilized by individuals, providers and researchers,” HIMSS claims.

The emphasis at HIMSS17 will go beyond just indicating interoperability in transactions to more complex information exchanges. The showcase has been redesigned to show how interoperability will be fleshed out in a variety of use cases.

Several tours in the interoperability showcase will follow the exchange of information in the following areas:

• Accountable care


• Public health reporting


• Commonwell care transitions


• Community health


• Diabetes management


• Surgery and recovery


• Patient data reconciliation

The showcase is the outcome of collaborative effort between public and private sector vendors and represents months of work to develop standards-based demonstrations of interoperability from the perspective of an individual like a clinician, caregiver, administrator or patient.

The Interoperability showcase is open February 20 through 22 anytime during exhibit hours in booth 9000 in the exhibit hall.

Basic information about the Interoperability showcase can be found here.

 

GAO calls CMS’ Medicare Advantage encounter data into query

The Centers for Medicare and Medicaid Services (CMS) has made insufficient development in validating the completeness and precision of Medicare Advantage encounter data, a crucial component for administering accurate payments for the program, in accordance to a Government Accountability Office audit.

CMS gathers Medicare Advantage encounter data, detailed data about the care and health status of Medicare Advantage enrollees, to evaluate payments. Although, despite GAO’s 2014 suggestions that CMS completely assess data quality before use, auditors discovered that the agency has yet to take critical measures to make sure the encounter data is right and complete, making the Medicare Advantage program susceptible to improper payments and wasted taxpayer dollars.

“CMS has still to undertake tasks that fully deals Medicare Advantage encounter data precision, like reviewing medical records,” states the audit report. “Moreover, few health insurance and provider trade associations GAO interviewed voiced concerns about CMS’s capability to accurately identify diagnoses utilized for risk adjustment…To the extent that CMS is making payments deployed on data that haven’t been completely validated for completeness and accuracy, the soundness of billions of dollars in Medicare expenditures sustains to be unsubstantiated.”

A CMS spokesperson refused to particularly comment on the GAO’s findings and suggestions, and instead referred to the agency’s official written responses released in the audit report. Among those responses, CMS officials pointed out that they are working with Medicare Advantage agencies to refine how the methodology used to gain diagnoses data is applied.

Additionally, the agency claimed that it has started compiling basic statistics on the volume and consistency of data submissions and preparing automated summary reports for Medicare Advantage agencies demonstrating diagnosis information used for risk adjustment.

Specifically, CMS started phasing in patient diagnosis data from Medicare Advantage encounter data in its risk adjustment process in the year of 2015 and told the GAO it intends to depend completely on those data by the year of 2020.

Because it has primarily concentrated on collecting comprehensive encounter data for risk adjustment purposes, CMS officials also informed auditors that the agency has highly deferred planning for extra uses of the data.

Nevertheless, in accordance to the GAO, few stakeholder agencies have objected to the risk adjustment transition time frame, compelling that it does not permit sufficient time for a victorious transition. Still, CMS asserts that the multiyear transition time frame is reasonable.

Provided the agency’s limited progress, auditors claimed that they continue to believe that CMS should execute GAO’s July 2014 suggestion that the agency completely develop plans for the extra uses of Medicare Advantage encounter data.

“This latest GAO research proves once again that the encounter data system isn’t ready for full implementation,” stated House Ways and Means Committee Chairman Rep. Kevin Brady (R-Texas) in a written statement. “While the system was developed to ensure right payments for the millions of seniors who depend on Medicare Advantage, it won’t work with incomplete and inaccurate data and could lead to higher premiums or decreased benefits down the road. CMS must ensure this significant system is based on the right information so taxpayer dollars are going to Medicare recipients who require them most.”

Likewise, House Energy and Commerce Committee Chairman Rep. Greg Walden (R-Ore.) claimed in a written statement that the GAO report “raises more uncertainties about the encounter data system and either it is ready to perform its duties.”

While applauding that few improvements have been made since GAO’s 2014 report, Walden noted that “key suggestions from the government watchdog have still to be implemented” and voiced his support for the “GAO’s asserting that CMS should completely assess its data quality before implementing” the Medicare Advantage encounter data system.

 

New attempt targets to improve EHRs to support medical research

One of the primary benefits expected of electronic health records (EHRs) is the contribution that digital systems would make to support medical research.

Because sufferers’ records had been significantly paper-based, so, too, were medical research programs. Several hoped that electronic records would assist in recognizing patients for research initiatives, gathering their medical data and facilitating research in myriad ways. Even though the huge majority of hospitals and physician practices have shifted to electronic records, medical research programs have been slow to identify benefits.

