It seems as if we’re inching ever closer to a wide-scale proliferation of electronic health records (EHRs). The much talked about American Recovery and Reinvestment Act contained major incentives to encourage the meaningful use and adoption of the promising technology. Add to the equation some variation of healthcare reform which will further promote the digitization of medical records, and it’s safe to say we’re on the cusp of a significant technological revolution in healthcare.

And that got me thinking…Where exactly do personal health records (PHRs – remember those?) shake out in all of this? Will we ever see significant uptake to the extent that there’s a legitimate demand for them? Products such as Microsoft’s HealthVault and Google Health created a lot of buzz when they appeared on the scene in recent years, but it appears that people haven’t exactly been waiting in line to open accounts. Will they ever?

The simple answer is yes. And when they do, look out. Here’s how I see it playing out…

In a few short years our currently younger, tech-savvy and web-dependent generations are going to become better acquainted with the healthcare system. Whereas they now maybe see a doctor once or twice a year for basic services like a physical or a flu shot, they’ll soon start catching up to us older folks who utilize healthcare more frequently, even if it isn’t for themselves. As their parents’ medical needs grow, many will undoubtedly become primary caregivers and enter the system that way. Already used to executing the rest of life’s serious business digitally — banking, taxes, job hunting, dating, clothes shopping — almost on cue they’ll begin seeking products and services that enable them to manage their health (or that of loved ones) the same way. Collaboration among all stakeholders will be critical to easy-to-manage healthcare.

So there’s your demand. It’s going to be an enormous opportunity — and an equally large challenge — for health IT. As much as these current whippersnappers depend on technology to make their lives easier, to a degree they also want it supplied to them, and they want to be assured of its value. In other words, if they have to create their own PHRs by inputting data themselves, it’s not going to happen. Just as they expect their paychecks to magically appear in their checking accounts every two weeks and their car payments and utility bills to be paid in the same automated fashion, so too will they expect ready-made health records that not only contain an accurate medical history but also suggest to them what they might be thinking about in the future based on their past. The information can’t just be data; it needs to be smart and meaningful. It needs to make a measurable, if not quantifiable difference in their lives.

We have to be ready. There isn’t going to be much of a ramp-up to this revolution. It’s going to happen rather abruptly, and the HIT industry can’t afford to wait and react; we need to start preparing now. The industry has already begun laying the groundwork to capitalize on this opportunity. Interoperability, collaboration and health information exchange have been and will continue to be dominant themes. This is exactly what it’s going to take to support the demand that rises in the wake of the PHR big bang. We need to ensure that we can facilitate the exchange of clinical data among all parties in the healthcare ecosystem so that each can have mutual access to actionable, real-time information that creates a complete picture of the patient. This will be the lifeblood of successful PHRs — essentially meeting consumers where they want to be met in whatever technical format and through whatever device they choose.

I suppose you could simplify things by thinking of it this way: when the Wii generation starts needing healthcare in a few short years, it’s up to us to ensure that they have an app for that.

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Carole Hodsdon is MEDecision's executive vice president and chief technology officer.

Healthcare payers have been feeling some trepidation about meeting the mandates of the 2008 Federal Mental Health Parity and Addiction Equity Act (MHPAEA). (While the rest of the industry, hopefully, is scrambling to find a better way to refer to it!)

MEDecision has been working hard to support payers’ ability to meet the mandates of healthcare reform, and the particular challenges brought on by MHPAEA compliance are no exception.  It is important that health plans take measures to address the critical relationship between medical and behavioral health so that they can maintain a holistic patient view for utilization and disease management.

So, today is a rather proud day for all of us at MEDecision as we announce the general availability of Alineo 3.0.

How do the two align?  Alineo 3.0, the latest version of our Alineo collaborative health care management platform, features a new behavioral health utilization module designed to support compliance with the MHPAEA.

Today’s release is significant as Alineo 3.0 is one of the only products currently available with the intelligence to help ease the MHPAEA adoption process. Alineo 3.0 offers the ability to designate care requests and programs as medical or behavioral health related and incorporates standard DSM 5-axis coding to capture behavioral health information.This then delivers an integrated patient view, which is critical for more holistic patient management and care.

I’m happy that we’re forging ahead in these respects while many seem to be in a wait-and-see mode.  

Combined with the introduction of our InFrame HIE product earlier this year, the forthcoming release of our Nexalign iEXCHANGE 8.0, a number of new strategic alliances and ongoing development and innovation, the arrival of Alineo 3.0 represents some tremendous momentum for MEDecision right now. We’re approaching a really exciting time in healthcare. Given all that we have underway, I predict it will be a really exciting time for our company as well.

