Health IT

October Physician Focus: Telemedicine

Posted in behavioral health, Health, Health IT, Physician Focus, Primary Care on September 30th, 2016 by MMS Communications – Comments Off on October Physician Focus: Telemedicine

Technology has been rapidly changing the practice of medicine, and one of the fastest growing areas is telemedicine, using such means as video platforms, text messaging, patient portals, and health “apps” that permit communication between physician and patient.

From left: Dr. Dale Magee, Dr. Adam Licurse, Dr. Steven Locke

From left: Dr. Dale Magee, Dr. Adam Licurse, Dr. Steven Lockepatient.

The October edition of Physician Focus takes a look at this emerging area of medicine with Adam Licurse, M.D., a primary care physician and Associate Medical Director of Brigham and Women’s Physicians Organization and Partners Population Health Management, and psychiatrist Steven Locke, M.D., Chief Medical Officer and Co-Founder of iHope Network and member of the MMS Committee on Information Technology.  Hosting this edition is Dale Magee, M.D., a past president of MMS.

The discussion examines the impact of telemedicine on physicians and patients, its advantages and shortcomings, how the field of mental health has acted as a pioneer in the field, how it can help to ease the stigma that prevent patients from getting care, and the concerns clinicians still have with the application of telemedicine in patient care.

Physician Focus is distributed to public access television stations throughout Massachusetts, reaching residents in more than 275 cities and towns. It is also available online at www.physicianfocus.org, www.massmed.org/physicianfocus and on YouTube.

The President’s Podium: A Renewed Effort on HIT

Posted in Electronic health records, Electronic Medical Records, Health IT, meaningful use on May 20th, 2016 by MMS Communications – 1 Comment

by James S. Gessner, M.D., President, Massachusetts Medical Society

Physicians well know the rapid advance of information technology in medicine over the last Gessner Cropdecade.  Pushed by federal and state regulations and requirements, the adoption of electronic medical records has been swift. Today, some 90 percent of physicians in Massachusetts use some form of electronic medical records.

While health information technology (HIT) arrived with great promise and adoption has been quick, widespread acceptance has lagged, and EHRs remain a major concern among physicians of all specialties. Among the most contentious issues: interoperability, clinical workflow efficiency, and the myriad demands of reporting patient data as required by Meaningful Use and the Physician Quality Reporting System, among others.

Some physicians have embraced HIT; they see it as a way to reduce medical errors, streamline workloads, and offer a path to improved outcomes.  Others view it as an impediment to the physician-patient relationship, a huge expense, a tool that consumes too much time, and a source of immense frustration.  Some have even stopped practicing medicine because they found the rules and regulations and operations too onerous.

Health information technology has been a major focus of the Massachusetts Medical Society since the establishment of the MMS Committee on Information Technology (CIT) some 20 years ago. The Committee’s Guide to Health Information Technology has provided useful information and direction for physicians as we struggle through the obstacle courses of HIT and EHRs.

The last year has seen a renewed effort by physicians nationally and locally, to share our concerns about the impact of HIT on physician practices and how we deliver patient care.

In September, MMS hosted an AMA Break the Red Tape Town Hall, to voice concerns about Meaningful Use.  More than 100 physicians attended, and the collective message was clear: EHRs are cumbersome, time-consuming, and hurting productivity.

MMS officials have also met with CMS Acting Administrator Andrew Slavitt on multiple occasions, including a visit last fall, at our suggestion, to Massachusetts and the office of a local family physician.  The visit provided Mr. Slavitt with a first-hand, real-world look at the issues affecting physicians as they work with electronic health records and wrestle with interoperability.  The encounter influenced his thinking about Meaningful Use; Mr. Slavitt has made it clear that EHRs should be patient-centered, physician-focused, and simple.

Our most recent effort was the adoption of a new set of principles governing health information technology.  Proposed by the CIT, the principles were adopted unanimously by the House of Delegates at our May annual meeting.

The essence of the new policy is contained in seven statements. It states that information technology available to physicians should accomplish the following:

  • support the physician’s obligation to put the interests of the patient first;
  • support the patient’s autonomy by providing access to that individual’s data;
  • be safe, effective, and efficient;
  • have no institutional or administrative barriers between physicians and their patients’ health data;
  • promote the elimination of health care disparities;
  • support the integrity and autonomy of physicians; and
  • give physicians direct control over choice and management of the information technology used in their practices.

