Quality and Safety

LAS VEGAS - While healthcare industry veterans were speaking on lessons learned at HIMSS16, health IT's up-and-comers were participating in a meeting of the minds at the first HIMSS-hosted event dedicated to Millennials. Overheard at the Future Leaders of Health IT Reception, held March 2 at the Venetian's Label Lounge, was a range of conversations touching on everything from favorite new technologies to strategies for business initiatives. [Also: See photos from Day 3 of HIMSS16] But the overall theme was a changing landscape for healthcare and and technology alike. Millennials see great potential in the latest tech, but say the key to incorporating new IT is culture change. "My hope is that healthcare should become like the hospitality industry, like a spa or airline," said Neel Mehta, co-founder of EpiFinder, a tool that helps providers effectively diagnose epilepsy syndromes at point-of-care. For instance, he said, airlines have a black box that records all activity on flight; healthcare lacks a similar device. There's value in transactional data, following the patient from the time they check in until they leave, Mehta said. Right now, "healthcare is reactive, rather than proactive." The HX360 Executive Leadership Forum was another point of interest for attendees, who appreciated the smaller scale and more "digestible" format. For these emerging healthcare leaders, the new innovations and crucial care delivery models were "inspiring." One attendee noted the health IT landscape was much different than it was 30 years ago: It's much more diverse. But despite these changes, some Millennials are still waiting for the industry to catch up. Kunjan Divatia, director of revenue cycle and access at Yale New Haven Health System, said his organization is making great strides in terms of innovation, but still sees room for progress on a nationwide scale. He said some states – California, for instance –  are doing better than others in setting the stage for getting newer ideas into the mix. But he said he looks forward to the day when government and private-sector health organizations are able to include more healthcare leaders from his generation into regulation and leadership committees. Twitter: @JessiefDavis This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.

Medical practices spend an average of 785 hours per physician and $15.4 billion annually reporting quality measures to Medicare, Medicaid and private payers, according to a new report in Health Affairs. The study, led by researchers from Weill Cornell Medical College and funded by the Physicians Foundation, looked at the quality reporting efforts of primary care, cardiology, orthopedic and multi-specialty practices, polling 1000 of them (250 of each type), drawn at random from the membership rolls of the Medical Group Management Association. Their findings suggest that, while "much is to be gained from quality measurement, the current system is unnecessarily costly, and greater effort is needed to standardize measures and make them easier to report," researchers said. [Also: Slavitt, DeSalvo: Health IT has to work better for doctors] Practices reported spending 15.1 hours per week per physician wrangling quality measures -- 2.6 hours each week for physicians, with the rest of the work going to nurses or medical assistants. About 12 of those hours were spent logging data into medical records solely for quality reporting. Some 80 percent of practices said they spend more time managing quality measures than three years ago. Almost half said that's become a significant burden. But just 27 percent thought those measures necessarily correlated with quality care. Beyond the time invested, the dollars add up too. Weill Cornell researchers found that practices spent $40,069 per physician each year on quality reporting – totaling $15.4 billion annually. "The cost to physician practices of dealing with quality measures is high and rising," researchers said. "On top of the obscene waste of billions of dollars each year on quality measures, the most alarming thing about this study of MGMA member practices is that nearly three-fourths of the groups reported being measured on quality measures that are not clinically relevant," said Halee Fischer-Wright, MD, MGMA's president and CEO, in a statement. "The vast majority also stated current measures are useless for improving patient care," she added. "This study proves that the current top-down approach has failed. It serves no purpose to have over three thousand competing measures of quality across government and private initiatives." While care quality is essential and reporting standardization is critical, "if measures don't improve patient care, it’s an exercise in futility," said Fischer-Wright. "As the largest contributor to the problem, the federal government needs to get out of the business of dictating patient care through wasteful mandates and create simplified systems to support medical practices in improving quality across the country." As HIMSS16 in Las Vegas this past week, officials from the Centers for Medicare and Medicaid Services emphasized that quality measures would continue to be a key component in CMS' reimbursement programs. [Also: Meaningful use will still be part of MIPS reimbursement, CMS says] Kate Goodrich, MD, director of CMS' Center for Clinical Standards and Quality, said new payment rules under the Medicare Access and CHIP Reauthorization Act, or MACRA, would reimburse physicians based on a composite performance score factoring in quality measures (30 percent), resource use (30 percent), clinical practice improvement activities (15 percent) and meaningful use of information technology (25 percent). "Our intent is to have a single, unified program," she said, while acknowledging the need for flexibility and avoiding a one-size-fits-all approach: "We know physician practices are very different from one another." Earlier in the week, CMS Acting Administrator Andy Slavitt said the agency has been listening more intently than ever to physician feedback, working with those on the front lines to understand their pain points. He cited actual quotes from physicians, including one who said, "Most of what I'm doing during the day is entering data into the EHR." While offering few policy specifics, Slavitt seemed to indicate that's a message that's resonating with CMS. Doctors are "not describing problems we don't know how to solve," he said. "Job one is to bridge the gulf between our public policy work and what's actually happening with patient care. That has to become an integral part of how we do things." Twitter: @MikeMiliardHITN

As electronic health records have proliferated in recent years, so has the use of medical scribes. That's an unwelcome development for two big reasons, said two CMIOs at HIMSS16.

