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Alistair Jackson 

Meet TransforMED

In our recently published paper, "The Roadmap to Inclusion" (available here for free download, see article #01-A8) we discuss a 5-phase continuum for ECP inclusion in the transformation of health care. We call the third phase, "position your practice for team delivery of care". None explains better what it means to transform your practice culture than TransforMED. 

Why is it important that you get to know and understand the work of TransforMED? Several reasons:

1. TransforMED is a subsidiary of the American Academy of Family Physicians (AAFP), and a trusted leader in Patient-Centered Medical Home (PCMH) transformation. Its mission is the transformation of health care delivery to achieve optimal patient care, professional satisfaction and the success of primary care practices.

2. The Ohio Department of Health has recently selected TransforMED to provide tools and resources to assist in its Patient-Centered Primary Care Initiative. TransforMED will provide medical home facilitation services and resources to accelerate adoption of the PCMH model of care and help practices earn PCMH recognition by the National Committee on Quality Assurance (NCQA).

3. Ohio is one of the seven states/regions selected for the Comprehensive Primary Care Initiative, therefore a visible, observable and instructive example of how primary care will use PCMH transformation to shape the future of health care, including eye care. 

4. Integral to the National Eye Care Communications Project and the CPCI, we believe independent Eye Care Providers must work intentionally to strengthen referral relationships with local Primary Care Physicians, especially those who are pursuing their own practice transformations to the PCMH model.

5. TransforMED is delivering the same message to PCPs practices as we are delivering to ECP practices. Read more here then continue to peruse the TansforMED website. 

To your success!

Alistair Jackson, M.Ed.

Jim Grue, O.D.

The Romney Factor?

There's a new myth circulating: that Romney, if elected, will abolish health care reform. As they say, don't believe everything you hear. The truth of this matter is more than likely quite the opposite. Abolish or accelerate?

The confusion originates with an old failure, the failure to distinguish between health care reform and health insurance reform. Obamacare is about health insurance reforms. Who gets covered and who pays? How? When? You know, the usual menu when it comes to money. That's very different from the basic tenets of health care reform: transparency, portability, interoperability, higher quality at lower cost. These are shared values that players and parties tend to agree on more than they differ.  

As for the money side of the equation, we would naturally expect a Republican president to replace Obamacare with something like "Romneycare", right? Something's going to happen to redefine and rebrand the program. But what will those changes be?

Here's what the American Academy of Family Physicians had to say following last week's presidential debate (see the full statement here):

“Regardless of the election outcome, health care reform will continue. The AAFP calls for reforms that ensure Americans’ access to health care by building the primary care physician workforce, laying a path that enables all Americans to have health care coverage, and improves the quality and lowers the cost of health care services.”

Would you believe that, rather than abolish the reform movement, a new government could expedite it? How so? In reality, it's the federal government that is keeping the pace of change moving as slowly as it is. You've seen the delays: stage 1 certification was released months later than planned, now stage 2 is delayed (until October 2014) far behind the original schedule. The switch to ICD-10 codes has been postponed. By and large, the reasons are good ones, giving time for more public input, allowing room for industries to adapt.

An important pilot project in which the AAFP is deeply integrated - the Comprehensive Primary Care Initiative - involves both private and public payers. CPCI is a 2-year initiative at the behest of CMS. Were it up to the private payers, this project would wrap up in about 6 months.

More or less across the board, private industry would drive change much faster than government agencies permit. Without the political process and federal agencies applying the brakes, reform measures would accelerate not dissipate.

Alistair Jackson, M.Ed.
Jim Grue, O.D.

MU2 and Direct Messaging, Part 2.

Last day, we looked at the clear inclusion of Direct Messaging as a Stage 2 MU requirement that helps you meet the objective for transitions of care. While SMTP is the primary standard being used by the HIEs, we believe that Direct Messaging will be the preferred communications option for independent healthcare providers, including ECPs. 

In the Stage 2 Final Rule we also read that Direct Messaging will be central to Care Coordination and Patient Communications. Again, I am quoting from Dr. John Halamka's bog post, August 23, 2012:

Care Coordination data must be receivable using the Direct protocol and incorporated in structured form.
"(B) Data incorporation. Electronically incorporate the following data expressed according to the specified standard(s): (1) Medications. At a minimum, the version of the standard specified in § 170.207(d)(2); (2) Problems. At a minimum, the version of the standard specified in § 170.207(a)(3); (3) Medication allergies. At a minimum, the version of the standard specified in § 170.207(d)(2)."

Our recent posts on the Comprehensive Primary Care Initiative are all about coordinated care. It is through care coordination that communications rubber meets reform road. As PCPs establish care teams, participating physicians (ECPs) must be able to exchange patient health information. Above we see specified meds, allergies and problems. But there's much more that can also be conveyed through Direct Messaging, and it's this "much more" that stands to set you apart as the ECP of choice for the care teams in which you wish to participate. 

Health Information Exchange with Patients is required using the Direct protocol. EHR technology must provide patients (and their authorized representatives) with an online means to view, download, and transmit to a 3rd party the data specified below. 

If you've been following our blog, you'll have seen us reference Microsoft HealthVault. Your patients (and you personally) can register for a free HealthVault account and a free Direct address. Your CEHRT software needs to allow you to send your patients their Summary of Care Record using Direct. And while this is a requirement for MU Stage 2, it is available from leading EHR vendors today.

Alistair Jackson, M.Ed.

MU2 and Direct Messaging, Part 1.