But an attempt at the Yale School of Medicine might offer hope to medical research in the U.S. Researchers there have deployed a latest cloud-based system that enables them to pull patient electronic health records (EHRs) from across multiple healthcare agencies and to synchronize that data.

The system, known as Hugo, was established in a partnership between Yale-New Haven Health System and health information exchange vendor Stella Technology. Hugo is designed to permit patients to accumulate all their health-related data for healthcare research studies.

The platform is presently being tested to ensure that the technology works well and to identify any areas that require improvement, in accordance to Harlan Krumholz, MD, professor of internal medicine at Yale-New Haven and one of the developers of Hugo. An update on the initiative will be presented during an educational session at HIMSS17 on the day of Monday, February 20.

“Our first studies with Hugo are offering real-world experience and focus on the capability of individuals to have Hugo fetch their data and sync it securely with a research database,” claims Krumholz. “Ultimately, Hugo is about motivating people with their health data, putting them in a position to leverage it, and making partnerships possible for sharing data with researchers and others. But, the premise is that individuals should be in a position to use their data for their own benefits and, if they select, for the benefit of others.”

Patients sign up for Hugo and utilize a portal/password to verify their identity to link with EHRs that have their records. Then, with their permission, the platform harmonizes the information from different sources offering the ability to share it with researchers.

“Unless we, as researchers and clinicians, partner with our sufferers and find a way to provide them the capability to exercise their federal right to achieve their own data and share it, then we are not going to make progress,” states Krumholz. “This is a fundamental shift in the way we consider about medical research.”

Yale-New Haven has initiated a study to see if a central repository of patient EHRs, like Hugo, can be used to decrease readmissions and post-discharge emergency department utilization.

Krumholz and Lin Wan, co-founder and chief technology officer at Stella Technology, will offer an update on the Hugo beta test in the HIMSS17 session, “What is next: People-powered knowledge generation from digital,” at 12 p.m. EST February 20 in the Room W304A.

 

Health Information Technology (HIT) Permits Payers to Share Data

The Centers for Medicare & Medicaid Services (CMS) strive to develop programs meant to bring “better care, smarter spending, and healthier people.” CMS joined hands with healthcare payers across 7 regions to make better primary care through the Comprehensive Primary Care initiative (CPC), in accordance to The CMS Blog. Through the utilization of health information technology (HIT) and multi-insurer payment reform, the program was established to support primary care practices in advancing the quality of care.

Payers across 3 regions involving Ohio, Colorado, and Oklahoma and CMS partnered to establish reports with private patient information to give quality information straightly to primary care offices. Payers worked closely with primary care practices while CMS constantly transformed the format and wording of the reports.

Utilizing health information technology (HIT) and sharing significant patient data has become a major aspect of making better patient care inside and outside of primary care physician offices. By ensuring primary care doctors have access to a sufferer’s overall medical information outside of their office, physicians will be capable to reach out to their sufferers and offer services before a patient seeks more expensive emergency care.

Prior to the Comprehensive Primary Care initiative, primary care doctors mostly had numerous reports from different healthcare payers with several quality measures and formats. Such diverse reports made it more complex for providers to target what data mattered and how they could act on the given information.

Although, CMS programs like the Comprehensive Primary Care initiative give aggregated data reports, which provide doctors with a stronger understanding of their patient populations and enable them to recognize gaps in care. Physicians can then concentrate on areas where population health management could be improved.

“This was a much anticipated solution to the complications posed by not having access to consistent claims information, and a continuous desire to make better our approach to meeting CPC Milestones [program requirements],” stated Dr. Austin Bailey, Medical Director of University of Colorado Health (UCHealth).

“Our practices will sustain to leverage the utilization of aggregated claims data using Stratus [the tool for practices in Colorado] to recognize the cost patterns of high risk patients — for instance, among our sufferers with diabetes, is the greatest cost linked with specialists, emergency department utilization, or medications?  Having this data across several payers makes it more relevant and assists to build our confidence in choosing the suitable interventions, recognizing trends, and effectively assigning care management resources,” Bailey summarized.

The Comprehensive Primary Care Plus program is a modern version of the former initiative and began operating on the day of January 1, 2017. More than fifty private healthcare payers have partnered with state Medicaid agencies and CMS across fourteen regions to participate in the Comprehensive Primary Care Plus program.

