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What Can We Learn from eClinicalWorks’ Big Mistake?

Electronic health record (EHR) vendor eClinicalWorks (eCW) and several of its executives are on the hook for $155 million to resolve a False Claims Act lawsuit alleging that the company misrepresented the capabilities of its software. The U.S. Department of Justice announced the settlement on May 31.

Resolution of the case also required eCW to enter into a Corporate Integrity Agreement (CIA) with the Office of the Inspector General at the U.S. Department of Health and Human Services (HHS-OIG), which oversees “meaningful use” incentive payments to healthcare providers relating to their adoption and implementation of certified EHR technology.

According to the government, eCW concealed that its software was “hardcoded” to meet certification requirements for standardized drug codes instead of actually retrieving the proper drug codes from a complete database. Other cited faults in eCW’s software included:

  • not having an audit log for accurate recording of user actions;
  • not reliably recording diagnostic imaging orders;
  • not reliably performing drug interaction checks; and
  • failing to satisfy data portability requirements for transferring patient data from eCW’s system to other vendors’ software.

All told, because of the deficiencies, “eCW caused the submission of false claims for federal incentive payments based on the use of eCW’s software,” HHS-OIG charged. $125 million of the company’s fines will go to repay Medicare and Medicaid for incentive disbursements under their respective meaningful use programs. (eCW customers who successfully attested to meaningful use in good faith will not be linked in on the government repayments.)

Aside from the financial penalties, eCW’s CIA, which extends for five years, requires the company to retain an independent oversight organization to assess its software quality control systems, with semi-annual written reports to be filed with HHS-OIG. The CIA also mandates that eCW allow its customers to obtain free software updates; customers also have the option of transferring their data to another EHR vendor without penalties or service charges.

Industry fallout

eCW agreed to the settlement without acknowledging any wrongdoing. The company said it did so to avoid lengthy and costly litigation. eCW’s EHR system remains certified under the meaningful use program. Nonetheless, the underlying facts of the case appear to have cast a broad shadow across the health IT landscape.

A report compiled by market research firm Reaction Data after announcement of the settlement found 71 percent of respondents saying they would be extremely unlikely to consider eCW in the future. What’s more, 27 percent indicated that the case had lowered confidence in their current EHR vendor, and 35 percent reported being “significantly more suspicious” of other EHR vendors.

Healthcare attorney Bob Ramsey told Healthcare Informatics that the eCW allegations may be an extreme case, but added, “Interoperability and data portability is viewed as necessary in the health world, but it’s easier said than done.”

Peter DeVault, vice president of interoperability at EHR vendor Epic, recently noted that healthcare providers would be well served to rely less on EHR certifications moving forward and to concentrate more heavily on demonstrated benefits.

NetDirector’s vendor-neutral approach to data exchange elevates providers’ ability to achieve EHR interoperability while working toward meaningful use incentives. In an environment currently clouded by skepticism, the HealthData Exchange platform automates integrations in a manner that exceeds industry standards.

NetDirector CEO Harry Beisswenger puts the technology in perspective: “It’s important for us to aid healthcare providers and vendors in reaching meaningful use benchmarks because we know that ultimately impacts the level of patient care.”

For more information, please contact us or request a free demo.

Midyear Healthcare and Technology Progress Report

High availability, interoperability, and utility in population health management all figured prominently in an early 2017 forecast of areas where healthcare CIOs expect information technology (IT) to deliver significant impact for their organizations.

Here’s a look at how things are shaping up at the year’s midpoint.

Systems availability

While natural disasters or cyber-attacks can knock out — or lock out — critical IT systems without warning, healthcare entities still need to prepare for such events. In fact, the HIPAA Security Rule requires health care covered entities to have a contingency plan for responding to unavailability of electronic health information systems.

The Department of Health and Human Services’ Inspector General reported last year in a survey of 400 hospitals that about two-thirds have contingency plans addressing data backup, disaster recovery, emergency mode operations and testing/ revision procedures. Nonetheless, over half of the surveyed hospitals confirmed an unplanned disruption to their electronic health record (EHR) system, and about a quarter of those experienced delays in patient care as a result.

