Big Data and Analytics--The new Currency in Health Care

You are not alone, puzzling just how fee for service payments will change to quality based reimbursement methodology. Obvously the two will exist side by side for the forseeable future. Not all health care payments are amenable to pay for performance or quality based models.  CPT  codes will not disappear. 

With healthcare organizations churning out an increasing volume of clinical, financial, and operational data, IT tools and analytics are becoming essential for business intelligence and predictive capabilities.

The conversion from  volume (or procedural) based reimbursement to one of value-based presents the challenges of measuring new metrics and analyzing their association with diseases and treatment outcomes.   The model is still uncertain and in development..  Physicians must be aware of changes and participate in development of this crucial new paradigm.

The Key to Transitioning from Fee-for-Service to Value-Based Reimbursement

Clinical Practice Guidelines andQuality of Care for Older PatientsWith Multiple Comorbid DiseasesImplications for Pay for Performance

New Value-Based Reimbursement Models to Eclipse Fee-for-Service by 2020

Shifting reimbursement models: The risks and rewards for primary care 

The Affordable Care Act (ACA) places primary care physicians (PCPs) front and center in the mission to improve the health of Americans, and lower overall healthcare costs. But new ACA-derived payment models that reward value, not volume, are driving skepticism and uncertainty among physicians. 

“This is really a tough time because physicians still need high productivity, but they also need to start measuring value,” she says. “The levers haven’t really switched from productivity to quality and value, but you don’t want to have a learning curve that is so steep you can’t deal with it when the switch gets flipped.”

Reform, however, doesn’t mean physicians will be paid less, counters Reid Blackwelder, MD, FAAFP, president of the American Academy of Family Physicians. Cost savings to the system from better efficiency and reduced duplication of services should benefit physicians.

Anthem hack: 'Healthcare is a target'

Healthcare industry, listen up: you're a prime target for cyberattacks. If you don't think so, just ask Anthem – or virtually every IT security expert out there. They're all saying the same thing. 

Indeed, Anthem has notified 80 million of its members and employees that their Social Security numbers, dates of birth and personal data were swiped in one of the nation's biggest cyberattacks yet. An outlier, you say? Don't' forget the nearly 42 million people who have had their health data compromised in HIPAA breaches. Or perhaps the whopping 130 million affected by the Heartland Payment Systems breach in 2008. Then there's the Target breach, Community Health Systems Heartbleed attack, Sony – you see the trend.

DOI Launches Investigation Into Anthem's Response to Breach On Thursday, California Insurance Commissioner Dave Jones (D) launched an investigation into Anthem's response to the breach. Jones directed DOI staff to coordinate efforts with other California regulatory agencies and other state insurance regulators across the U.S. In a release, Jones said, "The Anthem breach underscores the need for insurance companies to take every precaution to protect their customers' information and make their consumers whole when a data breach occurs," adding, "We are working with other regulators and conducting a review to confirm that the company takes the appropriate steps to protect and assist consumers and guard against future breaches" (DOI release, 2/5). Meanwhile, California Attorney General Kamala Harris (D) said consumers should take steps in response to the breach by: Being wary of phone calls from individuals claiming to work for Anthem; Considering placing a security freeze on credit files; Contacting credit bureaus, which can put fraud alerts on their Social Security numbers and prevent the opening of new credit accounts; and Reviewing credit reports for discrepancies (Bay City News, 2/5).

Do you remember those folders locked in a secure filing cabinet ?  Perhaps not as legible, but they were in one place....your provider's office.

For the complete story, more........

Mayo Clinic CIO explains switch from Cerner to Epic
As he prepares to embark on one of the largest IT implementations in recent memory, Mayo Clinic CIO Cris Ross explains the thinking behind the choice of Epic for EHR and revenue cycle, and lays out his next steps.

HIPAA breach puts blame on business associate
A New York healthcare provider is notifying its patients that their medical data has been compromised after one of its business associates reported the theft of an employee-owned laptop and unencrypted smartphone.
An all too common occurrence.


ONC Officials Detail EHR Data-Sharing Goals 

Little Action Expected From Congress on Health IT: ONC 

Medscape Medical News

Medscape Medical News

State of the Union
President Barak Obama pontificates on his accomplishment for Healthcare


Infographic: Social Media Sites Outrank Physician and Hospital Websites in Search Results

As Americans enroll in healthcare through the Affordable Care Act for the second year in a row, a new study reveals how physicians are being evaluated by prospective patients. The study released by Mercury360®, which helps companies manage their online reputation, found that for over half of physicians observed the first link on a search [...]

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Infographic: Online Healthcare Information Trends

Women are more likely than men to use telehealth services for urgent care after calling an urgent care hotline, according to a new infographic by iTriage. The infographic examines other key online healthcare information trends based on the use of iTriage's services, including top health concerns searched and the most searched medications. Online health information combined [...]

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Mayo Clinic conversion from Cerner EHR to EPIC EHR

The Mayo Clinic in Rochester, MN has clinics in Florida, Arizona, and also MayoClinic Health System  are about to convert their electronic health record system.

The large health care system faces the challenges of RCM (Revenue Cycle Management) which the Affordable Care Act proposes to mandate. This change converts the fee for service model to one of reimbursement for quality of outcomes (Value based payment model) and Pay for Performance and is not based upon volume. This  is an enormous change about to take place.

