Pharma looks to mobile strategies to effectively reach prescribers

Sanjay Pingle, President of Skyscape and Physicians Interactive Holdings

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It is well documented that the pharma industry is facing many challenges in 2012. Drug makers are losing exclusive patents on drugs that have matured, causing unexpected losses of revenue in the billions of dollars. As a result, companies are cutting costs and significantly reducing their sales force – which in turn creates the new challenge of reaching practices and hospitals with fewer face-to-face office visits.

In the last five years, the size of the sales rep force has shrunk by nearly 30 percent, according to FiercePharma.com. In 2012, Novartis announced it was reducing its U.S. staff by nearly 2,000, including 1,630 sales reps – approximately 1.6 percent of its worldwide staff. This trend of reducing pharma sales forces also reflects impatience among prescribers with the hard sell from sales reps and tighter governmental regulations on what salespeople can convey to the healthcare professionals (HCPs) they’re trying to educate and inform.

Successful companies are those that will transition effectively from being primarily sales-driven to service-driven using a multi-channel marketing approach to reaching physicians and other prescribers. A key focus is providing services that fit into providers’ increasingly busy daily workflow: At point of care, when they’re making diagnosis and treatment decisions and when they’re prescribing medications for their patients.

Companies on the forward edge are putting a heavy emphasis on digital in their commercial models — but how can mobile technologies assist pharmaceutical and biotech firms in this transition?

Here are a few examples:

Tablets to support the sales force – While sales forces are shrinking, they still play a vital role in educating prescribers on new medications. The pharma industry, taking the lead of companies like GSK, is starting to incent sales reps based on quality of service versus amount of sales (read more here in the WSJ). One of the tools that is helping deliver better service is the tablet. Reps with an iPad can deliver more interactive and engaging product information, capture signatures for compliance and make the most of a few quick minutes with a doctor in the time it would take a laptop to boot up.

Online and mobile drug sampling programs – Companies now have the ability to leverage PDMA-compliant mobile apps and websites that allow physicians to request free product samples that they can distribute to their patients to gauge efficacy and assist with adherence. Because the Internet never sleeps, physicians can do this no matter what shifts they are working, independent of time zone or location, 24 hours a day.

Direct-to-HCP mobile advertising – It used to be that most online and mobile advertisements for drugs were placed only in industry magazines, blogs and online communities geared toward healthcare professionals and general consumer websites. We see this changing, with emergence of mobile networks focused on healthcare such as Tomorrow Networks, which is comprised of more than 50 medical apps. Pharma companies can now buy ad placements in mobile apps made exclusively for physicians and other healthcare professionals. A physician can be looking up treatment information at the point of care and see an ad for a medication that is relevant to their patient’s ailment. That’s incredibly powerful for the physician and advantageous for the advertiser.

mDetails – Physicians want to learn about the best drugs and treatments for their patients. mDetails are multimedia mobile product presentations that provide information about drugs in a way that allows physicians to absorb detailed information at their own pace — and in their own time. Because mDetails are distributed on smartphones – it lets physicians fit pharma product education into ‘found time’ at any point during their day that’s convenient for them.

By employing a multi-channel approach and by helping healthcare professionals do their jobs better instead of just selling to them, pharmaceutical companies can reach their target audiences and develop deeper value-based relationships. The aforementioned examples are just a few of the ways that pharmaceutical companies can leverage the ever-growing mobile channel; there are many more evolving every day.

What other strategies are you seeing pharma companies adopt in order to reach time-strapped physicians?

Sanjay Pingle is president of Skyscape and Physicians Interactive and has oversight of the combined pharma and eCommerce business. Prior to joining PI, he was co-founder and executive vice president of Medsite, the biotechnology and pharmaceutical marketing firm named a market leader by Forrester, Jupiter Research and Frost & Sullivan.

