Digital Health Newsletter – Summer 2017

Dear colleagues:

In Washington, D.C., a battle continues to rage over the Affordable Care Act (ACA) repeal and replace efforts. The House of Representatives has already voted to replace it with the American Health Care Act (AHCA), with the Senate drafting its own version as we speak (see table below). This reinforces the fact that health care is in flux and continues to evolve. In El Paso, we continue to grow and make decisions on who we are as an organization and what direction we are heading in, specifically with respect to digital health and quality. 

Digital Health Table

Table source: http://preview.mailerlite.com/m5i9l5/655160354157888962/j6m9/

What we will continue to see is that “health care is complicated.” Anyone who believes it is easy has never been a part of it, or has some magic wand we all need. The art and act of reducing costs, increasing coverage, improving quality and safety, and ensuring choice and access are easy to say but hard to legislate.

What We Are Facing in 2017 (and Beyond)

One thing I believe we can all agree on is that our health care system is in need of changes on the global scale. Case in point:

In 1967, our population was 204 million and our national health expenditures were 46.5 billion, the equivalent of 5.7 percent of our gross domestic product (GDP), or $253 per person. Today, for our population of 330 million, our health expenditures are $3.2 trillion, amounting to 17.8 percent of our GDP, or $9,990 per person. These costs are increasing at a rate of almost 6 percent annually — higher than food, fuel, housing, and every other category of spending (see below). Deductibles for the 170 million people insured by their employers increased 12 percent last year alone to $1,478 per employee (The Keckley Report, March 27, 2017 and June 19, 2017).

 Year

  Population

   National health         

     expenditures

  % of our  

      GDP

   Cost per

     person

 1967

  204 million

       $46.5 billion

     5.70%

       $253

 2017

  330 million

        $3.2 trillion

    17.80% 

      $9,990

Health care continues to be a main driver of piling credit card debt for most Americans. Physicians are also concerned, as traditional reimbursement is cut by Medicare, Medicaid, and private insurers. Mandates to invest in information technologies are not only increasing cost but also admittedly complicating operations. Lastly, provider discontent continues to complicate the trajectory to pivot care from volume to value (#J2V), evidenced by increased waiting times for patients as they battle over slots to visit an already limited pool of health care providers.

And while all this may seem daunting, I believe there are opportunities for change:

  • Veterans’ health: The Veterans Choice Program’s upcoming update will affect approximately eight million veterans and their ability to access non-Veterans Affairs (VA)/Department of Defense (DOD) health systems. The focus is expected to be on primary and preventive health care, which is a strength of our organization. The family medicine (FM) group is patient-centered medical home (PCMH)-certified. We will continue to work with them and internal medicine (IM) to ensure that transitions from VA/DOD are smooth and efficient.
  • Medicaid innovation: Whether it be in block grants, Medicaid Section 1115 waivers, or additional innovation proposals, Texas Medicaid is looking for unique and measure-driven ways to improve care and reduce costs. These changes can potentially provide us a runway to further the progress we made with the Delivery System Reform Incentive Payment (DSRIP) programs and leverage them into programs that improve care, potentially enabled by our people, process, and technology.
  • Physician satisfaction: As stated during his confirmation hearing, it is likely that Department of Health and Human Services (HHS) Secretary Tom Price will attempt to soften the regulations around physician quality reporting. This should allow us to optimize and improve our present electronic medical record (EMR) system to make it as user-friendly as possible with minimal work going into clicking boxes to meet requirements — the fourth piece of the quadruple aim, provider satisfaction. Assistant Chief Medical Informatics Officer (A-CMIO) Diego De La Mora, M.D., will lead the optimization effort, expected to start this fall.