MMS members may read the complete report of the CIT on these new principles here.

Guided by these principles, MMS will continue to work on health information technology issues and how these tools can improve the practice of medicine – and that means first and foremost a focus on patient care.  HIT does indeed hold promise, but its priority should not be on data collection, but on how it can raise the level of patient care – a goal shared by each of us as physicians.

The President’s Podium appears periodically on the MMS Blog, offering commentary on a range of issues in health and medicine.

 

 

 

Your EHR in 2016: Interoperability is Key Trend

Posted in Electronic health records, Electronic Medical Records, Health IT on December 18th, 2015 by Erica Noonan – Comments Off on Your EHR in 2016: Interoperability is Key Trend

Interoperability is expected be a key focus for EHR systems and the physicians who use them in 2016. We asked Micky Tripathi, founding president and CEO of the Massachusetts eHealth Collaborative, about the latest important developments on EHR interoperability and how they may impact your practice.


MMS: Tell us what the recent “KLAS” agreement means for physicians?

MT: The recent summit meeting (hosted by KLAS, the independent health information technology review organization) was a unique private sector initiative to establish objective “Consumer Reports” style measurements of interoperability performance across EHR systems. The summit brought together 10 major EHR vendors as well as 30 large provider organizations from the around the country. Over an intensive two days, the group achieved consensus on a measurement approach and process to be conducted by a credible, neutral organization. The measurement process will be the first comprehensive measurement of nationwide interoperability capturing both provider and vendor attributes. In other industries, the private sector comes together to hold itself accountable by working collaboratively on transparent measures of progress.  The KLAS agreement represents a significant step forward in the maturity of the health IT industry.

Micky Tripathi

Micky Tripathi

MMS: How will we know when interoperability is working?

MT:  When people stop complaining about it! Just joking. Interoperability isn’t a single thing – it’s a general term that describes different types of information exchange appropriate to a particular purpose. For example, email is very good for certain types of communication, but is a very poor substitute for those times when only a phone call will suffice. Similarly, sometimes a provider wants to have a complete medical summary sent to them, in which case they would want to receive a continuity-of-care document, whereas at other times they may just want to check on a medication allergy, in which case a “magic button” single-sign on viewer would be most important. Both types of exchange are important, each is appropriate to the specific clinical need.

Interoperability is already working very well in some areas — as (the science fiction author) William Gibson reportedly said, “the future is already here, it’s just not very evenly distributed.”  Take electronic prescribing, for example — a huge success across the country. Similarly, lab results delivery is very widely available in most health care delivery areas across the country.  EHR-to-EHR exchange has been harder to accomplish because it relies on coordination of many different vendors as well as many different providers. Even here we’re seeing tremendous progress though. The Massachusetts Health Information Highway has over 500 provider organizations connected and conducts over 2 million secure health information exchange transactions per month.

However, interoperability will never be “done.” As information technology gets better and medical advances continue, our expectations will grow as well.  We’ve seen with computers and smart phones that the more they do, the more we want. The same is true for interoperability as well.

MMS: What timeline do you expect in terms of seeing widespread improvements in interoperability?

MT:  We’re already seeing them. It’s important for us to have some perspective though. Just like you can’t have a good telephone network until most people have a telephone, you can’t have good interoperability until most providers have an EHR. A short 5 years ago, less than 10% of physicians had an EHR. That number is now over 75%, and for hospitals it is now over 90%.  So, why do we think that we should have universal interoperability already, when just a couple of years ago most physicians didn’t even have an EHR? No other industry has achieved it that fast, and yet, no other industry is as complex as health care.

The biggest barrier to interoperability until now has been lack of demand — physicians weren’t asking for interoperability because they didn’t have EHRs and because prevailing models of care and payment didn’t require interoperability. The world is different now, and physicians are demanding interoperability from each other and from their vendors, and we’re seeing the market respond.  Within the next few years I think we’ll see close to nationwide ability to send clinical documents to any provider in the country, and we’ll see the maturation of nationwide health information networks that also enable query and retrieve capabilities as well.