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While I have thoroughly enjoyed my retirement since it began in January, I’m also quite excited about being back at the helm here at MEDecision for a little while until we bring in someone for the CEO role on a permanent basis. Thankfully, my position on the company’s board of directors has enabled me to stay in close touch so I have never really been that far removed from our operations.

I’m very excited about the various initiatives we have undertaken in recent months to build momentum as we approach the post-reform healthcare era. We are very well positioned, perhaps much better than most, to serve as a strategic partner that can help health plans and partners manage these unpredictable times and capitalize on the opportunities that arise from the evolving reform environment.

For example, we have dedicated significant attention and resources toward updating our product portfolio – including the upcoming launch of Alineo 3.0, the latest version of our Alineo collaborative healthcare management platform.Nexalign iEXCHANGE 8.0, the latest version of our collaborative healthcare decision support service, is also forthcoming. Earlier this year we launched a significant new product, InFrame, our collaborative HIE service. With Nexalign and InFrame, we can offer a solution to meet reform mandates right now.

We have also been doing a lot of work on our strategy for developing solutions to support the patient-centered medical home and just a few weeks ago we announced a strategic alliance with NaviNet through which we will deliver our Clinical Summaries and advanced referral and authorization technology to hundreds of thousands of physicians, clinicians and caregivers enrolled in the NaviNet network. This, in addition to our partnership with Availity, offers a powerful opportunity for health plans to differentiate by seeking innovative ways to improve care coordination and manage costs.

I’m not sure yet whether I should be proud of, or cowed by, all the work that has gone into refining our products, services and approach since I left in December! Seriously, however, I believe strongly that MEDecision is in a terrific place and poised for even greater things going forward. I’m eager to get to work. This is truly an exciting time to be back in the business, even if it’s just for six months or so.

The widespread adoption of electronic health records (EHRs) throughout the healthcare system received another boost last week when the Centers for Medicare & Medicaid Services (CMS) announced its final criteria for the meaningful use of EHRs within the incentive program established by the American Recovery and Reinvestment Act. After releasing preliminary meaningful use regulations back in January, the agency spent the past several months collecting the thoughts and opinions of anyone and everyone in healthcare who took the time to submit one. CMS has said these factored into the finished product quite heavily, so score one for transparency. 

The final meaningful use regulations haven’t diminished the EHR incentive program’s impact on health plans, and its effect on health reform remains the same. If anything, they offer more flexibility than those proposed in January, which should increase EHR adoption within the plan’s first few years. The bottom line is that greater usage of EHRs will get electronic medical data flowing throughout the system. We’ll see more integration and sharing of information among payers, providers and even patients, which is a major step in the path to reform. 

For us at MEDecision, adoption of the final meaningful use regs—and the subsequent proliferation of EHRs that it will enable—is certainly an exciting development. Anyone who has followed our company over the past two-plus decades knows that we believe strongly in the potential of EHRs and healthcare IT to bring real, sustainable change to the healthcare system, and most importantly, better care to improve the health and well being of the population. We have long trumpeted technology’s potential to maintain costs, improve outcomes and increase operational efficiencies, so it’s very energizing for us to see healthcare finally heading in that direction. 

The coming months and years may turn out to be among the most pivotal the system has ever seen, and we’re gearing up to play a significant role in the transformation. 

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Eric Demers is senior vice president of health and life science at MEDecision, a leading provider of collaborative healthcare management solutions. Learn more about MEDecision at www.MEDecision.com. Follow the company on Twitter at @MEDecision and on Facebook at www.MEDecision.com/Facebook. 

Please feel free to publish the above commentary in full or in part with attribution according to the Creative Common license.

Often called the last great taboo, the burden of mental illness on health and productivity in the United States and throughout the world has long been underestimated. 

One in 17 adult Americans suffers from a serious mental illness. Many of these people suffer from more than one disorder and substance abuse condition at any given time, placing a substantial burden on individuals, families, the healthcare system, the economy and government. 

Beyond the personal cost of these conditions, mental health and substance abuse result in lost employee productivity, increased medical expenditures, and other costs including those resulting from social services, law enforcement, judicial and penal activities. 

Tough trend, tough story—does recent legislation offer hope? Congress enacted the Peter Wellstone and Paul Domenici Mental Health Parity and Substance Abuse Equity Act into law in 2008. This new law amends the Mental Health Parity Act of 1996 to require that group health plans of 50 or more employees, that provide both med-surge and behavioral health benefits, do so equitably. 

This sets the stage for insurers to take a closer look at the holistic member view necessary for the best behavioral health and medical disease management. 

