This weekend I had the pleasure of attending the Renal Physicians Association’s (RPA) annual meeting in Washington D.C. There were over a dozen Health IT vendors in the exhibit hall displaying a range of solutions from nephrology-specific EHRs to practice management systems. In addition, many presentations during the meeting dealt with Health IT, more than I have observed in years past. Here is my summary of the meeting related to Health IT and its implications for nephrologists:
I typically attend Deb Lawson’s nephrology coding seminar the day before the meeting begins and this year was no different. Lessons learned came from both content and informal surveys. There were roughly 130 people in the class, including perhaps 50 physicians. Deb asked for a show of hands: Who is using an EHR? Who plans to implement one this year? Roughly half of the people in the room raised their hands in response to one of these two questions.
Additional points: ICD-10 is coming but perhaps it will not be as bad as expected. (This, of course, is a matter of perspective. I think it may be one of the most disruptive changes nephrology practices will face over the next 5-10 years.) Prepare your practice for the change but leave the training for much later as the codes will continue to be updated through Fall 2012. Also, on the Office of Inspector General’s watch list this year are notes that look like duplicates. Templated EHR notes that sweep in historical data which is not changed by the provider will come under increased scrutiny. Pay close attention to this one.
The official meeting began with RPA’s President Ed Jones reviewing the organizations’ accomplishments over the past year. Under Ed’s leadership, the RPA has produced phenomenal results over the last two years. Two announcements at the meeting related to Health IT included the establishment of a portal to assist members in navigating the multitude of IT-related national programs and the collaboration with American EHR as a mechanism to assist the nephrologist searching for an EHR.
Later during the afternoon session, David Doane led a panel discussion that included Shawna Davis, Julie Harper and Brian O’Dea. The panel reviewed their collective experience shopping for, implementing and supporting an EHR. Many valuable lessons were shared, including:
• Identify a physician champion
• Obtain early buy-in from all stakeholders within the practice
• Set the expectation early that this is a painful process
• Maintain a positive attitude
• Address disaster recovery
• Anticipate transient reductions in productivity
The last presentation I attended was to be a review of ICD-10 by CMS. Apparently there was some confusion related to timing on the part of the speakers and my colleague Frank Maddux remarkably filled in at the last minute, performing admirably as he provided his interpretation using the slide deck prepared by CMS. The take-away was that it is not too early to begin considering your approach to this transition as the October 1, 2013, deadline looms on the horizon. Many anticipate a significant productivity hit as the ICD-9 codes we have used for almost 30 years give way to a much more granular code set.
John Glaser, CEO at Siemens, stole the technology show as he presented the Brian Ling Memorial Lecture. Telehealth was the topic of John’s presentation, and while the examples were generic, the message was clear: the barriers to telehealth are eroding. Telehealth is beginning to bring down the boundaries of distance and time in the delivery of certain aspects of care:
• Monitoring a chronic disease—blood pressure, blood sugar or weight monitoring for example.
• Sending reminders—such as take your medications and appointment reminders.
• Engaging in e-visits—like routine dermatology appointments, acute remote stroke diagnosis and care and second opinion consultations.
Next, Frank Maddux utilized a remarkable technology platform to deliver his presentation, describing how to incorporate performance risk within a nephrology practice. Health IT will clearly play a fundamental role as coordinated care and value-based purchasing become more than catch phrases in our vocabulary.
Later that morning Paul Palevsky provided a fantastic description of clinical quality measures as he described their anatomy, development and what they ultimately target. He focused on:
• Outcomes measures—mortality or progression of CKD for example.
• Intermediate outcomes measures—BP control or the presence of an AVF at the start of HD.
• Process of care measures—referred for an AVF or the use of an ACEi in patients with proteinuria.
• Composite measures—BP < 130/80 or BP > 130/80 and a care plan in place.
Paul made it clear that capturing these measures via information technology, such as an EHR or disease registry, was the only practical means to aggregate this data.
At the end of the day I conducted a well-attended presentation regarding the impact of meaningful use upon the practice of nephrology. Many of the topics have been covered in this blog. I also distributed a paper describing a practical approach to the meaningful use framework from the perspective of the nephrology practice, which we intend to make available on our website in the near future.
The annual meeting concluded with three excellent presentations on topics unrelated to Health IT. Overall the 2011 RPA annual meeting was exceptional. Hats off to Frank Maddux and his program committee who put together a remarkable agenda.
The importance of Health IT to the practice of nephrology was apparent not only in the large number of Health IT-related vendors exhibiting their wares, but also in the large number of Health Information Technology presentations. The message is clear: As Health IT becomes a key component of the nephrology practice, it’s important to stay abreast of new developments to ensure compliance, growth and effective care. If you would like to know about any aspect of Health IT and its implications for your nephrology practice, please leave a comment and we’ll try to address it.