I’ve said it before and I’ll say it again… it is impressively difficult to integrate data from one or more EMR systems into a cohesive analytical warehouse database. Especially if you’re doing it from scratch.

In my last two blogs (Data Integration: Taming the Beast of Healthcare & Data Integration: Taming the Beast of Healthcare – Part 2) I demonstrated how to reduce time and cost extracting data from your EMR systems and getting it into your warehouse ready for complex analytics and reporting through the use of pre-built “accelerators.”

Before any organization takes on the job to build a data warehouse there needs to be a reason to do it. In IT we sometimes call these “Business Requirements”.

Here’s How it Works.

Someone in a healthcare organization comes to IT and says “we need a bunch of reports to report to the Government and manage our procedures better. Plus, we’d like to analyze our patient and financial data to see if we can provide better service to our patients at a lower cost. We need it right away and we don’t want it to cost tons of money”.

You work with them to come up with the list of reports they want and the analysis type results their looking for.

Working from these, your technical staff looks at existing EMR systems to identify the data fields that meet the requirements and determine the scope of the project. You need Patient, Encounter, Account, Procedure, Diagnosis, Organization, Location, Claims, Medication and Medication Orders, Lab Orders, Clinical Findings and some other stuff, just to get started.

That’s somewhere in the neighborhood of 15+ systems, 353+ source tables, and 2,933+ columns. You’ll need to design a database, build hundreds of programs, test and verify the data and so on (a totally fictitious and ridiculously meaningless set of numbers but I’m trying to illustrate that it’s a bunch of work). You suddenly realize you’re going to need help or this will take forever to complete and cost millions of dollars.

To make things more complicated operational systems store and process data in a co-mingled subject state. This means an encounter focused system stores encounters with associated patient, diagnosis, procedure and supporting clinical orders and clinical finding data all designed mixed together. This makes it easier to store and update transaction data.

But a warehouse cannot be transaction focused. The data design needs to be highly normalized to reduce redundant data. Since it also requires data spread over long periods to spot trends and look for treatment and outcome patterns, the warehouse needs to store billions of records to get meaningful analytics results. This requires a different storage scheme. This is best served with a dimensional star schema design (as described in Part 2). But you will need to re-organize the data before you can load it into a dimensional structure.

So in order to load the warehouse we need to tear apart the source transactions and load the data into subject oriented (Patient, Organization, Encounter, etc.) Atomic database.

The Atomic database is a highly normalized 3rd normal form (sorry, that’s relational model terminology) making sure it is re-linked together to make sure you got it correctly stored.

Note: This is a key factor in the design of the intake gateway, the final piece of the Perficient Analytics Gateway for Healthcare.

Luck you!  You read my blog (all three parts) and you know just who to call!  But you’re skeptical.  Can this be true?  So you reach out to several healthcare organizations and they all tell you the same thing… call Perficient!  These guys are amazing and you’ll love them!

When we get the call we’ll tell you what we have.

In this illustration you can see,

1. The Perficient Analytics Gateway – for Healthcare, a set of pre-built processes that gets your warehouse built and loaded in significantly less time.
2. A stable Industry standard Unified Data Model (the one we partnered with and built our product for).
3. Nearly turn-key processes to move the data from Source to Stage to Atomic to Dimensional databases made ready for analysis and reporting.

What makes this a standardized process, is it’s alignment with the Atomic database of the Unified Data Model. The stability of the Data Vault Hub & Satellite structure (as described in Part 2) allowed us to design Pre-Stage database tables using a Standard Input Format (for those of you who can’t live without acronyms, we’ll call this the SIF) that has the same columns as the Atomic. A type for a Hub & Satellite combination and another for relationships etc. We have a few others, but you get the picture.

We use the SIF to store source data in subject oriented boundaries, maintaining relationships to all of the related Hubs aligning all with the Atomic model. This makes ingestion programming easy and reusable. It also provides a mechanism for filtering and transforming source columns as preparation for warehouse processing.