CMS is searching to continue working with payers to expand the execution of aggregated data reports and health information technology to share medical information that enables physicians to recognize gaps in care. Private and public healthcare payers are motivated to work with primary care physicians and the sufferer population to deliver medical data meant to make better the quality of care.

The sharing or exchange of information through health information technology enables doctors to reinforce care coordination, fill in gaps in care, and concentrate on increasing preventive care use, stated Dan Paoletti, CEO of Ohio Health Information Partnership at CliniSync.

In the previous days, hospitals, clinics, and payers had a fragmented system of healthcare delivery with inadequate communication and coordination. Since then, health information technology and the sharing of data enabled payers and providers to make better the coordination and the use of preventive care.

“Having access to data actually goes back to handling coordination of care,” Paoletti stated. “One of the most significant things related to that is preventative care because, finally, this is about trying to keep people healthy. That is how we are going to handle risk by making that pool of healthy individuals bigger and decreasing overall costs of care through that.”

“It actually is critical to get the data where it requires being in case to fill in the gaps that exist today,” Paoletti added. “That is what we are attempting to do and that is where we are headed on a larger scale.”

Furthermore, the results from health information exchange indicate that duplicative testing is decreased and wasteful spending is also decreased, stated Paoletti.

“I consider what will result [from health information exchange] will be a reduction in spending both because ultimately, it’ll increase preventive care but also realistically we’ll have a reduction in tests and duplicative services because the data will be available,” Paoletti contended.

Private and public payers are advancing their work with primary care doctors to share patient information more rapidly to fill in gaps in care and make better coordination.

MultiCare Health System: One hacked email account leads to PHI threat for 1,200 individuals

Five-hospital MultiCare Health System, serving the Tacoma, Wash., metropolitan area, is informing and notifying about 1,200 individuals after the email account of one worker was hacked.

The agency learned of the attack in the month of late November. As cyberattacks in the healthcare industry have increased, providers mostly learn that they have been hit when a law enforcement agency investigating one breach discovers other agencies have also been affected.

Protected health information that might have been compromised involves names, dates of birth, addresses, gender, dates of service, account balances, and diagnoses and treatment information.

Financial data and Social Security numbers weren’t accessed, and a media notice from MultiCare didn’t mention either the system would give protective services for affected consumers. The agency said it has no proof that any information has been accessed or misused, but cautioned sufferers to analyze their explanation of benefit statements for irregularities.

MultiCare now is re-educating workers on security precautions involving how to identify “phishing” emails that seem to be legitimate but launch malware when clicked on. The company didn’t respond to a request for additional information.

 

DMC's Michigan Pioneer Merges with CMS Next Generation ACO Model

Detroit Medical Center (DMC) is glad to declare it has been opted to participate in the year of 2017 Centers for Medicare and Medicaid Services’ (CMS’s) Next Generation ACO Model (Accountable Care Organization Model), a transformative step sponsored by the CMS Innovation Center. As a Next Generation ACO Model, DMC’s Michigan Pioneer ACO will sustain to join CMS to give Medicare beneficiaries with higher-quality care at lower charges.

The declaration is an outcome of a rigorous and competitive selection process that started in the year of 2015 with the national release of a request for Letters of Intent (LOI) from CMS. Building on the Pioneer ACO Model and the Medicare Shared Savings Program, the Next Generation ACO Model gives a new chance in accountable care that sets predictable financial targets, enables providers and beneficiaries greater opportunities for coordination with the target to attain the largest quality standards of care and make better health outcomes. The Model will permit the ACO greater flexibility in offering benefit enhancements and payment models involving faster access to skilled nursing facilities and other services.

"We are happy to build on the national victory of the Michigan Pioneer ACO," stated Dr. Anthony Tedeschi, chief executive officer of the Detroit Medical Center. "Our focus has always been our commitment to make better the health outcomes for our sufferers while increasing the efficiency of healthcare to provide the best possible model."

The Michigan Pioneer ACO is believed to be one of the original 32 Pioneer ACOs participating in the 5 year Model that began in the year of 2012, and is one of 9 still successfully participating. In fact, the Michigan Pioneer ACO was ranked the most successful Pioneer ACO of nation in the year of 2014 for financial benchmark savings improvements and has consistently increased its quality and efficiency every year. Since inception in the year of 2012, the Michigan Pioneer ACO has decreased Medicare spending for the health care services by $41 million, resulting in net savings to the Medicare program of $20 million.