These networks are already emerging rapidly – like Epic’s Care Everywhere, Surescripts, CommonWell, the MA HIway, etc – and in the next few years we’ll see the building of “bridges” across these networks in the same way that phone networks and ATM networks are stitched together to provide universal coverage.

MMS: Do you think some regulation or a government mandate is inevitable down the road?

MT: I hope not. It would be a terrible mistake, and I guarantee that most physicians will be very unhappy with any kind of government mandate for interoperability, whether at the state or federal level.  Health care and IT are too complex to expect that the government can get it right or keep up with it. The best prescription for getting more interoperability is to expand value-based purchasing through Medicare and Medicaid that pays for better care and improved outcomes. That will create more demand for interoperability but will allow providers and their vendors to come up with the best ways to accomplish it.

— Erica Noonan

CMS, AMA Announce Help with ICD-10 for Physicians

Posted in Electronic health records, Health IT, Health Policy on July 6th, 2015 by MMS Communications – Comments Off on CMS, AMA Announce Help with ICD-10 for Physicians

With the October 1 deadline for the implementation of ICD-10 looming, The Centers for Medicare & Medicaid Services road 1 icd(CMS) and the American Medical Association (AMA) today jointly announced some good news – and relief – for physicians.

The two organizations have reached agreement on important elements of a “grace period” for the implementation of version 10 of the new International Classification of Diseases that includes some 68,000 codes. The medical codes, used for diagnosis and billing, have not been updated in more than 35 years.

Among the major steps announced by CMS and the AMA:

• For a one-year period beginning October 1, Medicare claims will not be denied or audited solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes.
• To avoid potential problems with mid-year coding changes in CMS quality programs for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores. CMS will continue to monitor implementation and adjust the duration if needed.
• CMS will establish an ICD-10 Ombudsman to help receive and triage physician and provider problems that need to be resolved during the transition.
• CMS will also establish an ICD-10 communications and coordination center, to identify and resolve issues arising from the transition.
• CMS will authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation.

The organizations also said they will reach out to providers across the county, with webinars, on-site training, and educational articles to help them learn about the new codes and prepare for the transition. The free help from CMS also includes the Road to 10, The Small Physician Practice’s Route to ICD-10, a website aimed specifically at smaller physician practices to help them with the transition.

Today’s CMS/AMA joint announcement may be read here. More information on ICD-10 is available at this CMS site and from this post by AMA President Steven J. Stack, M.D., which contains links to additional information and resources.

The President’s Podium: Common Sense on EHRs

Posted in Board of Medicine, Electronic health records, Electronic Medical Records, Health IT, meaningful use on September 26th, 2014 by MMS Communications – 1 Comment

By Richard Pieters, M.D., President, Massachusetts Medical Society

In its landmark 2001 report,  Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine recognized the “enormous potential” of technology to improve health care.  Indeed, of all the changes sweeping throughout healthcare in recent years, perhaps the most revolutionary has been health information technology (HIT).

One area of explosive growth within HIT has been electronic health records (EHRs). The U.S. Department of Health and Human Services noted in May of 2013 that the use of EHRs by doctors and hospitals more than doubled from the previous year, with Massachusetts one of the heaviest adopters.  Statistics from the Office of the National Coordinator for Health IT show that 71 percent of physicians and 80 percent of hospitals in the Commonwealth have adopted EHRs.

Yet, 14 years after the IOM’s report, after billions of dollars spent in federal incentives, and despite skyrocketing adoption, physician acceptance of EHRs appears at best, a mixed bag, at worst, a struggle. Recent efforts are instructive.

In its 2014 Survey of America’s Physicians released this month, The Physicians Foundation found that nearly half of respondents (45.8%) felt that EHRs “detracted from efficiency” and slightly more (47.1%) thought it “detracted from patient interaction.”  More than half (50.5%) believe EHRs “pose a risk to patient privacy.”

Separately, on September 16, the American Medical Association called for an overhaul of EHR systems. “Today’s current EHR products,” said AMA President-Elect Steven J. Sack, M.D., “are immature, costly, and are not well designed to improve clinical care…. The usability of EHRs is a significant driver of physician professional dissatisfaction and a challenge to practice sustainability.” AMA then outlined eight priorities for improving EHR usability to benefit caregivers and patients.