ICD-10 Inches Closer to Delay, ICD-11 in the Wings

By Tom Sullivan, Government Health IT

WASHINGTON – The case for leapfrogging ICD-10 and holding out for ICD-11 just got a lot more curious. And though it’s not here yet, when ICD-11 is ready, it will be something ICD-10 cannot be: A 21st Century classification system.

Now that HHS Secretary Kathleen Sebelius has thrown her department’s hat in the ring, saying late Wednesday that HHS intends to delay ICD-10, the most pertinent question is how long will HHS push back compliance?

“My opinion is that CMS won’t be able to announce three months or six months of delay for ICD-10,” says Mike Arrigo, CEO of consultancy No World Borders (pictured above). “They will need to announce a delay from Oct. 1, 2013 to at least Oct. 1, 2014 because of CMS fiscal planning calendars.”

Others in the industry are suggesting that even one year is not enough to lighten the burden on physicians, providers and payers to make the transition smoother.

“I have a gut feeling they’ll go for two years, who knows?” speculates Steve Sisko, an analyst and technology consultant focused on payers and ICD-10. “Maybe January 2015?”

No more mixed signals
There it is on the Department of Health and Human Services Web site, a crystal-clear headline atop a brief explanatory statement: HHS announces intent to delay ICD-10 compliance deadline.

“We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead,” Sebelius said in the statement. “We are committing to work through the rulemaking process, with the provider community, to reexamine the pace at which HHS and the nation implement these important improvements to our healthcare system.”

Whereas acting CMS administrator Marilynn Tavenner was perhaps politically vague when speaking at an AMA meeting on Tuesday by saying that CMS would reexamine the timing of ICD-10 compliance, Sebelius’ statement was careful to erase any doubt about HHS’s plans.

“HHS will announce a new compliance date in forthcoming rulemaking,” the statement explains.

Neither Tavenner nor Sebelius clearly outlined “the rulemaking process” to which each referred. But any kind of rulemaking by the federal government tends to take a while, and there’s no reason to suggest that this instance will differ.

A formal process could take as long as a year, while the informal, conducted through the Federal Register, typically calls for a 180-day response period, after which the comments are taken into consideration to shape a new proposed rule. That, in turn, must be evaluated, eating up more clicks of the clock.

“The fact that [Tavenner] mentioned going through a rulemaking process implies to us that this will take a long time,” Wendy Whittington, MD, CMO of Anthelio Healthcare Solutions, said. “A short delay would be much more tolerable than a long one.”

If HHS has a tack for fast-tracking the rulemaking process for ICD-10, thus far it has not explained that. But if the agency intends only to change the compliance deadline then perhaps there is a way to abridge that cycle.

A time to question the value of ICD-10
Prior to the HHS statement, the AMA praised and AHIMA panned Tavenner’s commitment to reexamine the timing.

In an increasingly heated industry-association Civil War, both groups have fired shots, with the AMA calling on Sebelius and House Speaker John Boehner to block ICD-10 entirely, and AHIMA urging the industry to continue apace toward the new code sets.

Any delay, according to Dan Rode, AHIMA vice president of advocacy and policy, would increase costs while diminishing the value of ICD-10 and other health IT projects, including, of course, meaningful use.

HHS acknowledged the need for ICD-10. “ICD-10 codes are important to many positive improvements in our healthcare system,” says Sebelius.

Anthelio’s Whittington agreed, adding that “pushing the deadline back one year means that we can’t complete all aspects of healthcare reform. Information the government needs to collect to provide effective research on what works and what doesn’t is tied to the more specific information gathered by the ICD-10 codes. Folks who haven’t read ICD-10 don’t understand the benefits of the more detailed coding.”

Not everyone buys that the U.S. even needs ICD-10 codes, though. The argument against: Cost in education, systems remediation, time and training won’t yield better data for analysis and outcomes because resource-crunched U.S. providers will take a band-aid approach, employing crosswalks, GEMs, step-up/step-down approaches rather than moving to ICD-10 exclusively. And the unfunded mandate promises little in the way of ROI to those who implement the new code sets.