Members of the MEDecision Clinical Programs and Clinical Products teams conducted a really interesting webinar last week focused on member-centric behavioral healthcare management. The team reviewed immediate considerations for health plans as they prepare for the upcoming changes mandated by the Federal Mental Health Parity and Addiction Equity Act. 

They discussed the legislation’s implications for health plans with a special look at how it’s going to impact behavioral health UM workflows. The webinar offered really good insight into the societal, economic and regulatory factors that are driving insurers to increase access, improve outcomes and control costs for mental health and substance abuse care; along with the relationship between medical and behavioral health and how it’s important for payers to balance both in order to maintain a more holistic view of members. 

There are definitely a lot of things for insurers to consider as behavioral health takes on greater significance for them, but the MEDecision group did an excellent job of making sense of it all. 

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Just read a great article by Lucas Mearian in Computerworld. Last year’s American Recovery and Reinvestment Act to digitize medical records over the next five years is motivating and mobilizing the entire industry in a way it hasn’t been before. We, as the health information technology industry, have a lot of work ahead of us but we are poised to play a considerable role in facilitating EHR adoption. Allowing the real-time exchange of actionable clinical data among all healthcare stakeholders — to put smart patient data in the hands of users where they want it, whenever they want it and to enable them to utilize it regardless of technical platform —plays a pivotal role in healthcare’s technological transformation.

The technologies and approaches built on a patient-aware philosophy will be the most successful. Patient-aware solutions are those that put the patient at the center of the healthcare universe. They provide all stakeholders with mutual access to actionable, real-time information from throughout the healthcare ecosystem to create a deeper, richer understanding of patients and patient populations. This enables high-value, high-quality interactions that can improve care, streamline operational and administrative efficiencies and reduce medical costs.

Understandably, showing meaningful use through EHR technology can be a bit intimidating. By working together through new and innovative partnerships and alliances, it really seems as if we as an industry can bring real improvements to the healthcare system, and still make President Obama’s goal of creating EHRs for all Americans by 2014 a very realistic one.

On Thursday at AHIP Institute I had the pleasure of presenting a medical home case study with my colleague Elaine Olzawski, senior director of health care management at BlueCross BlueShield of Oklahoma. We were incredibly impressed with the turnout (standing room only!!) and the discussion and interaction that ensued. I think it was a clear indication of the way interest in the medical home has just exploded in recent months and a sign that the concept is and will continue to impact the future of healthcare in the United States.  

My approach to the session was to provide something of an overview of the medical home model, while Elaine shared some real life experiences from the pilot program our organizations are working on in Oklahoma. That really resonated with our attendees, and prompted some interesting discussion about the differences between commercial versus government-run medical homes and the role that pharmacy plays in the execution of the concept. Elaine and I emphasized the importance of IT as the backbone of a successful medical home and how it can enable the communication, decision support and outcomes tracking and reporting requirements necessary for success.  

Interestingly, it wasn’t just at our presentation that I encountered so much interest in the medical home. There was a distinct buzz about it throughout the conference in general as healthcare organizations gear up to meet the medical home mandates in the recently passed reform law. I got the sense, however, that the concept would be just as popular on its own because of its promise for improving care and controlling costs. Either way, it’s apparent the medical home boom is already beginning and, as we at MEDecision tried to make clear at AHIP, there’s no need for organizations to wait. Those that partner with a well-positioned, forward-thinking technology provider can begin implementing the concept now and be well ahead of the game by the time the reform-driven changes take effect.  

I left AHIP with a strong sense that healthcare is definitely on the verge of change and that the medical home, mandated or not, is going to be a key part of it. The coming months may be some of the most transformative healthcare has ever seen. I know I’ll be keeping a close eye on things as they unfold.  

Matt Adamson

A few weeks ago I participated in a MEDecision webinar regarding the proliferation of the patient-centered medical home model (PCMH), which set a record for attendance/viewership. While I’d love to attribute that to my tremendous charisma and stellar presentation skills, the truth is that interest in the medical home and its potential to improve the quality and affordability of care has never been higher. And the fact that it is strongly endorsed in the recently-passed healthcare reform law only underscores its promise.

The medical home structure calls for each individual patient to be treated by a team of medical professionals under the direction of a primary care physician (PCP). This is the ultimate collaborative approach which, in order to reach optimum effectiveness, will require each care team member to have access to complete and up-to-date patient data. The PCP will need to know when the cardiologist has discontinued a beta blocker. The pulmonologist will need to know when the PCP orders a chest x-ray. All of the patient’s physicians will need to know when the patient has visited an ER or been hospitalized, and so on.

