AAFP Urges Improvements to Fledgling Patient Data Initiative

The AAFP made detailed suggestions to improve CMS’ recently announced initiative to improve patients’ access to and control of their electronic health data.

March 22, 2018 04:11 pm News Staff – The AAFP is working to propel a new CMS initiative meant to give patients better access to — and control of — their health care data into action that improves patient care and reduces physicians’ administrative burden.

CMS Administrator Seema Verma, M.P.H., publicly unveiled the MyHealthEData Initiative(www.cms.gov) on March 6 during a speech(www.cms.gov) at the Healthcare Information and Management Systems Society annual conference in Las Vegas.

She told her audience the United States will never achieve the long-sought goal of value-based care “until we put the patient of the center of our health care system.”

Verma said the Trump administration is determined to ensure that patients “have the information they need to be engaged and active decision-makers in their care.”

A CMS press release(www.cms.gov) noted the initiative is headed up by the White House Office of American Innovation with active participation from HHS, CMS, the Office of the National Coordinator for Health IT, NIH and the Department of Veterans Affairs.

STORY HIGHLIGHTS

  • The AAFP recently responded to CMS’ announcement about its MyHealthEData Initiative with a letter outlining suggested improvements.
    In a letter to CMS Administrator Seema Verma, M.P.H., the AAFP urged CMS to require vendors to provide any new government-required updates to electronic health records systems without additional cost to medical practices.
  • The letter also urged the agency to utilize the AAFP’s Principles for Administrative Simplification to reduce physician documentation requirements.
  • Midway through her speech, Verma related a personal story about a recent out-of-town health emergency in her family that led to her husband’s hospitalization. After his discharge, Verma asked for a copy of the complete medical record amassed during the inpatient stay to ensure that doctors back home had all the information they would need for follow up care.

“After the federal government has spent more than $30 billion on EHRs (electronic health records), I left with paper (five sheets) and a CD-ROM” that was both difficult to utilize and incomplete, said Verma.

“I couldn’t help but contemplate the disconnect between the genius of the medical system that used the latest technology and science to save my husband’s life but didn’t have the tools available to just give me his medical records, which I thought would have been the simplest task out of all they had performed,” she said.

Verma also announced an update to the agency’s Blue Button initiative, calling the new Blue Button 2.0(bluebutton.cms.gov) a developer-friendly, standards-based application programming interface “that enables Medicare beneficiaries to connect their claims data to secure applications, services and research programs that they trust.”

AAFP Weighs In
The AAFP has advocated long and hard for interoperability of EHRs and supports certain portions of the new initiative; however, other key points raised eyebrows among Academy leaders.

In a March 14 letter(4 page PDF) to Verma signed by AAFP Board Chair John Meigs, M.D., of Centreville, Ala., the AAFP weighed in on important portions of the initiative during its formative stages to ensure the final program doesn’t create more obstacles to already overburdened family physicians.

The AAFP noted its approval of agency efforts that “encourage patients to have meaningful control of their data” and to improve interoperability and administrative simplification.

“We would, however, object to placing responsibility for the adoption of interoperable systems on physician practices,” the Academy stated. “The creation of standardized interoperable systems should instead be the responsibility of vendors.”

The AAFP pointed out that physicians were promised EHR interoperability and secure patient access when they purchased certified EHR technology or upgraded their existing systems; however, many systems do not meet this standard.

Lack of this promised interoperability leaves physicians beholden to EHR vendors — a situation that has allowed vendors to engage in price gouging when peddling software upgrades and maintenance.

“We strongly urge CMS to require EHR vendors to provide any new government-required updates to such systems without additional cost to the medical practice,” said the AAFP.

Multiple studies have shown that physicians spend far too much time — up to 50 percent of their workday and even after clinic hours — using their EHRs, said the AAFP, referencing a Feb. 7 letter(6 page PDF) to Verma.

“CMS must take the time and financial costs physicians endure into account while addressing improved patient access to health care data,” said the Academy in its most recent comments.

Stop Information Blocking
In her speech, Verma zeroed in on CMS’ intent to prevent providers and hospitals from blocking patients — and their physicians — from seeing personal health data. “We will not tolerate this practice anymore,” she said.

In response, the AAFP noted that too often physicians receive summaries of care that are too long and “filled with clinically irrelevant information.” Indeed, said the letter, unnecessary information often is inserted into summaries by automated processes “designed to ensure compliance with CMS regulations and requirements for the MU (meaningful use) and ACI (advancing care information) programs.”