Frustration and dissatisfaction with electronic health records among physicians had surfaced well before the AMA pronouncement, and complaints about EHRs have been increasing as well. The inability of different systems to communicate easily with one another – the “interoperability” issue – remains a drawback.  Perhaps most unsettling, however, is the reality that hazards and risks remain, as the promise of widespread and reproducible gains in patient safety has yet to be fulfilled.

Here in Massachusetts, electronic health records have captured physicians’ attention for quite another reason.  Chapter 224, a law passed in August 2012 that outlined phase two of health care reform for the Commonwealth, included a provision that required physicians to demonstrate “meaningful use” proficiency (which only applies to Medicare and Medicaid) with EHRs as a condition of licensure.  That mandate is to become effective on January 1 of next year.  Without proper interpretation, the law as written could have had severe unintended consequences by disenfranchising over half of the state’s licensed physicians.

Now here’s the good news: The Board of Registration in Medicine has proposed regulations that include a broad set of exemptions for certain license categories.  The Board’s proposal also establishes multiple ways in which physicians could comply with the requirement.

The Board has posted its draft regulations and is accepting comments on them through Friday, October 3 at 5 p.m. MMS offered testimony in strong support of the proposals at the public hearing on Monday, September 29, and I encourage members to add their comments as well. Comments may be submitted via email to Eileen.Prebensen@state.ma.us All comments become public records and will be posted to the state’s website.

MMS has advocated on this issue since the law was passed two years ago, raising the specter of severe disruptions in physician practice and patient access to care.  We are now near a resolution that is advantageous to both physicians and patients.

The Board’s proposal, which addresses all of our major concerns, represents a reasonable, prudent approach to complying with the law, easing physician concerns, and maintaining access to care for patients.

While physician frustration with EHRs is high, it is important to distinguish between problems of technology and problems of policy.  Technological issues are likely to be worked out over time, if only by continued physician persistence and outcry for solutions, as demonstrated by the AMA.

Policy issues, as shown by the Board of Registration in Medicine’s common sense approach to fulfilling the requirements of Chapter 224, are more readily capable of resolution.

MMS, like the IOM, believes that electronic health records do indeed have “enormous potential” for patient care. Our extensive policy on EHRs declares support for them and a desire to work toward improving them, to capture “an opportunity for dramatic benefits to patients in clinical care, research, and the delivery of health care.”

Reaching that potential, however, will require the strong voice of physicians. Whether the issue is one of technology or policy, our local experience has shown how important it is that physicians participate in the conversation.  I urge you once again to review the draft regulations and send in your comments.

The President’s Podium appears periodically on the MMS Blog, offering Dr. Pieters’ commentary on a range of issues in health and medicine. 

EHR Next Chapter: A “Tool” in the MD’s Medical Arsenal

Posted in Electronic health records, Electronic Medical Records, Health IT on May 5th, 2014 by Erica Noonan – 2 Comments

data 2By Debra Beaulieu-Volk

Some of the Commonwealth’s premier experts in health information technology and electronic health records gathered recently at MMS headquarters to take part in the day-long continuing education event, Electronic Health Records Next Chapter: Best Practices, Checklists, and Guidelines.

“The EHR revolution is not new,” said Jeff Loughlin, project director of the Massachusetts eHealth Collaborative, while opening the morning session about EHR best practices and pitfalls. “Along the way, we have seen a lot of failures, primarily because a lot of expectations were put on the EHR to solve the problems of the medical practice,” he said, “rather than using the EHR as one other tool in your arsenal to improve work flow and provide better care.”

To help attendees make the most of this tool, physicians representing small, medium, and large practices weighed in on lessons learned from their EHR experience to date:

Don’t Fear Switching

Today, many physicians are deeply worried that the EHRs they adopted a decade ago no longer suit their needs, said Eugenia Marcus, MD, FAAP, pediatrician and chair of MMS Committee on Information Technology. She can relate, having learned and implemented three different EHR systems since beginning her quest for the paperless office in 1996. “Switching is not that hard,” she said. “Every word of the record does not need to carry over.”

During Marcus’ transitions, staff were responsible for making sure critical information, such as demographics and medication lists, was transferred immediately. But high school students to copy over the rest of the material over a long time period.