The “Intake Gateway” portion of the Perficient Analytics Gateway – for Healthcare is;

1. Used to extract data from your sources into the intake “SIF”. This is designed to accept data from any system.
2. Processes and stores SIF records in the Pre-Stage database
3. It helps filter out duplicates, clean, validate, re-format, etc. incoming data for final loading to the warehouse.
4. ETL process to move the data from Pre-Stage to the Atomic.
5. Standardize date formats, eliminate garbage data, validate codes and consolidate similar input from multiple systems.

Shown here is the basic data flow from Source to SIF.

To make this all work we create mapping documents with adequate information to drive a mechanical code generating process that creates the ETL and ELT programming necessary to load the SIF tables correctly. The remaining pre-built ETL programs do the rest.

Data format in all of the columns in the SIF tables is a variable character (with some minor exceptions) at max length so no matter what length or value is coming in from a system for any given field it will be accepted. The warehouse field data types are then used to guide the programs for outgoing data types to match.

Since the warehouse model rarely changes, the programming to move the data from SIF (Pre-Stage) to Atomic works most of the time with little or no modification.

This is a tremendous time saver as shown below.

Of course, I’ve simplified this to keep it short.

Needless to say, Perficient’s BI team, source system knowledge and experience, the components of the Gateway and the Data model aren’t cheap. However, in comparison to doing it all yourself from scratch, it’s considerably faster, cleaner and less expensive than you might think.

Give us a call!

I just got back from the doctor whose office is in one of the leading hospitals in the United States. I was his first appointment of the day.

“They just updated Epic this morning, and everyone is getting into the office trying to make sense of the changes,” the doctor said. I asked if he knew that changes were coming. He said someone came around several weeks ago and told employees that a new release will be installed and that there would be someone available to answer questions from employees…at some point.

The doctor seemed a bit frustrated because the screens and process he’s been so used to have changed. At first glance, he said putting in orders for patients takes several more steps. The user experience has changed for doctors and other hospital employees. You could hear the chatter around the office, and everyone seemed annoyed.

The doctor said he just needs to sit down and figure out what changed. And, he’s right. He needs to take some time and explore the new version.

But as I was talking to him, all I could think about was organizational change management. If they had a good change management plan, it would have likely eliminated the frustration and allow employees to focus on their patients.

The four components to a good change management plan:

1. Define the change: Explain the change and why it’s important
2. Communicate the change: Tell the “what, when, how, and why” to the affected groups
3. Enable the change: Make sure employees have the training and support required
4. Sustain the change: Develop and share best practices, and adjust where necessary

Changes to EHR systems are inevitable. However, you need to plan accordingly. Time and time again, we see situations in which change management could help improve the user experience, increase adoption, and improve ROI. It’s time to take change management seriously and make sure it’s part of all your IT projects.

Let us know how our change management and healthcare teams can help you.

If you stopped by our Perficient booth at CA World, you would have seen our “Healthee Hub” healthcare demo running on our big screen. The iOS app was developed for the event to showcase CA technologies including CA Mobile Application Services and the CA Mobile API Gateway. The objective was to demo some capabilities to provide an edgy feature set to improve patient and provider relationships with FHIR.

Tech Specifics:

The application was built with Swift 3 and integrated with the MAS SDKs found on http://mas.ca.com. From the technology stack we integrated the Single Sign On options from the MAG, and Encryption, Storage, and Push Notifications from MAS. The FHIR data was pulled from the CA SaaS FHIR Developer portal which allowed the demo to access Patient, and Test data via REST API.

Provider Story

Healthee healthcare providers are saving money with new changes to patient intake and patient relationships. The Healthee Hub App from Perficient and CA Technologies manages updated records via EMR communication from patients to provide the latest health insurance information, patient updates, and medical records without any gaps. Healthcare providers can manage appointments through a mobile app, save time by posting test results online, and provide patients with referrals and pertinent information like latest visit information.

Healthee Hub is also enrolling patients into Apple Research Kit studies, which helps identify and measure patients’ health and wellness. Paired with Fitbit or assigned patient devices, Healthee Hub with updated EMR provides a measurement of how well prepared a patient is to undergo treatment or a procedure, or can provide data insight on immediate health concerns. Healthee Hub improves patient and provider relationships by delivering an engaging platform and more concise patient care.