So far this year, EHR outages continue to make headlines:

  • An April 2017 poll, conducted by online physician community Sermo, found that 55 percent of 1,678 responding U.S. doctors had experienced an EHR outage or malfunction that jeopardized the health or safety of a patient.
  • Also in April, Erie County Medical Center and an associated long-term care facility experienced a system-wide shutdown attributed to a ransomware attack. The hospital’s backup process prevented loss of any patient records or financial data, but its EHR was taken offline for six weeks, during which time activities such as patient admissions and prescription writing had to be handled manually.
  • In a separate incident at the end of February, an ophthalmology-specific EHR experienced “technical difficulties” due to outages of Amazon’s S3 cloud-based hosting service.

Data center and cloud services provider Peak 10 recommends that healthcare entities not only review their IT privacy and security policies and procedures but also insist that their service level agreements with technology providers specify agreed-upon security objectives and how compliance will be ensured.

Interoperability

In late March, the Office of the National Coordinator for Health IT (ONC) shared several examples of what it described as “interoperability in action from coast to coast.” Among the programs ONC showcased:

  • An app that imports patient data — including personal and medical device data, remote monitoring and reminders — into a comprehensive family health dashboard.
  • A solution that allows clinicians to create customizable push notifications that can be tailored to individual patients or groups.
  • A smartphone app that allows patients to grant or revoke permission for providers to access, send or receive health information electronically.
  • A secure system for users to seamlessly store and share data with trusted care professionals.

Additional projects outside of ONC’s purview are taking aim at other aspects of interoperability. In April, Ascension Health, Cedars-Sinai Health System and Hospital Corporation of America opened the Center for Medical Interoperability. The lab will provide resources for researchers to test data-sharing connections for medical devices and EHRs. In February, the Personal Connected Health Alliance agreed to partner with the Integrating the Healthcare Enterprise initiative in efforts to improve health data exchange through conformity testing and certification with a focus on standards-based, open specifications.

Population health

No single type of data serves as a comprehensive source of information for population health management. For example, claims data includes patient demographics, diagnosis codes, and dates and costs of services; however, the information is retrospective and limited to just billable aspects of care, explains a recent HealthITAnalytics report. Likewise, EHR systems provide clinical details but often contain unstructured, free-text descriptions that are difficult to extract and analyze.

Still, healthcare organizations continue to press forward with population health initiatives. Vanderbilt University just released a report card — the first of its kind in the nation — intended to guide the planning, implementation, and evaluation of programs and policies to improve men’s health across the entire state of Tennessee. It identifies heart disease and cancer as the leading causes of death in the state and reveals a deficit in men having a personal health provider. Meanwhile, Stanford University’s Center for Population Health Sciences has awarded $275,000 in pilot grants to fund studies seeking to improve population and community health, including a mobile surveillance system that will map autism and gaps in treatment services.

Efforts such as these will help drive discovery of what works in real-world practice of population health management. “As an industry, we can increase the socialization of toolkits and case studies so that healthcare organizations can more clearly define all aspects of population health management model design,” observes Jennifer Rogers, an analyst at Chilmark Research. She adds that optimal IT deployment will speed up gains in value for current and future adopters of population health models.

Availability, interoperability, and population health projects face a balance of challenges and opportunities as we enter the second half of 2017. NetDirector continues to innovate with cloud-based, foundational integration solutions that will help healthcare organizations seamlessly handle the electronic exchange of information in each of these areas within their respective ecosystems. For more information, please contact us or request a free demo.

NetDirector Launches Powerful Integration with Equator® for Orders and Deliverables

Tampa, FL – May 9, 2017 – NetDirector, a cloud-based data exchange and integration platform, has spent several months working alongside Equator, the leading provider of default software solutions for servicers, real estate agents, vendors and other mortgage and real estate industry professionals. The work has yielded a powerful zero-footprint integration option for default servicing firms utilizing Equator.