Use EHR to Improve Patient Satisfaction

EHRs do far more than simply house patient records, noted Hugh Taylor, MD, a family physician at an 11-doctor practice with three sites throughout the North Shore. In fact, out of the 17 functions Taylor listed that his EHR performed, the last four had little to do with practicing medicine.

“The EHR does many things that don’t affect the clinician so directly but are extremely important to how the office runs,” he said. Examples of these functions included scheduling, confirming insurance coverage, coding and billing, and tracking patient flow. That last item pulls double duty in Taylor’s offices, he said, by helping the practice inform patients when doctors are running behind and of how long they may have to wait. This data is also used to help the practice strive to improve its Press Ganey patient satisfaction scores, he said.

MDs Need Not Do All Documenting

Larry Garber, MD, and his team at Reliant Medical Group, where he serves as Medical Director of Informatics, pulled together a list of which individuals should do the documenting in the medical record, in order of preference, to promote optimal efficiency. “It doesn’t have to be just one person; it can be a combination of people,” he said.

The top choice of documenter, however, isn’t a person at all, but the computer itself. “Whenever possible, reuse data that you’ve already got,” he said. “Let the computer do as much work as it can.” (As a caveat to the pitfalls of copying and pasting, Garber noted that it’s a practice policy that physicians are responsible to review and update any information in notes they create.)

Next, Garber recommended letting patients populate some of their own data. Even triage nurses speaking with patients on the phone can contribute to the record, placing them in the third spot of preference. “What a great place to take history without tying up an exam room,” he said.

Rounding out the list of preferred documenters were medical assistants, doctors assisted by speech recognition, doctors assisted by transcriptionists, doctors typing, and scribes typing. When it comes to accuracy, Garber noted that physicians who use a combination of typing and speech recognition tend to produce the highest-quality notes.

More information about the event and links to faculty presentations are available online.

Free white paper for MMS members: “MMS Guide to Health Information Technology”

EHR Conference Speaker Emphasizes Importance of Protecting Patients’ Information

Posted in Electronic health records, Electronic Medical Records, Health IT, HIPAA on May 2nd, 2014 by MMS – Comments Off on EHR Conference Speaker Emphasizes Importance of Protecting Patients’ Information

By Vicki Ritterband

Ali Pabrai

Ali Pabrai

Encryption. Encryption. Encryption.

Those are the “three” most important activities doctors should do to protect the security of their patients’ electronic protected health information (ePHI), says cybersecurity expert Ali Pabrai, a  presenter at MMS’s recent conference, Electronic Health Records Next Chapter: Best Practices, Checklists and Guidelines.

Encryption is the conversion of data into a form that cannot be understood unless the reader has a key or password to unscramble the information. All sorts of electronic transmissions should be encrypted—including texts and emails—no matter what the device, said Pabrai. If data is encrypted, even if you have a security breach, it is protected.

“Unfortunately, application vendors in the healthcare industry have been lethargic about embedding encryption capabilities,” said Pabrai. “That makes it difficult for a practice or a healthcare organization to implement encryption.”

As more and health information moves between the cloud and mobile devices, organizations will increasingly need to focus their security efforts on those two areas, according to Pabrai. Healthcare data fetches a high price on the black market because it is so rich in identity information.

Cyber security attacks to all types of businesses are occurring at a breathtaking pace: the average organization experiences 1,400 attacks per week and of those attacks, approximately two accomplish their purpose, said Pabrai.  HIPAA fines for information security breaches can run into the hundreds of thousands and even millions of dollars. “Physician practices are more vulnerable to HIPAA fines than ever before,” said Pabrai. Often, organizations don’t know their systems have been broken into until months after the thieves have left the premises.

So what’s a practice to do? Here are the seven steps Pabrai suggests physicians take to ensure that their patients’ electronic protected health information (ePHI) is secure and complies with HIPAA regulations:

  • Assign someone in your practice to be the security or compliance officer. Make sure they have access to the appropriate resources to do their job.
  • Conduct risk analyses regularly, ideally on an annual basis.
  • Develop a security strategy and policies and document them. If HHS’s Office for Civil Rights investigates a security breach, the first thing they will ask is to look at your policies, said Pabrai.
  • Remediate when necessary: address any deficiencies in your protection strategy
  • Secure third parties: make sure your business associates are protecting your patients’ ePHI to the same degree you are.
  • Train your staff so they comply with your cyber security rules and regulations.
  • Evaluate your performance.