Patient Story

Healthee Hub is helping patients move into a paperless age. Digitally updated EMR records for each patient saves both the provider and patient time and money. Patients will carry their latest information to every visit, without any missing files or delayed paperwork that occurs with in-network ACOs or health insurance networks.

Patients can access data via secure mobile single sign-on, and from there can view upcoming appointments with any of their healthcare providers.

There is no barrier between patients and their healthcare data. Rather than waiting to receive a phone call from their provider, patients can access test results via a mobile app, anywhere, anytime. Any prescriptions will also display, and patients can conveniently fill them from the app.

Patients can also be referred to a new healthcare provider regardless of network or location. The patient can request a transfer from his or her current healthcare provider, and the necessary HIPAA signatures and paperwork are completed through the app to reduce intake time and risk of information. The transfer approval is relayed between the EMR and the new provider, with necessary and approved paperwork automatically being sent to the new appointment location. When the patient arrives, all test results, records, and family history are already provided, saving significant time.

On Thursday, April 23, 2015, we delivered a webinar on 21 CFR Part 11, based on a recent blog series. During the Q&A session at the end, someone asked the following question:

Does 21 CFR 11 apply to a CTMS (clinical trial management system), CDMS (clinical data management system), EMR (electronic medical record), or EHR (electronic health record) system?

The answer is basically the same for any system, regardless of the type of system. You need to consider these two factors:

• How you intend to use the system
• Whether paper or electronic records/signatures will be considered the official records

If the electronic records that are generated, contained, and/or approved in the system pertain to regulated activities and are going to be considered the official records (i.e., used instead of paper records), then we would say the answer is “yes.”

We suggest that you perform a GxP assessment on the system and then, if it is indeed GxP, evaluate whether it is also subject to 21 CFR Part 11. Based on the nature of a CDMS, it is most likely going to be both GxP and required to comply with Part 11.

If you have any comments or follow-up questions on this topic, we’d love to hear from you. To see what other questions were asked during the webinar, click here.

It seems appropriate on Valentine’s Day to write love letters. This is my letter of adoration to Meaningful Use. In the past, I have written about how much time and productivity is wasted in the average physician’s office handling phone calls about prescription refills. My physician’s office has successfully implemented their EMR software, and the patient portal is very, very handy for all of the right reasons. I could wax poetic about the ease of checking on appointments and reviewing lab results. The source of my real happiness is the ease of asking for refills and having the ability to route the request to the right pharmacy. It was love at first click.

Instead of calling the doctor, waiting on hold to talk to the nurse, fretting about getting the medication name and dosage right for the refill, it was magic. I signed into the patient portal in a secure fashion, clicked on medication refills, and there was a correct list of my medications! I selected the ones I needed refilled including a suggested number of days like 30 or 90, selected the pharmacy of my choice and Voila! Several hours later, I received an email confirmation from the pharmacy that they were processing my order. Now honestly, I didn’t have to see what went on behind the curtain in the doctor’s office to review my request, but I’m sure they like the elimination of potential communication errors on medications, too.

My doctor has shared with me about the financial burden of casting out his first EMR investment and starting over with a better EMR software. I have to say that from my point of view, he clearly chose the right one and it actually fulfills the basic tenets of Meaningful Use, particularly from the patient’s point of view. I plan to share my enthusiasm for the patient portal with him including the secure messaging that allowed me tell him that his changes in my medications worked and improved my quality of life. This secure messaging was another plus for productivity, and patient satisfaction, because those positive responses got lost in the challenges of telephone communication in the past.

Like a lot of relationships, alas, things are not perfect. The EMR and patient portal have a mobile application that is still very basic. It gets high marks for security, but lacks the medication refill capability of the patient portal. I would venture a guess that it will be there eventually, but it brings to mind the challenges of screen real estate on a typical web browser on a laptop versus a mobile phone. Nevertheless, love can overlook some imperfections.