The Future of Our EMR

A lingering conversation on our campus has been what EMR we will use going into the future. It is widely acknowledged that there is deep discontent with our present system, GE Centricity EMR (CEMR). There is not enough space in this newsletter to delve into our laundry list of dissatisfactions. Suffice it to say it is an open secret that there has been a search for an alternative system. With our recent, and potentially future budget issues, a switch to another system is on hold. However, the concerns over how our campus uses EMR systems will continue to grow, especially with the new Texas Tech Physicians of El Paso (TTP El Paso) at Transmountain location serving as a pilot site for a version of Cerner.

The reality is that over the next two to three years, we need to identify a systemwide EMR that serves our varied purposes, not only today, but also into the dynamic world of health care’s future, and is based on quality and value. This will be an expensive venture, but it is no different than the purchase of a DaVinci Robot, or finding a new clinical building to buy or build – it is a clinical necessity that becomes the cost of business. The Office of the President will put together a committee of stakeholders to review all EMR options for the next legislative session, which include, at a minimum:

  1. Continue working with GE
  2. Move to another EMR:
a) Our own independent version of Cerner; different than the ones used at University Medical Center (UMC) of El Paso and The Hospitals of Providence Transmountain Campus
b) Cerner aligned with UMC
c) Cerner aligned with The Hospitals of Providence Transmountain Campus
d) A totally different EMR (e.g., Athena Health)

 

Considering that it is an estimated yearly expense of $700 per provider per month, none of these options are inexpensive, which means that these system challenges will require a thoughtful process with thorough considerations from all of us to solve.

Digital Health Updates:

News on opioid abuse is front and center both nationally and locally. New York has used Electronic Prescription of Controlled Substances (EPCS) for over a year now. The Texas Legislature recently pushed back a mandate for providers to use electronic prescribing to ensure monitoring and reduction in prescription fraud until 2019. The TTP El Paso at Transmountain location is already using EPCS; however, an expansion to the main campus is on hold due to budget constraints.

The Referral Management System (RMS) is undergoing an overhaul and upgrade to ensure that, as a multi-specialty group, we:

  • Manage our patients’ referrals efficiently
  • Make available or return referral notes to the requesting provider, closing the loop
  • Provide measures to quality check our internal and external referral process

The feedback Clinical Information Systems (CIS) obtained, in collaboration with Juan Figueroa, M.D., and his team, and multiple clinical departments, is excellent. We look forward to a planned rollout by the fourth quarter of this year.

The Transforming Clinical Practice Initiative (TCPI) held a kick-off event in May. The goal of the TCPI is to coordinate and align our clinical processes with future Advanced Payment Models (APMs). Our TCPI partner, Vizient, came on-site to consult with President Richard Lange, M.D., M.B.A, and other members of the executive and clinical leadership. Jennett Alexander, nurse informaticist in the Office of Clinical Informatics (OCI), continues to meet with clinical quality leaders, guiding us in this program over the next four years. The program is nearing completion of Phase 1 of the project, “Setting Aims." It will be moving into Phase 2, “Data Driven Care,” soon.

A quality recognition event for the Internal Medicine Coding and Reimbursement Team was held this quarter. Carlos Franco accepted on behalf of the team, while Assistant Chief Medical Informatics Officer (CMIO) Diego De la Mora, M.D., discussed the critical role of the group in efficiently and accurately reporting all of TTUHSC El Paso’s clinical quality services to CMS, our payers, and the public at large. Congratulations to Pat Chavez and the IM coding team for their help in spreading the word on the university’s stellar quality care!

Internal Medicine Coding and Reimbursement Team

Digital Health Bytes

  • The Value Proposition for Medical Education Is Under Stress – Read here
  • Our Health Data Can Save Lives, But We Have to Be Willing to Share – Read here
  • The Future Of Health Care Is In Data Analytics – Read here
  • Data Show Prescribing Patterns Linked to $78B Opiate Problem – Read here
  • Why the Telemedicine Physical Is Better Than You Think – Read here

You can always find more information about digital health on the Clinical Information Systems (CIS) and Office of Clinical Informatics (OCI) websites.

Please feel free to contact me with any questions regarding our role in the digital transformation of health care.

Thank you,

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Oge