Equator’s infrastructure software as a service (iSaaS) solutions include EQ Workstation®, EQ Marketplace®, Midsource™ and EQAgent®/EQVendor® portals, which can be used a la carte or as an end-to-end solution. Equator’s REO, short sale and loss mitigation modules processed over $21 billion in transactions in 2015, and have processed more than $315 billion in transactions since its inception. Currently, 4 of the top 5 U.S servicers and the largest holder of real estate are on the Equator platform. With such a high volume of mortgage banking transactions taking place with Equator, it was an easy next step for NetDirector to develop the one-to-many style integration that has fueled their integration platform-as-a-service (iPaaS) business model tailored to the Equator platform.

“NetDirector has worked very closely with us to not only develop, but to thoroughly test this powerful integration suite for default servicing attorneys,” said James N. Vinci, Chief Technology Officer of the Equator business. “We’re excited to collaborate with them, and we believe this collaboration will generate serious efficiency for attorney firms utilizing Equator.”

The initial integration launch includes “Orders” and “Deliverables”, which resemble the referrals and events that are utilized by other industry standard software interfaces in the default servicing sphere. The “Deliverables” also allow for certain documents to be uploaded and other transactions and processes are on the table for future development. Automating these transactions through a cloud-based integration platform provides increases to efficiency through reduced data entry and automated processes. It also significantly reduces the labor stresses of developing and maintaining the integration internally at the attorney’s cost.

“Our ecosystem continues to expand with yet another powerhouse in the industry as we welcome Equator as a new participant,” said Harry Beisswenger, NetDirector CEO. “Our goal is to provide the integrations to default servicing firms that offer the most value, and there has been a major demand for this service. We look forward to the prospect of further data and document integration with the Equator platform in the future.”

Company Bio:

NetDirector provides a secure cloud-based data and document exchange solution for the healthcare and mortgage banking industries to deliver seamless data integration between parties. NetDirector bridges gaps created by disparate systems & technologies by allowing companies at any location to share data & documents securely over a single internet connection with any other member of the ecosystem. Our approach allows trading partners to collaborate and exchange data in a seamless, bi-directional, real-time manner. With security and longevity as a focus, NetDirector is a certified SOC 2 Type II Compliant company, a 6-year member of the prominent Inc. 5000, and currently, processes more than 8 million transactions per month.

Transaction Spotlight: Fees and Costs Request

Additional Events for a Variety of Servicers

4 Tips for Improving your BKFS/LPS Desktop APR Score

The BKFS/LPS Desktop (“BKFS/LPS”) APR scorecard is the benchmark for which BKFS/LPS ranks your firm against others in your state. We have put together some simple Blog_BKFS_LPSVCStips to help improve this score. Each state has their own weighting concerning the value of each step; however most states percentages are close to those given in the tips below. I invite you to add your favorite tips in the comment section.

Top APR Improvement tips:

  1. Referred to Received. This is calculated from the minute the servicer fills out the File Referred to Attorney event of BKFS/LPS and stops when the File Received by Attorney event is filled out. It is calculated from 8am – 5pm CST Monday – Friday excluding the 10 Federal holidays. The faster you can send back the event the lower this time will be and the better your APR score will be. However, this event only counts for approximately 2% of your overall APR score so in the big picture it is relatively unimportant. Any automation that can be done based of the file referred action can not only improve your APR score, but also allow your firms labor to focus on other manual processes required to complete larger weighted portions. Read more

Mortgage Document Automation

Default (i.e.: Foreclosure & Bankruptcy) attorneys and trustees deal with thousands of documents on a daily basis. These documents consist of Mortgages, Notes, Deeds, automate 2Assignments, Breach Letters, and many more. To retrieve these documents they need to go to various mortgage servicer (“servicer”) web sites (i.e.: LPS Desktop, VendorScape, etc.) and download the selected documents to their case or document management systems. Once downloaded – they attach or index the documents to the appropriate foreclosure or bankruptcy case file(s). These same firms also are required to upload documents (REO, HUD, affidavits, title, etc.) to these same servicer sites.

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