Getting to a pure ICD-10 environment could take years. And while proponents maintain that the U.S. needs to catch up to other developed countries that adopted ICD-10 years ago, therein hides ICD-10’s great flaw: Other countries adopted it decades ago – it’s old and showing its age.

Furthermore, much of the rest of the world doesn’t even use ICD-10 for reimbursement in the inpatient and acute-care setting, as No World Borders’ Arrigo explains. As a one-payment system Canada, for instance, only uses ICD-10 codes for hospital services, so their total number of codes is smaller than the U.S., adds Deb Grider, senior manager of revenue cycle at consultancy Blue and Co (pictured at right).

“We have multi-payment systems,” Grider says. “We code for professional services, we code for radiology services, all different kinds of healthcare services that providers deliver.”

An even starker reality is that while ICD-9 was essentially completed in the early 1970’s it was created in accordance with theories of health and technology from the 1960’s and, likewise, the WHO finished ICD-10 in 1990 so it represents mid-1980’s thinking.

“We’re moving up 20 years, which is an improvement, but we’re still not in 21st Century thinking as far as an underpinning of ICD-10,” says Chris Chute, MD, who spearheads the Mayo Clinic’s bioinformatics division and chairs the WHO’s ICD-11 Revision Steering Group.

What’s more, Chute participated in what he considers “a fairly objective comparison of the functionality of ICD-10 versus ICD-9. And we’re not getting a lot for our money. I don’t know how to say it more directly than that,” he explains. “The functional improvements in terms of representing patient data in a comparable and consistent way is not dramatically increased in ICD-10; in fact it’s almost negligibly increased.”

That, despite the fact that the original cost estimates for converting to ICD-10 were off by an order of magnitude, Chute adds, and not in a manner favorable to those physicians, providers, and payers upon whose back the burden of ICD-10 strains like many mythological enduring Atlas’s.

ICD-11: What is it?
If a bullet-proof technical reason that the U.S. could not simply leapfrog ICD-10 and adopt ICD-11 in its stead actually exists, then more than two years of asking just about everyone has yet to uncover it.

Political reasons are bountiful and powerful, to be certain. Spanning the gamut from potential lawsuits by providers who have spent millions already on the conversion being that it is, after all, a law to those who argue that charting a new course now would be more costly, more chaotic than seeing ICD-10 through – even though there is an existing argument that the conversion will be for naught. Add to that list that enormous undertaking of clinically modifying ICD-10 for the U.S.

“To change at this point, given that we are a year and a few months away from the magical transition date, would be, I submit, vastly more disruptive than just staying the course at this point,” Chute explains, hastening to add that he is not a proponent of ICD-10, but that “ICD-11 is not ready for prime time.”

Not yet, but 2015 is where the forthcoming new ICD-10 compliance deadline and ICD-11 might just intersect.

Should the U.S. delay the ICD-10 compliance deadline just one year, until 2014, then the WHO will have a beta of ICD-11 ready. And if Sisko’s gut is correct, and the new ICD-10 deadline flows into 2015, well, then a final version of ICD-11 will be fast-approaching.

When it arrives, currently slated for 2015 (but Chute said it could be 2016), the underlying structure of ICD-11 will be profoundly different than any anterior ICD.

[See also: ICD-10's Ten-year reign of fear.]

“ICD-11 will be significantly more sophisticated, both from a computer science perspective and from a medical content and description perspective,” Chute explains. “Each rubric in ICD-11 will have a fairly rich information space and metadata around it. It will have an English language definition, it will have logical linkages with attributes to SNOMED, it will have applicable genomic information and underpinnings linked to HUGO, human genome standard representations.”

ICD-10, as a point of contrast, provides a title, a string, a number, inclusion terms and an index. No definitions. No linkages because it was created before the Internet, let alone the semantic web. No rich information space.