Value-based program will score physicians on quality, resource use, practice improvement and certified technology.

Thomas Carton, director of health services research at REACHnet, also says tablets are changing the way data is managed.

CHIME touts OpenNotes partnership, early success of National Patient ID Challenge; opening keynoter talks challenges and opportunities of patient-generated data.

Memorial Hermann Physician's network says doctors must be behind the wheel and provide aligned incentives for physicians. 

McKesson is expanding its footprint in the oncology field with a combined $1.2 billion acquisition of two companies – Vantage Oncology and Biologics.

Too many healthcare organizations are focused on securing the wrong assets, leaving them vulnerable to cyberattacks and putting patients at risk, a new report from Independent Survey Evaluators claims. When healthcare leaders focus primarily on protecting patient data, they often fail to address actual cybersecurity threats that directly affect patient health, the report said. So if an active medical device or electronic work order were infiltrated by cybercriminals, the patient could be directly affected. On the other hand, an electronic health record is secondary – it requires a provider to alter the data before it could potentially harm a patient. ISE studied 12 healthcare organizations, two healthcare data facilities, two active medical devices, two Web applications and other devices found on healthcare networks over the course of two years to determine the possibility of remote attacks and the readiness of these institutions to keep data secure. "We found hospitals were antiquated in their network designs and unsure about the technologies that could effectively help them," the study's authors said. [Also: Hollywood Presbyterian gives in to hackers] "In many cases, vendor products purchased for a security purpose were inappropriate for the organization, and those systems that were appropriate were deployed incorrectly, all resulting in heavy waste while not achieving an improvement in security posture," they added. Researchers separated threat vectors into primary, secondary and tertiary "attack surfaces" that expose patient health, more than their health data. Many systems that are the focus of prevention efforts "have little value with regard to personally identifiable information or personal health information – the assets hospitals strive to protect most – yet they have direct consequences with regard to patient health," according to the report. "These attack surfaces are largely left unprotected by hospitals and are precisely the attack surfaces to be targeted by an adversary seeking to harm a patient." Among the primary surfaces: clinicians, medicine, active medical devices and surgery. Secondary (EHRs, passive medical devices, test results, work orders) and tertiary surfaces (climate controls, physical storage, barcode scanners, connected power) often get outsized attention. Actions taken by health leaders often only handled unsophisticated threats, according to study, which left plenty of openings for attackers to get into information systems. Often, protection strategies assumed the attacks weren't aimed toward garnering targeted information, and therefore ignored the specific strategies and motivations of cyberattackers. All of the hospitals in the study were failing on a range of levels to address modern security issues, largely in part, due to a lack of funding. [Like Healthcare IT News on Facebook] "Security vulnerabilities in healthcare are a result of systemic business failures," said Ted Harrington, executive partner at ISE and one of the study's leaders, in a statement. "We found egregious business shortcomings in every hospital, including insufficient funding, insufficient staffing, insufficient training, lack of policy, lack of network awareness and many more." According to the study, one of the greatest vulnerabilities is that patients and visitors often have physical access to networks and equipment – an issue unique to healthcare. Time, accuracy and the environment also played into sometimes adverse security circumstances. Along with the study, ISE published a blueprint to aid healthcare organizations in shifting the security focus. It outlines specific threats and the consequences of a breach, in addition to methods for healthcare institutions to better secure its systems. Twitter: @JessiefDavis

As policy wonks and advocates battle over just how much meaningful use will likely change in 2016, the Physician Quality Reporting System might have snuck up on healthcare IT staffs tasked with implementing new technology platforms. "The focus for most of the health IT folks has obviously been meaningful use regulations, and there hasn’t been a lot of focus on the PQRS," said Deborah Gash, CIO of Kansas City, Missouri-based St. Luke's Health System. In fact, Gash said she actually had what she called an "aha!" moment when colleagues at St. Luke's began asking her about how best to address PQRS stipulations in concert with other reporting requirements. [Also: 21 awesome photos from past HIMSS conferences] Gash and Anantachai Panjamapirom, senior consultant at The Advisory Board Company, will present on St. Luke's experience in "PQRS and Alignment Opportunity — Concept to Operationalization," during HIMSS16 beginning in late February. "Bringing awareness to what this program is, how we were able to work through all the operational issues, and create a program to allow us to follow through and successfully meet the requirements was something we thought would be worthwhile to share," Gash said. Panjamapirom said numerous Advisory Board clients, such as St. Luke's, have already taken steps to align not only MU and PQRS, but also try to devise strategies to bring other programs, such as Hospital Inpatient Quality Reporting and the Value-Based Payment Modifier, into efficient alignment. Twitter: @HealthITNews "Most of what you have to do is workflow and culture changes," Gash said, "such as documenting the right elements and being consistent about it, plus developing workflows and decision support tools in your EHR to ensure you're getting the quality data captured. That's really where the lion's share of the work is for organizations." Gash also said larger organizations are not necessarily better prepared to operationalize alignment. "I think the complexity of the organization can increase your risk," she said. "I find smaller practices that are paying attention do quite well.  It's that lack of awareness and understanding of what you have to do in the requirements that puts you at risk." "PQRS and Alignment Opportunity - Concept to Operationalization" will be presented March 1 from 2:30 - 3:30 p.m. at Sands Expo Convention Center, Palazzo D. Twitter: @HealthITNews This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.