In today’s and next day’s post, I would like to highlight some of the MU Stage 2 Rules that specifically concern Direct Messaging. To give due credit, the information that follows comes from John Halamka’s blog on August 23, 2012. Dr. Halamka, in turn, is commenting on the MU Stage 2 Final Rule. I’ll be picking out only the Direct Messaging items, so if you want a bigger picture, please use the link provided to go to Halamka’s blog.

SMTP is the required transport standard for all certified EHRs and has been included in the Base EHR definition, meaning that all EHR technology used by EPs, EHs, and CAHs and that meets the CEHRT definition will, at a minimum, be capable of SMTP-based exchange.

The SMTP standard is what mainly interests Health Information Exchanges. It’s not our primary interest today but sets the stage for the emerging importance of “transport”, which we also refer to as exchange or communications. As we have stated in our 5-phase continuum, we move from a stage 1 focus on EHRs to a stage 2 focus on communications.

There are two optional approaches for the transitions of care certification criteria SMTP/XDR and XDR/SOAP. The specific language reads, "The Secretary adopts the following transport standards: (a) Standard. ONC Applicability Statement for Secure Health Transport (incorporated by reference in § 170.299).
(b) Standard. ONC XDR and XDM for Direct Messaging Specification (incorporated by reference in § 170.299). (c) Standard. ONC Transport and Security Specification (incorporated by reference in § 170.299).

Today, I want to focus on (b) ONC XDR and XDM for Direct Messaging Specification. Note in the following that the ONC is providing “flexibility and options” for software vendors to help you meet the “transitions of care” MU objective. We believe this is particularly significant for independent eye care providers who need to be able to communicate both within and without health care systems. HIEs that primarily serve the interests of large health systems will neither favor nor facilitate the independent ECP. Therefore, Direct Messaging will become your friend and alibi.

To permit additional flexibility and options for EHR technology developers to provide their customers with EHR technology that has been certified to support an EP, EH, or CAH’s achievement of the “transitions of care” MU objective and associated measure, we have adopted two optional certification approaches for transport standards.     • The first option would permit EHR technology to be certified as being in compliance with our original proposal: certification to both the Applicability Statement for Secure Health Transport specification and the XDR and XDM for Direct Messaging specification.
     • The second option would permit EHR technology to be certified to: the Simple Object Access Protocol (SOAP)-Based Secure Transport Requirements Traceability Matrix (RTM) version 1.0 standard and the XDR and XDM for Direct Messaging specification."

Join me next day to read more about the applicability of Direct Messaging to two vital areas: care coordination and patient communications.

Alistair Jackson, M.Ed.

Stage 1 Cornerstones to Stage 2 Communications

Today's post is simply a pointer to a worthwhile reminder well said. Read Mike Jenkins, "MU stage 1 is the cornerstone of a much larger change". 

Here's the short version:

Meaningful Use stage one is not about direct savings.  Instead, this is building the stage for real reform down the road. ...

The HITECH Act and Meaningful Use stage one are about moving a lot of physicians from paper to online.  The goal here isn’t to realize an immediate improvement in outcomes, but to lay the foundation for these improvements.  Stage two is released and, guess what, it builds the walls.  Meaningful Use stage two is about moving this data out of the physicians’ offices and hospitals and making it available electronically to patients who can then transport it to other physicians and hospitals in a format that can be readily consumed.  

With such a plethora of information on the healthcare changes that we naturally want to resist anyway, it's easy to get shortsighted and myopic. One of our goals is to help you keep your eye on the big picture, moving forward knowing that you can reach the goal line way ahead of the pack. We help forward-thinking eye doctors win in the new healthcare game.

Alistair Jackson

So you wanted EHRs on your mobile device?

In our work with forward-thinking eye doctors, we commonly encounter questions like:

• Does your software run on the iPad?
• Can I use a tablet PC?
• Is e-prescribing connectivity available for my PDA?

While these are valid questions, they are often driven by a consumer mindset or perhaps by applications within healthcare that are more simplistic than what we encounter in the full scope of eye care. We've all seen the ads on TV about sending everything to the cloud and, of course, how dead simple it is to record all necessary health information on a tiny handheld device.

This week, we received a chilling reminder of the flip side of that magic and convenience: breach of ePHI through mobile devices. (See a link to the full story below.) 

"The Massachusetts Eye and Ear Infirmary and Massachusetts Eye and Ear Associates Inc. (MEEI), will pay $1.5 million to the Department of Health and Human Services (HHS) for potential violations of the HIPAA Security Rule."

In the event ePHI is a new acronym, it means "electronic Protected Health Information". As we've discussed in recent posts, EHRs are doing a great job of helping us document patient health information, and the next step is to start communicating it among health care providers. Unfortunately, as acronyms go, it's easy to miss the fact that the P in PHI means "Protected" not simply "patient".

How well do you protect health information? Does your statement of HIPAA practices extend past that patient consent signature? Do your office computers have automatic log-offs? Are your mobile devices password protected? Do staff members use Instant Messenger for in-office or personal communications while at work?

At EMRlogic, since we have access to ePHI, we are held to the highest standards of accountability. Conducting annual HIPAA-HITECH security assessments and all-staff security awareness training is an expensive undertaking, one that can easily be allowed to slide. But oh what an economy relative to an ePHI violation, even a potential one!

How about your own business? Are you in good shape or running an uncalculated risk? Chances are high that you haven't gone far enough with the way you protect health information. May I humbly suggest you click here, read the full story on MEEI, think it through and, as they say, "if the shoe fits, wear it." Take steps this week to protect yourself as well as your patients.

Alistair Jackson, M.Ed.