Has anyone even considered ICD-11?
Perhaps the most problematic reality the nascent ICD-11 faces today is that because the U.S. government mandated ICD-10 before anything was known about ICD-11, it ostensibly appears that the people thinking about ICD-11 are limited to the WHO’s ICD-11 Revision Steering Committee.

As Blue and Co.’s Grider tells it, most of her hospital clients are trying to kickstart the ICD-10 implementation and not even looking ahead to subsequent coding changes.

And who can blame them? Even the AMA, in all its vehement opposition to ICD-10, would not touch the subject of ICD-11 when asked. “AMA policy does not address ICD-11,” a spokesperson says. “The AMA would not be in a position to comment on ICD-11 until we work with others on a required assessment.”

The AMA, just like all payers, providers, vendors, everyone else in healthcare today, has more than ICD-10 to contend with.

“I guess my question is: Has HHS looked at ICD-11?” Grider wonders. “I am just guessing but I would say no. With healthcare reform, meaningful use and now ICD-10 everybody is spread very thin. And I can see that when I go into the hospitals, into the medical practices to help them with the ICD-10 transition and see their condition. Everybody is trying to continue business as usual while doing this and that’s been a real challenge. And I know the government is spread thin with all the regulations and everything they’re trying to do, so I wonder if they’re even thinking about it.”

Perhaps all are but no one has publicly championed ICD-11 as an ICD-10 alternative. Not even Chute of the WHO ICD-11 Revision Steering Committee. But this week’s announcement that ICD-10 will be pushed back again holds at least a nugget of potential that the horizon is broadening to include two ICD options, if not simultaneously, than certainly in rapid succession.

Now that the industry has more time for ICD-10, perhaps it would be wisely-used considering the more modern, more useful ICD-11, either instead of ICD-10 or at the very least to plan two steps ahead.

Because that old saying about the dictionary – that its essentially obsolete by the time it gets printed – just might apply to ICD-10 as well.

5 Ways Pharma Can Mitigate Compliance Risks When Using Social Media

We are all familiar with the old saying, “the best offense is a good defense.”When it comes to highly regulated industries such as pharma getting involved with social media, having a well-prepared defensive plan in place at the outset is critical to risk management. With the recent publishing of the FDA draft guidelines addressing unsolicited requests for off-label information about prescription drugs and medical devices, pharmaceutical companies are in an excellent position to expand their social media programs into engagement. Still, with the draft nature of the guidelines, risk management is critical.

While there has been some mixed reaction to the draft guidelines, the FDA is giving a clear show of confidence in pharma companies, stating, “FDA recognizes that firms are capable of responding to requests about their own named products in a truthful, non-misleading, and accurate manner.” In fact they take this a step further to say it makes sense for pharma to be engaging,

“…because firms usually have robust and current information about their products, it can be in the best interest of public health for a firm to respond to unsolicited requests for information about off-label uses of the firm’s products that are made in public forums, especially since other responders may not provide or have access to the most accurate and up-to-date medical product information.”

With all of that positive messaging, what are the key points affecting how pharma companies interact with the public? The FDA advises that pharmaceutical companies may give out information about off-label uses to patients, but only if the question was not solicited through marketing materials or advertising, for example. Additionally pharma companies are cleared to respond to public questions about off-label uses they get on social media sites such as Facebook, Twitter or forums, but the response must be private communication and shouldn’t come from sales or marketing personnel.

Okay, so that sounds fairly straightforward. Now, how do you help mitigate risk exposure when you venture into a more active and engaged social media program? The key is to establish clear guidelines for everyone participating, centralize your efforts and intercompany communications around social and create an audit trail by tracking everything. Let’s take a closer look at the five ways pharma can mitigate risk when using social media:

1. Establish a social media policy and keep employees informed. Of course the most important starting place for any company, in a regulated industry or not—whether they are currently participating in social media or just watching from the sidelines—is to have a social media policy in place and make sure employees and appropriate vendors are trained on it. Even if your company isn’t social, your employees probably are.

