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.

How Technology Can Aid the Opioid Crisis in America

More than 52,000 Americans died of drug overdoses in 2015 (up from about 47,000 the prior year). Among those fatalities, 63 percent were linked to opioids. The Centers for Disease Control and Prevention (CDC) reports sharp increases in deaths across many states involving heroin and synthetic opioids (largely, illicitly manufactured fentanyl) in what the agency describes as an ongoing epidemic requiring “intense attention and action.”

At the same time, prescription opioids are being misused in nonmedical ways that carry their own dangers and raise significant risk for subsequent heroin use.

CDC calls for a multifaceted response including prevention programs as well as enhanced access to treatment and harm-reduction services, while law enforcement focuses on reducing illegal opioid supply lines.

Technology plays an integral role, too — for example, streamlining access to and use of prescription drug-monitoring programs and analyzing public health data to deepen knowledge of overdose demographics.

What the numbers say

Researchers at health IT firm athenahealth studied records of more than 2 million patient visits and 500,000 opioid prescriptions written each quarter from 2014 through 2016. The analysis revealed that primary care providers write 50 percent of opioid prescriptions — far and away the most by physician type.  However, the share of primary care patients with an opioid prescription decreased from 10.6 percent at the beginning of 2014 to 9.1 percent at the end of 2016. The study also found the dosage strength of opioid prescriptions to be dropping, while the duration of prescriptions remained steady at about 23 days. According to the sample, patients over the age of 46 receive the largest share of opioid prescriptions.

A separate study conducted by the CDC, the Food and Drug Administration and the National Highway Traffic Safety Administration assessed trends and factors contributing to multiple naloxone administrations (NMAs), which are used by first responders to treat overdose patients. (Naloxone helps restore patient breathing and prevents respiratory arrest.) Tracing the MNA data enables researchers to identify when and where high-potency opioids have been introduced into a community. The findings: Significantly higher-than-expected MNAs were reported in the West, Northeast, and Midwest Census regions. “Local-level public health officials have used EMS data to create hot-spot maps of opioid overdoses and those maps are shared with program officials managing opioid overdose prevention programs,” the report states.

Automating treatment

Another key part of battling the scourge of opioid abuse is aligning recovering patients with proper medical treatment. NetDirector recently applied its integration services expertise in partnership with Addiction Care 101 (A101), which offers a platform for opioid users to anonymously go through treatment and recovery without notification of family members or employers.

NetDirector’s integration platform gives A101 the ability to accurately monitor patients’ compliance and ensure that they are not seeking drugs outside their treatment program. A101 drug counselors receive immediate alerts on out-of-compliance patients as indicated by lab testing partners within its network.

The behind-the-scenes technology integrates multiple network labs with practitioners and counselors. It supplies timely, actionable information while freeing caregivers from system-level concerns so they can concentrate on delivering needed care.

Learn more about NetDirector’s cloud-based data and document exchange solution here or request a free demo.