In a period when our government is making these big investments in electronic medical records and expecting Meaningful Use to be demonstrated in return, it’s time to send out some positive news: keep the faith and push forward because the healthcare consumer will benefit. I know that simplifying the ordering of refills seems like a small thing in the course of things, but if it saves time, productivity and especially errors, then it is a big deal. Thanks to my physician, who re-invested and made the commitment to real Meaningful Use. Here’s your love letter!

P.S. — No personal healthcare information (PHI) was harmed in the making of this blog. If you are curious about which EMR software is so terrific, stop by our booth #2035 at HIMSS, and I will whisper it in your ear. HIMSS 2014 is going to be a great event!

Recently our company has increased our focus on what healthcare organizations are looking for when it comes to cloud computing, in large part due to our acquisition last year of two fantastic Salesforce partners (ClearTask and CoreMatrix). I found this article in Healthcare Informatics to be very interesting. It’s titled “The Many Flavors of the Cloud” and includes interviews with some key CIOs regarding how they view private vs. public cloud solutions and the sensitivity – and often the mandated security requirements – around health data when stored in the cloud.

There are some obvious advantages to providers moving to private cloud storage for all types of data across the organization, but also some critical considerations for any CIO or CMIO. Here are the key takeaways I got from this article.

Medical imaging takes up a lot of storage space in the healthcare space. Imagine a 24 hour study of your heart that takes up a terabyte of space. The cloud can enable better scale for this type of need.

Key insights about cloud computing in healthcare:

• CIOs interviewed prefer “private cloud” solutions over public cloud solutions like those of Google, Amazon and Microsoft – more control around access & rules
• CIOs don’t want to deal with power issues, cooling issues, and capitalizing hardware over time – 3 reasons they enjoy Cloud
• They enjoy reduced costs in scaling a storage room, servers, etc..
• CIOs take personal ownership over creating their own stringent security requirements for their cloud vendor, making them feel better about storing PHI or other sensitive healthcare data in it.

• They also lean on a shared-risk model with their vendors. (Trust is key to building relationships here.)
• Data storage requirements in Healthcare are growing at a fast clip, which is why the cloud is often the best solution for scale. Imaging takes up a lot of space here – imagine a 24 hour study of your heart that takes up a terabyte of space.
• Virtualization is driving them to the cloud.
• CIOs want vendors who:
  • Understand policy requirements under HITECH Act
  • Follow best practices that closely match those of the clients’ IT org.

Read more about how our salesforce.com team at Perficient has helped healthcare organizations with cloud solutions:

• PharMerica Replaces Underutilized Tools with Salesforce Sales Cloud and Chatter Plus
• PharmaNet Integrates Salesforce Organization with i3

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

Consolidation and Mergers

Healthcare entities, both payers and providers, have been making an increased effort to capture market share and dominate their geography. Smaller players are being picked up by larger players, consolidating physician practices and health plans. These mergers have driven digital strategy projects and paperless environments, with an increased interest in advertising and public facing websites to try to attract market share.

• Changes in Hospital Finance Drives Flurry of Mergers
• Partners-South Shore merger review grows
• Cadence Health plans to merge with Rockford Health System
• Blue Cross of NEPA, Highmark exploring ‘stronger’ partnership
• Area hospitals promise transparent merger

Extending Your EMR

Healthcare professionals have been very vocal about the challenges that come along with electronic medical record systems. The workflow in many EMR systems was created by a programmer and works the way it was programmed, not the way healthcare professionals work. Several technology tools were made to extend or approve upon EMRs without ripping the code apart, often by putting it into a browser or allowing it to be mobile.

• EHRs can’t do everything
• 9 Reasons Doctors Hate Their EMR
• Docs blame EHRs for lost productivity
• So much data-gathering, so little doctoring
• How connected is EHR user satisfaction to vendor choice?

Security and Privacy of PHI

The further we develop our technology, the more security risks we’re introducing at the same time. BYOD and wireless networks increase the mobility and sharing of data, which is helpful for diagnosis and storage but risky for protecting PHI. There is a delicate balance between how much security is enough and when security will make it impossible for us to manage the system.

