Beyond EHRs - Phase 4

Today's post focuses on the fourth of a 5-phase continuum. If you're joining the discussion today for the first time, please refer back to our July 20th post for the big-picture overview.

Assuming you're working through the phases of the "beyond EHRs" continuum, you've implemented a certified and Direct-enabled EHR, you have tested Direct communications with other Direct-enabled colleagues and perhaps exchanged CCDs with one of your local Primary Care Physicians who is also Direct-enabled. In so doing, you have been preparing for and participating in the team delivery of care for some of your patients. 


Phase 4, Get accepted and involved in coordinated care moves us from the technology of team-based care to the practice thereof. As we saw in phase 1, certified EHR technology is really just a precursor to something bigger. So we need the technology of communications first. That's the Direct standard. It's a national standard and, very importantly for independent providers, it gives direct access both to other providers and to state Health Information Exchanges. All state-based HIEs are required to offer the Direct standard.


Now the relational piece. Getting accepted into a local ACO or a local PCP's coordinated care team is all about your value-added professional relationship. It's an application process. You must be qualified, professionally and technologically. You'll need to add value. Your competent use of the right EHRs, for example with advanced Clinical Decision Support, will aid greatly. And you'll need to be liked and valued as a colleague. After all, you'll work on a team for years to come with all the other team doctors.


One of the examples we've used in the case of the CPC Initiative (see earlier posts) is of helping your referral PCP understand the benefits of the Direct standard. Many are oblivious to it because they're affiliated with large health system that primarily use a closed HIE. If you can help the PCP communicate - send and receive CCDs for your shared patients - you truly add value. That value is what will make the PCP want you as part of her or his care team.

Last point for today: navigating the tides of change in healthcare is not easy. Nothing in itself is particularly hard; it's knowing what to do, what not to do, where to turn. The NECC Project is designed for you to navigate these waters in the company of your colleagues. We offer free and open webinars every 2nd and 4th Tuesday of the month. Join our LinkedIN group, National Eye Care Communications Project, to get the details.

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

Beyond EHRs - Phase 3

Today's post focuses on the third of a 5-phase continuum. If you're joining the discussion today for the first time, please refer back to our July 20th post for the big-picture overview.

Phase 3 of the "beyond EHRs" continuum is prepare for team delivery of care. Team delivery of care is being piloted all across the country. For some time now, we have been seeing and hearing of shared savings programs and accountable care organizations. Those programs and entities may have led us to believe team-based care is primarily for hospitals where we perceive that team care is the norm. 


Let's pause there for a moment and consider an important change management principle found throughout health care reform: change will be pilot tested in select environments then applied system wide. This means that in due course, sooner than you may think, team delivery will affect your business. Another truism readily observed: pilot programs will be financially incentivized to create momentum but in the end health care reform will drive "higher quality lower cost". Get involved in pilot projects!


A recent pilot project that is quickly and decisively changing anyone's view that team-based care delivery may only be for hospitals and health systems is the Comprehensive Primary Care Initiative, from CMS Innovations. Effectively, the CPC Initiative is moving patient-centered medical homes into the offices of Primary Care Physicians. Once again, this is a project we are following closely as part of our National Eye Care Communications Project. If you haven't already done so, read our post from June 13. It touches more thoroughly on this initiative.


Our big takeaway here is one word: prepare. As your colleague Dr. David Chandler said in his July 16 commentary, "...We've had our heads buried in the sand too long already." The profession is forcibly in a reactive mode. Without forethought and preparation, independent ECPs will lose out on many opportunities to be involved in team delivery of care. We've said it before, teams want eye care participation. That's not the problem. The question is whether the ECPs will be private practice or employed doctors. 


Prepare your business for team delivery of care!

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

Beyond EHRs - Phase 2

Today's post focuses on the second of a 5-phase continuum. If you're joining the discussion today for the first time, please refer back to our July 20th post for the big-picture overview.

Phase 2 of the "beyond EHRs" continuum, use your EHR to communicate electronically, is where we first step outside our new EHRs. It's highly probable that you went into EHRs thinking, "I'm only doing this because I have to." And if you loved your paper charts you may have asked yourself , "Why can't I keep using my records as they are? They're perfectly legible. I know where everything is. I don't lose files." Unfortunately, that rationale reflects a provider-centric model of healthcare, a model that has failed financially and technologically.

The reason the government mandated Electronic Health Records was not so you'd have neater files or a computer versus a wall of charts. Electronic records are the precursor to electronic sharing. So, let's say you've got your EHRs, you've attested to Meaningful Use and been paid already for Year 1. You're feeling good about your progress ... and so you should. But you're thinking you're just about there. "I just need to keep doing what I'm doing. A few more years, I'll have my $44K. All good."