For an overview of what’s required from healthcare providers to comply with various aspects of the HIPAA Privacy and Security rules, the U.S. Department of Health & Services offers six free, CME-eligible online educational programs.

More information about the event and links to faculty presentations are available online.

Free white paper for MMS members: “MMS Guide to Health Information Technology”

Why Your Windows XP Computer Could Become a HIPAA Security Risk

Posted in Health IT, HIPAA, practice management on April 3rd, 2014 by MMS – 1 Comment

photo by stevendepolo via flickr.comIs your practice using computers that run Microsoft Windows XP? If so, you could be exposing your practice to security risks in the near future.

After April 8, Microsoft will stop supporting Windows XP, its venerable but aged operating system. This means that Microsoft will no longer send you regular software updates to correct new security holes and software bugs.

Will your XP computers suddenly become non-compliant? Not simply because Microsoft is withdrawing technical support. But without software regular patches, your computers may be increasingly vulnerable to the hackers and trolls who scour the internet. Usually they’re seeking credit card and bank account information, but if your system has security holes, they could access your patients’ protected health information more easily.

Will your computers continue to run on XP? If they’re functioning today, they probably will continue to function for a while. But many computer consultants are advising their clients to assess their risk and determine how they will modernize their systems.

Can I upgrade myself? Many computer users have tried upgrading to Windows 7 or 8 on their existing machines, but some have reported the process to be difficult, and sometimes a failure altogether. Many older machines simply don’t have the processing power or memory to run the newer versions of Windows. Sometimes the best solution is to get new hardware. Microsoft does offer brave, intrepid do-it-yourselfers  free data-transfer software.

Our advice? Talk to your computer vendor or consultant, and develop an upgrade plan. Granted, Microsoft derives commercial benefit from this decision, but security-sensitive users are left with little choice.You don’t necessarily have to upgrade today, but it’s not wise to delay the process indefinitely.

The President’s Podium: Mass. Medicine, After Cost Control

Posted in Board of Medicine, Electronic health records, Electronic Medical Records, Global Payments, Health IT, Health Policy, Health Reform, Regulation, Uncategorized on December 9th, 2013 by MMS Communications – 1 Comment

By Ronald Dunlap, M.D., President, Massachusetts Medical Society  

Massachusetts entered its second phase of reform with the 2012 passage of DSC_0003 Dunlap 4x6 color 300 ppi_editedChapter 224, cost control legislation officially titled “An Act Improving the Quality of Health Care and Reducing Costs Through Increased Transparency, Efficiency and Innovation.”

While the first phase, Chapter 54 passed in 2006, was indeed landmark legislation and served as the model for the Affordable Care Act, Chapter 224 alters the state’s health care industry perhaps like no other law.

The changes this law brings are vast, from payment reform to giving the Attorney General new powers in the health care marketplace. Although 224 does include some benefits for physicians (medical malpractice reform for one), other provisions pose significant challenges, particularly for physicians in small practices. Here are two that raise concern.

Health Information Technology (HIT) One of the biggest challenges presented by Chapter 224 is its embrace of health information technology. Physicians will be required – as a condition of licensure – to demonstrate proficiency in all aspects of health information technology by January 1, 2015.

While MMS supports HIT and recognizes its intent to improve patient care, this provision of the law could severely disrupt medical care. Because the statutory language creating the requirement is tied to Federal standards of “meaningful use” (which in turn is tied to participation in Medicare and Medicaid), it raises concerns that strict interpretation of this provision would lead to denial of license renewals for some 26,000 physicians.  Our state has a high certification rate for meaningful use, with more than 14,000 physicians having met stage 1 requirements, but nearly 40,000 physicians have a Massachusetts license, and most are not included in the population targeted for meaningful use certification.

Additionally, the costs of establishing HIT can be huge. The outlay for such items as implementation, maintenance, software and hardware upgrades, conversion to Federal ICD-10 codes, training, and data conversion could approach well over half a million dollars for some practices while not including the “opportunity loss of income” from decreased productivity.  While the law allows for assistance to providers for HIT, the level of help is unknown, and the financial burden can be crippling to small practices.