• Addressing BYOD security at a large medical research center
• Factoring healthcare BYOD policies into network security
• 3 tips for proactively protecting PHI
• Sloppy Handling Of Patient Data Always A Danger
• Data Security Added to Worries About Website

Fragmentation of Health Records

While interoperability is a key trend in healthcare, the cost of care is driving us away from this goal. In order to save money, patients are now going to several different pharmacies and stores to get discounted prescriptions where they can, fragmenting their health records. If the only time these medications are reconciled is when patients visit their primary physician, that’s not often enough to prevent adverse drug reactions.

• Why Healthcare Tech will save your life …and your wallet
• Interoperability: A critical mess
• Connecting a new world of care: why interoperability is vital for the NHS
• Health IT can improve care coordination for complex conditions
• Docs can prevent adverse drug reactions by looking up info on mobile phones

FDA Oversight

In September, the FDA revised its guidelines on what mobile medical applications need to be regulated and what are harmless to consumers. Now the FDA is wading into the issue of what else they need to regulate and what they don’t. This week they decided t to block 23andMe for providing medical advice without a physician involved. The FDA will battle where the concept of ensuring accurate medical information will start and stop.

• Congress delves deeper into FDA mHealth oversight
• U.S. approves drug tracking, compound pharmacy oversight law
• The HIT Group wants input into FDA regulation of health IT
• Here’s why the FDA is targeting 23andMe
• FDA to 23andME: Stop genetic tests

Chronic diseases are among the most common, costly, and preventable of all health problems in the U.S². The use of disease registries can play a large role in effectively managing these diseases. Despite some of its limitations, disease registries can provide useful knowledge on specific patient populations, allowing for more proactive, coordinated and focused care and education, ultimately resulting in improved outcomes and decreased cost.

What do you think? Do you believe disease registries can improve the management of chronic disease?

Resources for this blog post:

1. http://www.medterms.com/script/main/art.asp?articlekey=33490
2. http://www.cdc.gov/chronicdisease/overview/index.htm
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1490197/
4. http://www.idph.state.ia.us/hcr_committees/common/pdf/clinicians/1005_draft_disease_registry.pdf
5. http://www.chcf.org/publications/2004/05/chronic-disease-registries-a-product-review
6. http://azdhs.gov/biomedical/aztransnet/documents/The_Value_of_Patient_Registries_in_Clinical_Research.pdf
7. http://www.healthandwelfare.idaho.gov/Portals/0/Health/Rural%20Health/Watts%20-%20Chronic%20Disease%20Management%20Patient%20Registry%20Final.pdf
8. http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/C/PDF%20ComputerizedRegistriesInChronicDisease.pdf
9. http://azdhs.gov/biomedical/aztransnet/documents/The_Value_of_Patient_Registries_in_Clinical_Research.pdf

By Lesli Adams, MPA
Director, Oracle Healthcare Business Intelligence

In a recent blog, I wrote about parallel industries; Manufacturing, Airline, and Healthcare and the need to get to a Balance Sheet of Clinical Results for the Healthcare Industry.  With EMR Adoption Rates increasing year over year, HIMSS is reporting for the Final 2012 reporting period, that over 36% of facilities have at least a CPOE in place.  As that number advances, there will be more and more harvestable data.  Data will no longer be siloed, but available and ready for data mining, analysis, comparison, and predictive analysis.

Now that you have the data, what are you going to do with it?

Are pre-defined vendor provided reports adequate for analysis?  To any user?   Is the single threaded view of the patient and an a la carte Q&A sufficient?  Remember folks, this is the ENTIRE data set for your ENTIRE facility.  Just because you adopted your EMR and CPOE to receive incentive dollars from CMS, don’t stop there!  I am in awe of the amount of data that resides in these colossal giants of patient medical records and yet I find too often that the facility and the champion of the EMR is focused only on Meaningful Use measures.  Don’t get me wrong, this is the right step in the right direction.  But don’t stop there, the Quality department could use it, Performance Improvement, Provider Credentialing, Financial Planning & Analysis….