Well, there's more. It's never really been about the stimulus money. That's just an incentive, a catalyst for change. What it's really all about - and always has been - is ushering in a different way altogether of doing healthcare. As individual providers, we can't get the whole picture for any patient. We have to work in teams. We have to share information, insights, opinions. Each member of a team must contribute expertise such that the whole is greater than the sum of the parts. That's what drives better patient outcomes.

So, your task in "beyond EHRs - phase 2" is to start communicating electronically with other providers. Your local Primary Care Physicians need to be your top priority. Sharing CCDs (or Summary of Care Records) is the mandate. That's what the Direct Project and the DIRECT standard are all about. And our National Eye Care Communications Project is all about helping you accomplish this step. If your EHRs are Direct-enabled, these communications are not difficult. However, there's a considerable maze to get through even to know where to begin. Join us in this project. We're here to help.

Alistair Jackson, M.Ed.

Jim Grue, O.D.

Beyond EHRs - Phase 1

Today's post focuses on the first of a 5-phase continuum. If you're joining the discussion today for the first time, please refer back to our July 20th post for the big-picture overview.


The "beyond EHRs" continuum begins naturally with selecting and utilizing a certified EHR. Sounds straight-forward enough, right? Well, that's probably not what anyone would tell you who has been through the process.


Lessons from the trenches:
1. Think different. Steve Jobs said that, and it's true for you as well. Selecting modern EHRs is not business-as-usual. If you go about selecting your EHR based on your current grid, mindset or business model, you are more likely to choose poorly than well. 
2. Begin with the end in mind. That end constitutes a whole new way of practising eye care, a patient-centered way, a team-based coordinated-care way and a way that aims at best-practice outcomes using Clinical Decision Support tools built into the software.
3. "But I thought ..." Rid yourself of the assumption that any certified EHR will do. Yes, it would appear that certification brought everyone onto a level playing field. Perhaps so in the sense that there are common certification criteria. But, just as you still want to know why you should buy one versus the other, one is still a superior choice over others. (We came across an excellent example of this at the ONC Summit. All vendors were required to have a functional CCD. So most created a viewable CCD. We were set apart as the only ones able to demonstrate a consumable CCD. Most met the letter of the law; we met the spirit of the law.)
4. Put features in their place. If you consider the five phases of the continuum we're discussing here, you won't see an EHR feature list. Instead you'll see new business requirements. So look beyond software features and assess on the basis of how the solution will help you adapt to a whole new way of thriving in reformed health care. In the long view, platform is more important than features. Like you, software must adapt to survive. 
5. Think national. We've been used to practising on our own "eye care island" and not being much affected by what's happening elsewhere in healthcare. Most of the country, for example, is live on the Direct communications standard. That should tell you something significant.
6. With or without the money. If you're able to go after stimulus money, great. Go for it. But if you're not, remember health care is transforming anyway. Your Medicare volume really has nothing to do with communications for example, the step we'll be discussing next.


Disclosure: We, Jim Grue and Alistair Jackson, represent an EHR product, activEHR by EMRlogic. Our purpose in this blog is not to promote or sell activEHR rather to inform and educate eye care providers about the EHR marketplace and the bigger-picture implications and requirements to succeed as healthcare and eyecare transform.


Blog comments: Dr. David Chandler of Jacksonville, AL added a worthwhile commentary to our July 16 post. We encourage you to go back and read the Comments and Reactions link at the bottom of the post, and to respond further. EMRlogic Live becomes truly LIVE when you join the conversation.


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

Beyond EHRs

With the Supreme Court decision on the health care law, news of ONC's Permanent Certification Program and the onset of Stage 2 Certification, there's still plenty of buzz around EHRs. Many ECPs are now, at last, acceding that they better get going on EHRs and have joined the search. That's great. 


Whether you have or are looking for EHRs, the real reason for them is beyond EHRs. 


Here's a five phase continuum we need not only to understand but to be engaged in pursuing right now:

1. Select and utilize a certified EHR
2. Use your EHR to communicate electronically
3. Prepare for team delivery of care
4. Get accepted and involved in coordinated care
5. Get paid through a bundled payment system

Over the coming series of posts, we're going to unpack these five phases. What do they mean? What are the details? Why are they important? Why, in particular, are we saying they're important today, that you should be pursuing them right now? What's the big rush?

I hope you'll join us for this important dialog. And, as always, you are welcome to join an ongoing discussion with your colleagues through the National Eye Care Communications Project. You can also find a group by the same name on LinkedIN. The above continuum is what they Project is all about. We're not simply talking about it, we're doing it.

Alistair Jackson, M.Ed.

Jim Grue, O.D.

Is Reform Predictable?

It's good to be back after an early-July recess. Prior to it, the big news was the Supreme Court ruling in favor of the health reform bill. Since we began writing about the transformation of health care in 2007, there have been detractors who claimed reform was not important, nobody cared, that it would all go away or that no one could know how it would unfold anyway ... "no one has a crystal ball". At last, it seems, we've put to rest the notion that it would all go away. And hopefully we agree by now that reform is important, even for eye care and beyond the Medicare fence.