Your policy, which should be documented, should be specific as to who has the authority to speak on the company’s behalf on social networks and the consequences that exist if any of these rules are broken. If expectations and processes are not clearly outlined and regularly communicated internally, well-meaning or disgruntled personnel can be one of your greatest liabilities. Policy templates and examples are available here if you need examples to help you get started.

2. Centralize your program with a social media monitoring and engagement platform. Running a social media program requires the means to effectively collect, organize and manage large volumes of social media content to make sense of it, report on it, find insights in it and react where appropriate. Sure you can use Google Alerts to get an idea if people are talking about your brand and some conversational themes. But if you are tying metrics and accountability to your program, you’ll need a professional platform designed to do the job.

Working with an enterprise-ready social media platform will no doubt make your job easier. However when it comes to risk management, centralizing all of your social activities becomes more than a convenience, it becomes a requirement. Managing risk requires the functionality to see your entire social media ecosystem in one place while enabling staff in all departments to operate and communicate within the same “sandbox” keeping everyone on the same page. This minimizes duplicate efforts, faux pas such as multiple responses being to the same consumer and missed opportunities when the right hand doesn’t know what the left is doing. Here is an analyst report by Gleanster that can provide some guidance to choosing the right one for you.

3. Be proactive with Adverse Event tracking and reporting. Pharma companies are used to reporting them and thanks to recent Adverse Event (AE) reporting rate research, companies are breathing a little easier with their social media programs knowing that on average, only 0.3% of brand mention posts contain an AE. While FDA guidelines do not require companies to seek out AEs, brands are starting to proactively monitor for them building goodwill in the process, creating risk-deflecting records and doing their due diligence to keep the health and interests of the consumers they aim to help a priority.

4. Establish a workflow with built-in checkpoints. Your social media policy should outline both the expectations for employees but also the basic workflow and escalation path for reporting social media content they feel needs a response. For those employees who are actively working with social content, your brand and company Facebook pages, Twitter handles and other profiles, building in checkpoints to approve content can be invaluable.

For example consider putting controls in place to automatically review any outbound content for policy violations. Having a process like this ensures that communication can still be published in a timely manner without exposing the company to unnecessary risk. Social media monitoring and engagement platforms designed for enterprises will let you to do this even customizing it to your own situation. Look for one that allows you to have multiple users work with your social accounts, if you need, without exposing your password credentials to anyone but an administrator as well as reporting on user activities.

5. Create audit trails for activities and users. Any company facing regulatory controls can face an audit at any moment. Your social media policy should take this into consideration and include implementing technology that archives all content and activity in a way that can quickly and adequately prepare you for an unexpected call from the auditors. Knowing your ducks are in a row and you are continuing to do your best to meet and exceed all regulatory guidelines should enable you and your executives to sleep a little better at night.

What other steps do you feel help protect pharma companies from compliance risk in social media?

Could Legislative Change Improve e-Prescribing and Simplify ‘Prior Authorization’?

One of the primary benefits behind implementing electronic medical records is the way EMR systems make the healthcare industry more efficient. That includes office workflow, treatment, diagnosis, scheduling, billing and even prescriptions.

The widespread initiative to improve EMR use comes at the perfect time where many physicians and hospital administrators are pushing to reduce overhead and cut budgets. One of the best ways to reduce costs throughout the health care industry comes in the additional feature of e-prescribing available with electronic medical records.

Insurance Tug of War

For years, physicians have had to deal with prior authorization on medications, essentially forcing clinics and physicians to go through the lengthy process of getting authorization for a treatment or medication before it can be given to the patient and billed. When you consider that the healthcare industry is already weighed down with paper charting and never-ending “to-do” lists, ‘prior authorization’ adds time wasting requirements to already over-burdened schedules.

When you consider there are more than three billion prescriptions written in the United States each year, it’s obvious why we need a more efficient system. Electronic medical records fitted with e-prescribing functionality not only reduce errors due to illegible handwriting, but the checks and balances built in to the software greatly reduce the likelihood of a harmful drug interaction.