Oh, but wait.  Learn to crawl before you walk.  Facilities of every size have “analysts”, some are exclusive resources dedicated to analytical support, sometimes with large teams, but still in other cases, analysis is a defacto collateral assignment that happens in addition to everything else in the day.  Clinicians and non-clinicians, not trained in the science of reconciliation and balancing, but trained in lab medicine, nursing care, or discharge planning.  So then how will you serve up the data to let these “non-analysts” do analysis?

A few years ago I sat inside the Washington DC beltway and had a great discussion about clinical measurement.  I was asked “How do you do this?  How did you learn this?  Did you go to NQF school?”  My answer was a simple NO.  I was trained as an Accountant.  I learned GAAP, Generally Acceptable Accounting Principles.  I learned FASB and GASB, the Financial and Government Standards.  So to me it is a natural extension to see a Clinical Data Warehouse through the same lens that I saw a Financial General Ledger.  The rigor that I apply GAAP to Financial Statements is the same rigor I apply to HEDIS, MU, NQF, and Clinical Operations Measures.  Looking at the entire organization and having the ability to see how it all fits together.  Not tunnel vision, asking one specific question with personalized parameters, but seriously applying consistent and repeatable processes to the entire data set to get the holistic and absolute truth about the patient’s served.

And now technology supports that rigor in the Healthcare Industry. Oracle’s Enterprise Health Analytics (EHA) solution coupled with Oracle Business Intelligence speeds the delivery of clinical event reporting with the exacting precision of financial reporting.  EHA’s Healthcare Data model is fully mapped for 800+ tables and 12,000+ Attributes.  Each discrete clinical metric is captured.  No longer does clinical activity remain outside the data warehouse or an afterthought to financial analysis. EHA and an OBI dashboard deliver actionable information, with integrity and precision, ready for decisions.

For more information on Oracle and the Enterprise Health Analytics solution, please contact me at lesli.adams@perficient.com

For more information on the Final 2012 EMR Adoption rates, http://www.himssanalytics.org/stagesGraph.asp

Follow me on Twitter, lesliadams

As I have written before, I currently see several physicians who do NOT use an EMR in the office. They are awesome diagnosticians, people and mentors but they have not taken the leap to the electronic health world. Now, add in two hospital networks that do NOT have patient portals for accessing my records and you get one big, fat medical record quagmire! I would love to have my entire medical record in one place AND have portable access to it. Will I ever reach that goal? Do I need to establish a relationship with a new physician just to obtain my goal? I certainly hope not! So what can be done to make my dream a reality?

This quest has certainly led me to devour insights from industry experts, read countless blogs and articles and consider the drastic move to a new physician. So I was intrigued when I read the Wall Street Journal article, “Image Sharing Seeks to Reduce Repeat Scans“, this week. Allowing patients to have access and the ability to TRANSFER images to multiple providers reduces cost, redundancy and ultimately, radiation exposure for the patient. In addition, it allows the patient to “own” their health. Although this is certainly a step in the right direction, this is an isolated sharing of information, not connected to the rest of the patient’s history, just another piece of the puzzle. How can we solve the entire puzzle?

Health Information Exchanges (HIE), Personal Health Records (PHR), and Patient Portal development could certainly help create a more complete record. Development of a unique patient identifier, recently advocated by Health IT evangelist, Brian Ahier, could hasten collection of records across the country. All of these would help collect medical records that are now being electronically generated.

However, many of us have records that were created long before EMRs even existed. These would need to be attached as PDFs or scanned and attached as documents to the record. Perhaps a very progressive site would be able to use Natural Language Processing (NLP) to mine those records and pull out discreet data to populate the record. Finally, the record would invariably need some good old- fashioned manual entry to finish the job.

So will my dream of a complete, portable Health Record ever be realized? I think so…with a little help from my “friends” (EMR, HIE, PHR, portal, scanners, NLP and others) and a lot of manual work on my end. Even as a physician patient, there’s work to be done. What about tackling yours?