The law further requires all providers to implement fully interoperable electronic health records that connect to the statewide health information exchange by January 1, 2017 (a goal not in sight) and imposes penalties for noncompliance. These technologies are not only critical for physicians to practice medicine, but also to participate in quality measurement programs.  The specter of this kind of commitment to HIT, however, with its financial outlay, is certain to make physicians pause and think, especially those close to retirement.

MMS has had lengthy discussions with the Board of Registration in Medicine (responsible for implementing the HIT requirement) and has testified in support of legislation to delay this requirement and provide relief to physicians. Our voice has been heard, and we are hopeful such relief will be forthcoming.

Data Collection and Reporting Chapter 224 is equally enthusiastic about data collection and reporting.  It creates a “provider organization registration program,” requiring organizations to provide detailed information about their operations: costs, financial performance, utilization, total medical expenses, and patient referral practices, among other information.  This data is hard to extract from many EMR systems.

This information will be collected by the Center for Health Information and Analysis (CHIA), a new independent state agency created by 224 that takes over most of the responsibilities of the Division of Health Care Finance and Policy, which was abolished by the law. Physician groups are now required – for the first time – to submit such data. The law contains language focusing on the reporting on risk-bearing groups while exempting smaller groups, but the applicability of this language has not been fully tested yet, so it isn’t clear how reporting requirements will be enforced and upon whom.

On a promising note, CHIA Executive Director Aron Boros told our House of Delegates at the Interim Meeting on December 6 that CHIA’s goal is to gather “reliable and meaningful” information through an “engaged transparent operation.”  He believes his agency must be “transparent, open, and collaborative” to build credibility.

The law also stipulates that by January 1, providers must disclose to patients within two working days of their request, how much a proposed procedure or service costs and what the health plan offers as payment.

I am not optimistic that physicians will be prepared within a month’s time to inform patients about specific or estimated costs for all procedures. We are encouraging legislators and the Health Policy Commission to implement the law incrementally, by considering the most expensive procedures first.

HIT and data collection/reporting requirements are but two areas that Chapter 224 dramatically changes. These changes, coupled with constant concerns over Medicare reimbursements as well as added requirements such as those imposed by ICD-10 codes, continue to strain physician practices.

What policymakers and regulators must keep in mind is that, even in a highly sophisticated medical environment like Massachusetts, no less than 64 percent of our physicians are in practices with fewer than 25 physicians. Policies and regulations that burden these practices and reduce their viability will not only affect the quality of care but will also reduce health care access for Massachusetts residents.

The President’s Podium appears regularly on the MMS Blog, offering Dr. Dunlap’s commentary on a range of issues in health and medicine. For a section by section analysis of Chapter 224, click here.  

 

Annual Education Program: How Technology Is Improving Patient Care

Posted in Electronic health records, Health IT, medical homes on May 10th, 2013 by MMS Communications – Comments Off on Annual Education Program: How Technology Is Improving Patient Care

From electronic health records to medical devices to the latest in research, technology is continuing to push into new frontiers in medicine, and that bodes well for patient care.

In introducing the 2013 Annual Education Program, Navigating the Currents of Change: Integrating Innovative Technologies Into Your Clinical Practice, MMS President Richard Aghababian, M.D. said “Incorporating technology into our approaches to patient care is one of the biggest challenges we face as physicians today. The tools and data we now have at our disposal are truly amazing. But we must balance the machines with the humans side of medicine.”

The educational program on Friday, May 10 included four distinguished clinicians and scientists who addressed concrete examples of how the latest technologies have made advances in the surveillance, diagnosis and management of disease, and how those technologies are being incorporated into patient care.

Dr. Robert L. Jesse, Principal Under Secretary of Health at the Department of Veterans Administration, discussed health information technology and how it affects patient care.

Dr. Marc Semigran, Medical Director of the Massachusetts General Hospital Heart Failure and Cardiac Transplant Program, talked about how technology and the latest medical devices are improving and extending the lives of patients with heart disease.

Dr. Suzanne  Topalian, Professor of Surgery and Oncology at Johns Hopkins School of Medicine, examined how nanotechnology and targeted immunotherapy are making progress in the battle against various forms of cancer.

Dr. John Moore, of MIT’s Media Lab, discussed the application of technology for patient empowerment within the medical home model.

The participants’ presentations, along with their biographical information, are available for viewing here.