Time is one of the most important factors with prior authorization. Some patients have to wait days for approval while they go without a critical medication. If authorization is denied, the appeal process can take weeks (even months).

Electronic prescribing with EMR systems opens new doors that can help eliminate many of the barriers that prior authorization has put into place in the healthcare industry.

The main issue with prior authorization is that not only must it be done manually, but each insurance provider has its own system for authorization and submission, and its own process for approval. With advancements in technology and e-prescribing, officials are seeking a way to simplify the process – mainly for the good of the patient but also to reduce the workload on physicians.

More Efficient e-Prescribing Through Uniform Approval

The Maryland Health Care Commission is continuing to lay out plans that would change prior authorization, using a unified and standardized e-prescribing system for filing and processing prior authorization requests. No more printing, faxing or constant follow-up calls with physicians chasing calls between insurance offices and pharmacies on behalf of the patient.

This system, if it takes and spreads across to other regions in the United States, could greatly impact quality of care and healthcare costs – in a positive way. If this type of electronic prior authorization is able to integrate with electronic health records and practice management software, physicians could finally give patients faster access to medical services, reduce their operational costs within the clinical environment and ultimately spend a lot more time with individual patients.

Insurance companies aren’t expected to improve the system or work together to create a simple process. That’s why Senator John Astle and Shawn Tarrant are introducing legislation that will empower the state to streamline the process of prior authorization, enforcing guidelines they develop that are intended to reduce strain and burden on the healthcare system.

Advances in electronic medical records that include rapid electronic authorization along with e-prescribing have the potential to improve widespread acceptance and implementation of EMR software, to improve efficiency, reduce health care costs and help patients overcome some of the greatest barriers to palliative care and medications.

“Meaningful Use” rules driving healthcare sales of handheld devices

The total market for handheld devices in healthcare reached $11 billion globally in 2011, reflecting over 10% growth since 2007, according to Kalorama Information. There are a number of factors fueling growth, but the healthcare market research publisher sees the fastest growth in administrative devices — the kind of devices used by healthcare providers to enter patient data — as a sign that ‘meaningful use’ requirements for EMR systems are having an effect on this market.

The EMR incentive program, created by Health and Human Services (HHS) in 2009 to boost paperless medicine, was specifically designed not to reward mere purchases of software. To qualify for federal government incentives, hospital and physician groups are required to show that they have entered patient visits and transactions electronically.

“To qualify you have to show that your healthcare providers are actually using the EMR — entering patient data and ordering prescriptions electronically,” Kalorama Information publisher Bruce Carlson said. “We think that realistically it means handheld devices. Meaningful use of EMR means meaningful use of handhelds, as the patient-centered nature of healthcare work doesn’t permit a lot of desk time.”

Kalorama Information divides the market for handheld devices between patient monitoring and administrative use. Patient monitoring devices such as ultrasound and ECG systems have historically accounted for the largest share of sales in the handheld market, largely due to the range of product availability. However, this is changing with the growing applications and capabilities of tablet PCs, and the need to enter patient data electronically. Administrative device usage has exploded over the last five years with the growing use of PDAs, smartphones, and tablet PCs taking hold in the healthcare industry. Tablet PCs are being used for a variety of uses in the health field, including access to patient records at the point of care, improved viewing capabilities for medical images, and easy offsite patient monitoring.

EMR is not the only driver of handheld devices in healthcare. Several factors are driving the growth of this market, including cost restraints, medical error reduction measures, government incentives, expanding capabilities of devices, off-site medical care and more, according to Kalorama Information.

“The use of handheld devices in healthcare was growing before the first EMR payments were wired,” said Carlson. “Better patient outcomes and the ability of providers to always have a patient record in front of them; these factors have driven purchases even more.”