The AAFP told CMS to improve its regulatory requirements and focus on “how and when data is exchanged rather than focusing on the data in the exchange.”

Furthermore, the AAFP called on CMS to use the authority it was granted in the 21st Century Cures Act(www.fda.gov) to penalize health care organizations that are not sharing information.

“Policies should be focused on penalizing bad actors blocking information,” the Academy said in its letter.

Streamline Documentation, Billing Requirements
The AAFP pointed out that the level of documentation required of physicians has escalated in recent years despite the widespread adoption of EHRs. In particular, the Academy took issue with CMS’ documentation requirement guidelines for evaluation and management (E/M) services.

The letter argued that the guidelines, written for use 20 years ago in a paper-records era, “do not reflect the current use and further potential use of EHRs or team-based care.”

CMS should recognize and adhere to the AAFP’s Principles for Administrative Simplification to reduce documentation requirements. In these principles, the AAFP calls for

eliminating documentation guidelines for E/M codes 99211-99215 and 99201-99205 for primary care physicians;
applying a new standard to all public and private payers to allow medical information to be entered into a patient record by any care team member related to a patient’s visit;
discarding data templates and box-checking requirements that do not enhance patient care; and
redesigning and optimizing EHR systems through the collaborative efforts of physicians, vendors and workflow engineers.
Improve Related Programs
The AAFP addressed additional points in its letter to CMS, including suggestions related to

streamlining requirements associated with meaningful use and the Quality Payment Program’s advancing care information component;
interoperability of quality measures, including elimination of all health IT utilization measures and implementation by all payers of the Core Quality Measures Collaborative’s core measures sets championed by the AAFP;
widescale interoperability of patient admission, discharge and transfer data in as close to real time as possible; and
reducing hospital admissions and readmissions, and duplicative testing.
“With the modifications we have suggested and attention to other overarching health care IT issues as outlined above, we believe these programs will lead to great success for our patients by catalyzing better, more efficient quality care,” concluded the AAFP.

Related AAFP News Coverage
Fresh Perspectives: Doctor or Patient? Who Owns Medical Records?
(1/18/2016)

 

Source: AAFP Urges Improvements to Fledgling Patient Data Initiative

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Cerner to showcase Apple collaboration at HIMSS18, president Zane Burke says 

The EHR maker will also be featuring innovations in longitudinal health records, cloud services, machine learning and more to help customers manage value-based contracting.

“We’ll showcase our collaboration with Apple to make health records available at your fingertips in the Apple Health app,” said Cerner President Zane Burke.

HIMSS18 will be a pivotal one for Cerner in many ways. It’s the first with new CEO Brent Shafer, who has big shoes to fill as the first outside hire to lead the company since founder and longtime CEO Neal Patterson passed away last summer.

And it comes as the company has arguably more big projects on its to-do list than ever, including the massive ongoing MHS Genesis project for the U.S. Department of Defense and the upcoming contract with the Department of Veterans Affairs – to its continuing innovation on any number of fronts, from consumerism to the cloud, interoperability to artificial intelligence.

“Recently, Cerner and Apple worked together to make personal health information accessible on a consumer platform, and we’re working with a range of partners and clients to turn up the heat on the conversation about interoperability,” Cerner President Zane Burke said. “We’ll showcase our collaboration with Apple to make health records available at your fingertips in the Apple Health app.”

Burke added that Cerner will also be offering a look at virtual health solutions that empower individuals to manage their health via telemedicine and remote monitoring technologies as well as intelligent solutions for hospitals as they adjust to rising costs and value-based care.

“We’re at a pivot point with the digitization of health information, and we are redefining the idea of ‘care.’” Burke said. “We’re moving from managing patient encounters to providing for the well-being of populations.”

Cerner is particularly focused on the growing clout of the healthcare consumer and is committed to activating and engaging patients to be more proactive in their own health. Central to this work is the agility and speed offered by cloud technology, and Burke said Cerner continues to work with leading companies in industries other than healthcare to build on its own cloud-based offerings.

Cerner’s founding membership in the CommonWell Health Alliance – which was first announced five years ago at HIMSS13 – is one way to help innovate on the interoperability front, he said, and the company is committed to the co-creation of an open platform for innovation by leveraging FHIR standards through its work with the Argonaut Project.

More fluid data exchange, particularly with the DoD, was a major driver for the contract Cerner was awarded for the VA’s new EHR this past June, of course. Although the contract is currently on pause while MITRE does an independent assessment of its specifications, Burke said the VA project ultimately will “not only create seamless care for our nation’s veterans, it will also fundamentally change interoperability in the commercial healthcare space — something we are very excited about.”