The HIT department at Mayo Clinic is quite large, supporting clinical, administrative and educational functions. Mayo Clinic is heavily invested in  Cerner's EHR, and 'patching'  software requiring multiple changes for RCM, measuring outcomes, attesting to meaningful use present a formidable exercise at considrable expense. Ostensibly the number crunchers, clnicians, and administrators believe a fresh start allows for a more efficient transition both financially and in training staff to meet the new regulatory standards.

Cris Ross, CIO for Mayo Clinic explains,

'The scope of Mayo's practice is very large, so we have a lot – a lot – of detailed decisions to make'

John Noseworthy MD, President and CEO of Mayo Clinic, states,  “We’re confident in choosing Epic as our strategic partner as we continue to enhance Mayo Clinic’s excellence in health care and medical innovation,” said John Noseworthy, MD, Mayo Clinic's president and CEO, in a statement announcing the partnership.





The Mayo Clinic  Health System is a large health care enterprise. They have many facilities dispersed throughout the United States, and interoperability is a key factor for them. Their old system from Cerner did not provide this functionality, nor did it meet the requisites for Meaningful use and/or conversion from fee for service reimbursement to a value based reimbursement system. Redesigning or patching a legacy system would be too expensive and may not have provided the changes, or future changes to comply with CMS requirements.  User friendliness may have also contributed to changing to an entirely new software vendor.

The original concept for EHR was to make  a record more legible and to store data that was easily retrievable. This has been expanded to include data fields which allow analytics

The technical aspects to achieve interoperability, a built in tree to compute outcome analytics and quality of care go beyond this blog. In fact health clinicians must now depend upon others to design systems which will integrate record keeping with all the other mandates of the Affordable Care Act, and Accountable Care Organizations.

Accountable Care Organizaitons may well go beyond one health care provider, both clinics and hospitals. In some cases depending upon whether it will be an IPA, hospital, or insurer, each responsible organization will need to use appropriate software to integrate the ACO.


Early experience has not been all that successful.  A few 'Pioneer' ACOs are operational, but several Pioneer organizations have failed, including the Sharp Health System in San Diego.

Some insurers are forming their own ACOs as an alternative for fee for service reimbursement. It promises to be a learning experience for all users

The Mayo Clinic has always fashioned itself as a 'leader". It's partnership with Epic signals a change. Kaiser Permanente already uses Epic for their system, replacing it's original system from IBM. Called Kaiser Connect it bases it's overall operation on Epic with some additional software modules to build upon it's success.

Kaiser's CEO states it's operational infrastructure upon EPIC .

Philip Fasano: We have every piece of information about that patient available to us to draw upon. The primary care physician has all the information about the patient, the specialists have all the information about the patient, and anyone they encounter in any of our hospitals has it as well. He or she can see the patient's health history, diagnosis by other providers, lab results, and prescriptions are all there. X-rays are stored digitally and are there. That information is also available if a patient goes to the ER.

Cost is significant, About $4 billion, a substantial amount of money, but we have 9 million members [so it costs about $444 per member]. This is not a one time investment.  You have to invest continuously in the infrastructure over its lifetime. People have to recognize that these systems are life-critical once implemented, so you have to invest in the infrastructure to be sure they are always on.  InfoWorld: What would it cost nationally to do what Kaiser did?Fasano: The health care reform act states that "meaningful use of technology" by providers nationally would be $11 billion. At the time, I said, "That's a nice down payment." It will cost tens of billions of dollars to implement this.

Kaiser, says Fasano blazed a new path, with considerable challenges and failures, a price from which  all future users will benefit.

The new system was built with Epic Systems, a specialist in electronic health records that is now one of the top two EHR vendors, along with Cerner.)

Health Information Technology Updates

While many providers are disappointed and also infuriated that the current first generation of EHRs which have been designed to meet arbitrary rules from HHS and CMS it is also obvious that the time has come for providers to play a more active role in addressing the significant shortcomings in EHRs that prevent them from playing a significant role in improving practice efficiency.


While CMS and  HHS have done their  'best' to foster development with a dual system of rewards and penalties it is not enough that they totally ignored "meaningful usability".  The current crop of meaningful use and EHR benefits 'pencil pushers', insurance companies, quality assurance, and others, as yet uknown who will  tap into the huge data base that is developing.

One way of speeding development is to incentivize not only providers and hospitals but  EHR vendors into developing more uniform standards, and common interfaces that are easily translated for physicians who often attend patients in numerous facilities, as well as their clinics. Some very large integrated health systems approach this goal successfully.

Perhaps a form of tax credits would stimulate interest in modernizing interfaces.. Microsoft is taking this approach to harmonize their desktop, tablet and smart phone GUI, making their use smooth and not requiring the learning of three separate screens.  EHR vendors should follow their lead.

Our opinion here is that CMS, and HHS have rushed to force a roll out of EHRs, much as they did with the Affordable Care Act.  We will be  discussing the ACA in a later post.

A second generation is now becoming available, however Digital Health Space is still catching up on the older versions.

Our biggest announcement is the grand opening of our new Channel .  Digital Health Space,  will correlate with the blog, hopefully in a  'meaningful way'.Please subscribe.

Health blogs are ubiquitous, and we are attempting to remain relevant, creative and exciting for authors and viewers (readers) alike.

In the next several weeks a schedule will be forthcoming to be posted at Digital Health Space. The first broadcast (test) was accomplished today...it is rough, but technically it is working.

We need a video production expert to help produce the broadcast, so that  do not have to multi-task. which cuts down on the professionalism, and distracts from content.

We are also recruiting providers and consultants who have opinions and can address controversy in this area.