This all creates a tremendous opportunity for the health IT industry. Reporting and tracking outcomes for quality performance measures is essential for the medical home to succeed. Currently, these tasks are predominantly performed manually with paper-based medical records — a labor-intensive, time consuming and costly endeavor. Technology can expedite these processes by giving each care team member consistent, real-time access to clinical data. Imagine the PCP receiving an email when that beta blocker is discontinued or all of the team members being able to view the chest x-ray through a secure Web portal. Of course this will require open, standards-based systems that can transmit and receive data across native enterprise platforms and delivery mechanisms, essentially giving end-users access to information where they want it, when they want it and in whatever format best suits them. This is currently an area in which health IT needs to improve, although certain technologies already available enable this type of interactivity. It’s a good bet we’ll begin to see more as medical homes continue to grow.  

There is a lot of pressure on the medical home concept to succeed and, by association, on health IT to help make it happen. If we adopt the same spirit of collaboration and interoperability that the medical home itself requires, we’ll exceed expectations.

Vice President

There’s a really good article on CMIO.net by Jeffrey Byers discussing a piece by Drs. David W. Bates and Asaf Bitton of Brigham and Women’s Hospital in Boston that appeared in the April edition of HealthAffairs. The doctors basically conclude that EHRs are essential to the success of the medical home concept but that in order to be optimally effective they could use some further development in areas such as telehealth, quality and efficiency measurement, care transitions, PHRs, registries, team care and clinical decision support.

It’s great to see the association between health IT and the medical home getting some attention. It’s something MEDecision has been extensively involved in for quite a while. In fact, just a few weeks ago we conducted a webinar to discuss our experiences with care management processes in a medical home pilot program in Oklahoma. It’s an important proof point that illustrates how the industry has already begun to address some of the perceived EHR deficiencies Drs. Bates and Bitton highlight. In fact there are some really impressive technologies already out there that address most, if not all, of the issues they mention. And, of course, as the medical home, reform, ARRA and other external factors force demand, we’ll see even more advanced EHRs and health IT in general in relatively short order.

I’ll admit it. In the fall of 1999, I was one of the many IT professionals who waited until the very last minute to ensure that their company’s technology was Y2K compliant. In fact, in October and November of that year I aged significantly. Two months with virtually no sleep will do that to you.

So you think I would have learned my lesson a few years later when it was time to ensure compliance with the then-new HIPAA regulations for electronic transactions. No, once again, despite ample fair warning, my team and I kept putting it off until it was down to the wire. And once again, I aged 10 years in a matter of about six weeks.

I’m fairly certain I’m not the only one. All of you fellow regulations procrastinators out there can now make yourselves known. It’s OK.

But please, whatever you do, join me in vowing not to make the same mistake again when it comes to the looming ICD-10 deadline. Let’s learn from our past mistakes and not think of October 2013 as some far-off, distant time only to wake up one morning in July of 2013 in an utter panic. By now, we should all be well aware of what happens to he (or she) who hesitates.

Our ICD-10 implementation work has already begun here at MEDecision and, thankfully, it appears a growing number of other organizations have started too. While it may be a bit premature to finalize a fully vetted plan, my experience recently has revealed that a lot of companies have at least put the ICD-10 deadline on their proverbial radar and have begun thinking about it. That in and of itself is a pretty good place to start.

As we learned from Y2K and HIPAA, these things are scary and intimidating. And with all of our other day-to-day responsibilities monopolizing our precious time, it’s no wonder we put them off. But health care organizations, particularly insurers, have a real opportunity — now — to spare themselves a lot of grief in a few short years. When the ICD-10 switch goes on in 2013, you can’t just assume you’re going to start receiving ICD-10 claims exclusively. There is inevitably going to be some crossover, and now is the time to start planning for how to deal with that. Larger payers have an even greater challenge since many of them deal with more than one claims system.

So let’s make it a point this time to not wait until the last minute. If ICD coding is the guts of your system(s), start planning now. It’s not necessary to stop the presses and focus on this and this only, but it would behoove us all in the long run to start running some test cases to see what happens. If you get an ICD-10 claim in your system, mock it up, see what it’s going to look like and what it’s going to do. Wouldn’t you rather find out now whether it’s going to send your system into a complete meltdown or process the way you’d like it to? It’s better than waiting until you only have a matter of weeks to get things right. And don’t just make testing a one-off thing — conduct tests regularly so you can work out all of the bugs in a timely and thoughtful way.

If we all start planning now, we can all breath a collective sigh of relief when the fall of 2013 rolls around.