Population health management is another imperative in the era of value-based reimbursement, and it’s another area “where Cerner continues to grow,” he said. “Providers need data that is actionable at an individual and community level to improve care. Cerner is uniquely positioned, through our cloud-based platform HealtheIntent, to pull all those data points together, aggregate and normalize the data and feed it back into the workflow for clinicians to act on.”

And analytics to help mine that data for the most useful insights are fast-evolving too – largely driven by lightning-fast advances in artificial intelligence and machine learning, which “remain a key focus for Cerner,” said Burke.

He pointed to early efforts such as the Cerner HealtheDataLab technology, which offers a secure environment where researchers and data scientists can “query de-identified data, extract and transform data sets in research-ready formats, build complex models and algorithms and validate findings in a single elastic environment.”

Cerner is in Booth 1832.

Source: Cerner to showcase Apple collaboration at HIMSS18, president Zane Burke says | Healthcare IT News

Top 5 free apps to keep you healthy in 2018

The most-downloaded health apps on iPhone and Android app stores reveal where Americans are turning to take control of health issues.

A new year means it’s time to comply with new resolutions for many people. Most often, that means targeting health and wellness. A Google search analysis conducted last January showed that getting healthy was the most popular resolution, with more than 62 million searches, almost double the second-most-searched New Year’s resolution: getting organized.

The ubiquity of smartphones in daily life makes it easier than ever to make a resolution related to health — sticking to it is something else. App tracker App Annie provided CNBC with data on the most popular free versions of health and wellness apps from 2017 based on both the Apple and Android app-store downloads. The data was through Dec. 28, 2017.

As technology giants such as Apple, Amazon and Google get serious about remaking the health-care sector, these results show how Americans are using their phones to take more control of their health, and the specific health issues that are proving to be most app-friendly.

Source: Top 5 free apps to keep you healthy in 2018

Many hospitals lack strategy for leveraging smartphone technology | Healthcare Dive

Dive Brief:

  • Smartphones are ubiquitous in today’s culture, but many healthcare organizations are still figuring out how to leverage them to support providers and patient outcomes, a new KLAS Research report concludes.
  • Shared-use smartphones that are under an organization’s control can build out the clinician tool kit and increase efficiencies by enabling mobile access to patient data. Other options include personal use phones, usually reserved for physicians and management, and “bring your own device” (BYOD) programs that allow employees to access and share personal health information.
  • Meanwhile, nearly 76% of practices use mobile health on a weekly basis, but half of those use it five hours or less, according to the Physicians Practice 2018 Mobile Health Survey. More than 22% of practices use mHealth six to 10 hours a week, while just 27% use it more than 10 hours.

Dive Insight:

The Apple iPhone’s ease of use and broad application library have made it the go-to choice for shared-use phones, but weaknesses could cause other companies to gain ground, according to the KLAS report. Drawbacks include cost, poor Wi-Fi connectivity, no built-in barcode scanner and inability to switch batteries between different iOS models. The iPhone also lacks ruggedization — a feature required for it to be considered healthcare grade.

By contrast, Zebra (previously Motorola) offers a healthcare grade smartphone, is more durable and has an integrated scanner, the report notes. “Two EHR and secure communications vendors now favor Zebra over Apple due to Apple’s inadequacies.”

Organizations issuing personal-use devices almost exclusively use Apple, while half also offer Samsung primarily as a secondary device. The primary use of these phones is communicating with the care team and accessing EHRs. But again, some of the same limitations — like poor WiFi connectivity — apply. While Apple is seen as more secure, Samsung wins on flexibility.

Unless organizations ban personal smartphones, KLAS recommends having a corporate BYOD program to keep the phones HIPAA-compliant when employees access patient data. Successful programs should include stipends to support usage of approved personal phones, an approved secure messaging app, remote device security and lockdown and means to access EHRs.

Asked their motivation for purchasing smartphones, 87% of organizations said securing messaging, while 60% cited EHR mobility.

The Physicians Practice survey shows practices using mHealth for a variety of purposes, with the chief one being communicating with staff (70%). The next most common usage is mobile EHR application (51%), followed by communication with providers (50%) and education on clinical issues (47%).

The National Institute for Standards and Technology developed a practice guide on mobile device security that describes enterprise mobility management, in which a profile is installed on a device to enable monitoring and control. The problem, according to critics, is that staff in organizations that permit BYOD don’t want their personal devices monitored.

 

Source: Many hospitals lack strategy for leveraging smartphone technology | Healthcare Dive