"Shifting to the Next Generation ACO Model gives for larger collaboration between our sufferers and providers, closing the gaps in care while enhancing the quality of services," claimed Roger Wiseman, senior vice president of Population Health at the Detroit Medical Center. "We look forward to working with our almost 18,000 Medicare beneficiaries served in the Michigan Pioneer ACO to increase the benefits and further decrease charges."

The Next Generation ACO Model gives important services for all stages of healthcare involving chronic disease programs, preventative care reminders, transportation assistance following hospitalization, transitional care call follow-ups, appointment assistance and the support of the high quality specialists on staff at DMC

American Medical Informatics Association considers data sharing plan for clinical research

The American Medical Informatics Association (AMIA) has submitted comments on an intended data access and data sharing plan that the Patient-Centered Outcomes Research Institute released in the time period of late 2016.

PCORI is an independent agency authorized by Congress in the year of 2010 that funds clinical effectiveness research to assist healthcare stakeholders to make informed health decisions. These involve clinicians, patients, employers, insurers and policymakers.

In its comments, American Medical Informatics Association recommended PCORI consider needing a preliminary data sharing plan as part of the award application. The agency representing healthcare informatics experts also called for earmarking particular amounts of grant funds to support data preparation and curation.

In its request for comment, PCORI laid out expectations for researchers granted funding to reproduce genuine analyses to maximize the integrity of findings and promote data sharing to enable conduct of extra analyses, AMIA contends in its comments.

“The data access and sharing is significant and foundational to advance and modern scientific discovery,” claims AMIA President and CEO Doug Fridsma, MD. The PCORI plan, he added, will make sure that comparative effectiveness research adds to evidence-based medicine while tearing down data silos.

Other AMIA suggestions to PCORI involve defining metadata that includes requisite attributes and vocabularies utilized to give attributes as an explicit component of the Analyzable Data Set; motivating use of emerging community metadata models; and developing ways to ensure data originators get credit for their work. The PCORI request for comment is available here.

 

Use of DirectTrust secure electronic messaging soars in 2016

Use of DirectTrust secure electronic messaging between the patients, providers and other healthcare consumers through the Direct Project protocols for secure communications, grew importantly previous year, underscoring increasing national interest and activity in exchanging health information (HIE) during the care delivery procedure.

The service utilizes DirectTrust-accredited health information service providers (HISPs) that commit to complying with specific protocols for secure messaging.

More than ninety-eight million Direct message transactions were conducted during the year of 2016, in accordance to the vendor; more than 33.5 million messages were sent in the previous 3 months of 2016 alone. The service reports a total of 165 million transactions since it was inaugurated in the year of 2013.

The number of healthcare agencies using Direct message transactions rose to 71,000 previous year, in contrast with 52,000 in the year of 2015. A total of 41 HISPs now work with DirectTrust secure electronic messaging, and more than 350 certified electronic health records (EHRs) support the messaging service.

In addition to the certified EHRs, vendors mostly have several other products that support Direct—about 1500 other products are certified for the service.

“I did not expect growth to be this rapid,” claims David Kibbe, MD, president and CEO at DirectTrust. “That means we’ve to work harder so it stays reliable.”

Primary use cases for DirectTrust secure electronic messaging sustain to involve support of care coordination and clinical messaging for referrals and alerts, in accordance to Kibbe. “But w are also initiating to see Direct messaging for administrative and research data communications,” he adds.

DirectTrust soon will issue a white paper, significantly done by physicians and nurses using the service, with suggestions to EHR vendors and users on how to make better their products by mentioning features that best support Direct messaging.

Also, the service soon will support the capability to copy messages to other parties beyond those included in the exchange of information, and it also will support message notification, like informing a user that a message was victoriously received or the message was not delivered, Kibbe claims.

 

Texas ACO Produces $14M in Savings, Acquires Perfect Quality Score

Rio Grande Valley Health Alliance, LLC (RGVHA), a Texas ACO (accountable care organization) based in the region of McAllen, Texas, is acquiring important cost savings and quality improvements spearheaded by area primary care physicians who’ve joined hands with population health technology provider Lightbeam Health Solutions.

The Texas ACO contains 18 primary care physician practices working with the Centers for Medicare & Medicaid Services (CMS) to give coordinated care to Medicare sufferers in the Rio Grande Valley of South Texas. Since it started operating as an ACO in the year of 2013, RGVHA has saved more than $28 million – almost $14 million in the year of 2015 alone – by better stratifying and serving its population with tools from Lightbeam.