More information can be obtained in Kalorama Information’s report on the subject, Handhelds in Healthcare: Markets for Smartphones, Tablet PCs, PDAs, Monitors & Scanners. The report includes key company profiles and market share, revenue forecasts, and breakouts by device category.

10 health IT Wishes for 2012

It’s easy to make predictions about health IT for the year to come, but what if someone asked what your IT wishes were for 2012? What would you like to see happen most in the health IT space?

We asked Wendy Whittington, MD, a practicing pediatrician and chief medical officer of Anthelio Healthcare Solutions, to list her top 10 IT wishes for 2012. From interoperability to telehealth, Whittington outlined what she, and most of her peers, would hope to see come true during the upcoming year.

1. A greater emphasis placed on the federal health IT strategic plan. According to Whittington, healthcare professionals and government officials alike should be paying closer attention to federal health IT strategic plan, and she suggests a revision of sorts could be helpful. “I would like to see that become a working document that we’re constantly referring to,” she said. “One of our biggest problems is a document comes out and it’s good, but what’s happening in healthcare is changing – a document needs to constantly be tweaked.”

2. The emergence of more affordable solutions for healthcare systems and hospitals to attain meaningful use. Many hospitals and systems have been scrambling to find a fast solution to an EHR, said Whittington, to gain access to those meaningful use dollars. “But what ends up happening is they think to get there, [they need to] buy the biggest and the best,” she said. “The total cost of ownership far exceeds the return they’ll get back. I’d like to see a lot of the lesser-known providers of EHRs getting more attention.” Whittington also added alternatives to EHRs, like open source, could be just as successful for a 100-bed hospital, for example. “I’d put the money into optimizing the less-expensive option,” she said.

3. Real interoperability and not just “lip service” interoperability of our health IT systems. Whittington referenced vendors who promise true interoperability, yet, months after implementing the technology, hospitals are still left with communication issues. “[Hospitals] will ask, ‘Will this communicate with doctors in the outpatient clinic?’ and the answer is ‘yes,’” she said. “But years after hearing that answer, you still have the same problem. So interoperability is important, but there’s no progress and, in fact, no financial incentives for vendors to play nice.” And financial incentives, in theory, wouldn’t end with vendors and interoperability – Whittington suggests the same goes for communication among hospitals. “Both technology and health communication,” she said. “Less financial disincentive to communicate and more real interoperability.”

[See also: Telehealth helps cardiac patients improve conditions, study reveals.]

4. A better health IT “roadmap.” Ultimately, Whittington would like to see a healthcare system that’s, “patient-centered, evidence-based, efficient, equitable and prevention oriented,” she said. The health IT strategic plan, she said, has vision but isn’t a “cookbook.” “In medicine, we resist cookbooks,” she said. “It’s taken a long time for physicians to assess protocols and evidence-based medicine order sets, so it’s in our nature to not be told how to do things.” However, with everyone left to his or her own devices, it’s easy for chaos to ensue, so Whittington suggests a more standardized way of implementing required technology.

5. The optimization of EHRs. Installing them is just the beginning, said Whittington. “We end up doing what we need to do to get by … slap in that EHR and meet those standards, when really, there’s so much more work that needs to be done.” She said not to forget to optimize your EHR, and when it comes to doing so in hospitals, she suggests doing away with commonly held “silos” and working holistically. “[We need to] work more holistically to optimize clinical documentation and ICD-10, and optimize EHRs around those same principles,” she said. “Work as one big team rather than little, individual ones.”

6. Less whining about going to ICD-10 and smarter planning about how to get there. Whittington said her point with this wish is simple. “It’s like,’Come on guys, we’ve known for a long time that we’re the last country in the world [to transition to ICD-10] and we need to go there,’” she said. “For a while … the argument from the AMA was, ‘We’re too busy and we have a lot of other things going on,’ and I agree; there is a lot of change. But we’ve known about this for years.” There’s going to be change in how care is delivered for many years to come, she continued, and waiting for things to calm down would take even longer. “Just suck it up,” she said. “That’s what I tell my kids.”