The question remains though, is health care reform predictable? If we can go back 5 years and see predictability, is that helpful while we consider the next five? Or even the next two or three? Our answer, of course, is a resounding "Yes!"


In our original white paper, Medicare Pay-for-Performance & Value-Driven Health Care published June 2007, we explained the basic tenets of health care reform. It's still a good read today (in our humble opinion!) and gratifying to see very little we would change, nothing that was "way off in left field" or that proved to be wrong.


So what? Why is that important now? Well because we're still making statements about where this is all going. Are our assertions trustworthy? We think they are.

• 2011, the year of the EHR. EHRs were only the beginning.
• 2012, the year of the HIE. It's time to move beyond EHRs to sharing health information, paying particular attention to the DIRECT standard.
• Exchanging health information sets the stage for team delivery of care and care coordination.
• Coordinated care means bundled payments, marking the obsolescence of fee-for-service reimbursement. 
• You cannot qualify for the new models of reimbursement if you're not playing the new game by the new rules.
• Coordinated care pilot projects all around us are the open doors through which we must go individually and as a profession.

Alistair Jackson, M.Ed.

Jim Grue, O.D.

Taking a break!

Thank you for following EMRlogic Live. Early July is a popular vacation period, and we like it too!  We'll be taking a break and look forward to being back online soon. We encourage you, in the meantime, to read our Archives for posts you've missed. May we suggest you select a Category to the right side and read up on one of the topics you find most interesting and relevant for your business. 


Having just completed a series of posts on the National Eye Care Communications Project, we also encourage you to find out more about it through our website. See ABOUT/Thought Leadership or click here to be re-directed.

The title “National Eye Care Communications Project” is linked to a Screencast folder where you’ll find recorded webinars, PowerPoint presentations and PDF documents that you can view and download. 

When visiting the Screencast folder for the first time, you’ll note that the default view is the “Tile View”. We recommend that you switch to the “Details View”.  

See the top right corner and simply select the Details View. This will change your view permanently.

Lastly, join us on LinkedIN. We’ve created an open Group, not surprisingly called National Eye Care Communications Project

Thank you again for your interest and participation. 

Alistair Jackson, M.Ed.

Jim Grue, O.D.

Eye Care Communications, Part 4

Continued from Part 3 ... 


Last week, we looked at EMRlogic's National Eye Care Communications Project, understanding what this project is and why we need it. We began by looking at it through the eyes of a new and very important pilot project, the Comprehensive Primary Care (CPC) Initiative. We discussed the importance of pilot projects and of ECP involvement in them. We looked again at the big picture: primary care and the Medical Home model. Today, we conclude with the role that the NECC Project plays in helping you transform the culture of your practice.

Practice Transformation

An important term used on the CMS Innovation website is “practice transformation”. For example, from page 13 of the participant solicitation guide for the CPC Initiative (italics ours), 

“The Innovation Center is working with national experts in practice transformation and primary care to develop resources and activities to support the CPC Initiative practices in achieving the aims of the program … Just as importantly, the market-based learning communities will help practices to set up a routine schedule of testing and implementation of changes to support the fundamental transformation required for comprehensive primary care.”

Another significant aspect of the NECC project is to assist local eye care providers in the process of the culture change – practice transformation – required to be a participant in a team delivery system, as compared to thinking the way we have traditionally thought as independent private practitioners under a fee-for-service system.  Providers in any area of medicine who have participated in structured team delivery understand that team-based care is a “culture change” that requires a redefining of your role as a health care provider.  This paradigm shift is not done overnight; it takes time and effort.  

The collaboration mechanism of NECC Project allows providers to discuss issues, share ideas, brain storm, test concepts and work through this process with like-minded providers doing the same. One of the values of this collaborative process is creating a portfolio for each provider that answers the question, “what do I bring to a team?”  Traditional issues such as doing a great exam, having all the right equipment, and writing a letter to the primary care physician on every diabetic patient are just givens on a chronic care team. You are not going to get on a team if you don’t do and have those things. What teams are looking for is providers who understand what it means to share the responsibility that every patient gets the best possible outcomes. That goal is achieved only by utilizing every resource from every provider on the team with a process in place to drive continuous improvement.  This fascinating process opens many doors for independent eye care providers. It offers whole new levels of capability to a local team, capabilities the team doesn’t know exist unless you show them. The NECC Project will help you embrace those concepts and capabilities and see the new possibilities emerging with these new delivery systems.

In summary, just as your state and national associations are working diligently to make sure eye care is involved in the new delivery and reimbursement models, the NECC Project asserts that you need to be equally diligent in your local community. Position and prepare your practice, be involved in shaping the delivery system as it emerges in your local community.  Additionally, the NECC Project strongly encourages all participants to stay in close communications with your state association. It is important for them to know what you are doing and finding locally, and important for you to know what they are doing on your behalf at the state level.


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