“Lightbeam’s value to our ACO goes beyond population health software because we benefit merely as much from Lightbeam’s information and best practices for orchestrating proactive and efficient work by physicians and care management teams. Lightbeam assists us stay a step ahead of our populations’ health requirements, which lets us deliver both quality and cost savings that we are very proud of,” stated Victoria Farias, assistant administrator at Rio Grande Valley Health Alliance, LLC. “We sustain collaborating with Lightbeam to recognize and deal new ways of cost-effectively providing high-quality care, especially for those patients with the most acute and chronic conditions.”

In the latest ACO Financial Report from CMS profiling results from the 2015 Medicare Shared Savings Program (MSSP), RGVHA was also one of mere four ACOs in the nationwide program to acquire a perfect 100% quality score. These outcomes were because of the ACO working with a scorecard system based on Lightbeam quality measures that also targeted non-compliant patients so care teams could more proactively handle those individuals’ care.

“We are proud to join hands with Rio Grande Valley Health Alliance to find ways to decrease healthcare charges while identifying sufferers whose lives can be improved simply through heightened healthcare education and more proactive care coordination,” claimed Pat Cline, CEO of Lightbeam. “The Lightbeam platform assists ACOs such as Rio Grande risk-stratify their populations to a granular level and our tools deliver that reliable information to care teams that use it to move more rapidly and decisively to close care gaps, increase patient engagement and decrease cost. We consider that Rio Grande is an outstanding blueprint for other ACOs looking to deliver similar savings and quality scores.”

Key points of the victory of RGVHA Texas ACO involve:

• Reducing home health spending by 41%


• Viewing sufferers’ underlying data, comparing it to CMS home health criteria, and recognizing patients who qualify for alternative avenues of care


• Decreasing emergency room visits and associated hospitalizations by 10%


• Improving care coordination across the health system and connecting area providers to better handle several patient populations

A significant next step for the ACO is deploying the Lightbeam Cohort Builder to assist RGVHA further identify high-risk sufferers who can enroll in several evidence-based care programs to make better patient outcomes and lower costs. Cohort analysis assists ACOs and providers by offering clear guidance and prioritizing where care management and other attempts should be focused.

 

EHRs provide potential solutions for trimming unnecessary health care

As the healthcare system of nation sustains to grapple with the issues of overuse and low-value care that gives little or no benefit to sufferers, electronic health record (EHR) systems can offer potential solutions for trimming unnecessary health care. It can also serve as strong technology platforms for data collection and intervention to deal overutilization.

So elaborates David Bates, MD, chief of the Division of General Internal Medicine and Primary Care at Boston’s Brigham and Women’s Hospital and co-author of a new viewpoint article in the Journal of the American Medical Association. Electronic health record (EHR) systems can offer potential solutions for trimming unnecessary health care.

In the article, “We concentrate on the issue of overuse and what can be done about it,” claims Bates. “One of the greatest changes in healthcare in recent years is that we are now using electronic health records (EHRs), which could actually be very helpful in reducing the overuse problem.”

Bates and his co-authors assert that EHRs have inherent advantages in combating the overuse of diagnostic processes, like the ordering of unnecessary tests by clinicians. They see the EHR as “an ideal medium” to give that kind of critical clinical decision support.

Although, the authors of the opinion piece also point out the limitations of EHRs the way that they are presently configured.

“There is lots of overuse, and EHRs do not necessarily do all they can to help reduce the frequency,” Bates adds. “The decision support in several of them is not as good as it should be. EHRs should routinely recognize things that are redundant, and they should assist people recognize things that are unnecessary. But most of the EHRs that are in broad use today aren’t doing that routinely.”

Bates and his co-authors give 3 current examples of U.S. healthcare organizations with mature EHRs:

• One agency has incorporated 100 of the American Board of Internal Medicine’s “Choosing Wisely” recommendations into their EHR to develop automated alerts that provide physicians with evidence and alternative options.


• Another agency aggregates data to compare physician orders against each another.


• The third integrated delivery system mines patient records to give physicians with best practices prior to a visit.

“We do not have robust evidence about which of the 3 works best,” Bates appreciates. “All three would be reasonable approaches to take—probably what we require at the end of the day is some amalgam of the three.”

At the similar time, he notes that EHRs “should be used to straightly influence physician behavior at the point of care, and that is what organization A is doing” by giving an alert in real time to physicians with patients who fit a Choosing Wisely scenario.

Nevertheless, Bates gives that organization B is “looking more at variation and that is also a very strong approach for finding situations in which there is overuse.”

Finally, he summarizes that all healthcare agencies will need to customize their respective EHR systems to establish tailored solutions and trimming unnecessary health care that best fit their requirements.