7. More innovation across all of healthcare but mainly health IT. EHRs in hospitals just aren’t innovative enough, said Whittington. “There’s a lot of money being dumped in and all these systems being put in, but doctors are still complaining that it slows them down and is cumbersome,” she said. According to her, there needs to be more innovation around ways to get information into the EHR from the beginning. “We’re starting to see a little glimmer of hope with transcription work and being able to put info into an EHR, but we haven’t begun to realize of the benefit [of EHRs] because we still struggle to get information in and out,” she said.

Interoperability should be top priority for NHS, report says.lista-gold-sunrise-highlite-lista-under.jpg

8. A shift to patient-centered care and population health. “The way we have our health delivery system set up, with hospitals being the center of the universe and EHRs being the information repository, we aren’t necessarily making populations more healthy,” said Whittington. She referenced once again the strategic plan, which calls for more attention paid to shifting the center of care out of the hospitals. “As we build out HIT infrastructure, we need to think about where patients need to go to find the right care at the right place at the right time to keep populations healthy.”

9. Value out of big data in healthcare. Professionals are constantly “throwing data” into their EHRs, but, said Whittington, we haven’t even begun to realize the value we can get out of it. “You can even tie in ICD-10 and a lot of other principles into this as we get better at capturing granular data in patients,” she said. “ICD-10 helps with that: apples to apples coding, more specifically. We should get better at comparative effectiveness research and knowing what’s going on.”

10. The expansion of telehealth principles into the wellness space. “The way we deliver healthcare today is inefficient, and it’s not going to take us into the future if we ever intend to be cost effective and affect the health of more people,” said Whittington. She recognized the positive ways telehealth is being used in rural communities, but she said she would like to see it being used more to keep populations healthy. “So if a patient wakes up and checks [his/her] glucose levels, the results are beamed to a case management center,” she said. “And if you take that one step further, all of the people who walk into the ER for their strep throats. It’s about using the principles of telehealth to keep those folks where they belong.”

Sebelius Says $3.1B Paid Out for EHR Incentives

Health and Human Services Secretary Kathleen Sebelius said that 2,000 hospitals and 41,000 physicians have received $3.1 billion in incentive payments for the meaningful use of certified electronic health records (EHRs). Sebelius’ report on the most up-to-the-minute stats on the EHR incentive program sets the scene for the imminent release of the meaningful use stage 2 proposed rule. “Health IT is the foundation for a truly 21st century health system where we pay for the right care, not just more care,” she said Feb. 17 at Metropolitan Community College-Penn Valley Health Science Institute in Kansas City, Mo., where she discussed the growth of health IT professional jobs to improve patient outcomes and the economy. If HHS delays ICD-10 long enough, could the U.S. adopt ICD-11 instead? The Centers for Medicare and Medicaid Services has paid $3.12 billion in incentives to physicians, hospitals, and other health care providers who have started to meaningfully use EHRs to improve the quality of patient care. In January alone, CMS provided $519 million to eligible providers. Sebelius also cited results from a survey conducted by the American Hospital Association and reported by the Office of the National Coordinator for Health IT which found that the percentage of hospitals that had adopted EHRs has more than doubled to 35 percent from 16 percent between 2009 and 2011. And 85 percent of hospitals said they intend to take advantage of the Medicare and Medicaid incentive payments by 2015. According to the Bureau of Labor Statistics, the number of health IT jobs is expected to increase by 20 percent from 2008 to 2018, a much faster pace than the average for all occupations through the same time period. The administration has launched workforce training programs, including through 82 community colleges and nine universities nationwide. As of January, 9,000 community college students have been trained for health IT careers and another 8,706 students have enrolled. As of February, participating universities have enrolled 1,200 students and graduated nearly 600 post-graduate and masters-level health IT professionals, with over 1,700 expected to graduate by the summer of 2013.