As a big fan of kevinmd.com, I enjoyed reading David Nash, MD’s take on how doctors need an “EMR 3.0” analytic engine for accountability and that creating an analytics tool that monitors gaps in care for a provider’s population is very important for accountable care. We also agree that as successful as the big EMR vendors have been that they don’t have an analytics engine that promotes accountability and measurements of quality and safety. My argument is that as a result of the large number of data sources in the typical healthcare organization due to the myriad of healthcare applications, the analytics engine needs to combine data from all of those sources, normalize the data and deliver the quality and gaps in care dashboards independent of the EMR system.

David’s practical idea that clinicians need an analytics engine that sits on top of the EMR, one that is capable of sweeping up clinical data and converting it to information that will improve clinical decision making, is accurate and exists today. Moving all of those data sources into a centralized enterprise data warehouse with a comprehensive and standard healthcare data model is the key to success. Reconciling the medical vocabularies to a set of consistent data elements empowers real analytics. Those capabilities exist in a well-established product called BI-Clinical from CitiusTech and that product has the key capabilities outlined on David’s wish list as an “accountable” primary care clinician in the modern healthcare environment, including:

• A data warehouse that combines clinical, administrative and financial data
• Calculates and reports on all 33 of the Accountable Care key measurements
• Disease registries to monitor and evaluate patients – not just individually but as a population
• Tracking of chronic disease management for patients with specific diagnosis like asthma
• Information on medical management including appointments, receivables and operations
• Ability to set and compare a practice with national benchmarks
• Ease of accomplishing these analytics on-line and via mobile devices, like a tablet

The best aspect of this comprehensive analytics engine is that it is built on the Microsoft business intelligence products to keep the total cost of ownership down and it can be deployed as a cloud-based solution, if needed. If my response seems too enthusiastic, there are many incomplete or partial solutions for healthcare analytics in the marketplace that solve only one or two key aspects because they lack a measurement engine that comes with 600 pre-built key performance indicators including certified Meaningful Use metrics or Physician Quality Reporting metrics. It is a common complaint fielded by those of us in healthcare consulting: “We know that we collected the data in the EMR and it needs to be combined with cost data to evaluate treatment alternatives or the cost of outcomes.”

I hope Dr. Nash is attending HIMSS 2013 in New Orleans and he can see this EMR 3.0 analytic engine solution in the CitiusTech booth (#4169), the Microsoft booth (#1127), shown as HealthBI, or the Perficient booth (#1555). I believe he will be impressed with how the BI solution addresses his wish list and is available today. Be sure and ask to see the Gaps in Care demonstration as well; it is really state of the art.

Based on the most recent meaningful use statistics published by CMS, the majority of Eligible Physicians submitting MU claims for Medicare have not been paid. Medicaid is only marginally better.

Providers who are shopping for EMR systems must pay attention to the track record of the vendor and investigate claims these systems are MU compliant. Vendors have to conduct an in-depth certification process. Shoppers should expect to see the resulting confirmation from ONC proving EMR systems they are considering have passed this certification. They also should be clear all along what is expected from them to qualify for MU stage 2 reimbursements.Collecting Meaningful Use dollars is difficult but not impossible. It will require the Provider to study and understand the nuances of these requirements and start developing habits that ensure payment well in advance. Providers must shop wisely. The statistics above indicate many systems claim to support Meaningful Use during stage 1 apparently fall short in some way or another. Meaningful Use stage 2 will be much more onerous for both the EMR vendor and the Provider to qualify. This implies the majority of EPs are not demonstrating MU as per the CMS guidelines. In my last blog, I talked about software forcing providers to change the way they practice medicine to qualify for Meaningful Use. Today, I’m sharing some numbers that illustrate the difficulty of getting paid even after all this change.In order to be included in this report, Providers must successfully demonstrate Meaningful Use, and meet the allowable-charges threshold as well as all program requirements to be included in this report.

Meaningful Use Stage 2 requirements will push a lot of EMR vendors out of the market. This is good for Providers since they have fewer choices and far less marketplace noise. On the other hand, many vendors will claim to be stage 2 compliant who are not.

Buyer beware! The Savvy Shoppers will prevail.